Cerebral Palsy Litigation Research Articles

Forensic Analysis of Umbilical and Newborn Blood Gas Values for Infants at Risk of Cerebral Palsy.

Cerebral palsy litigation cases account for the highest claims involving obstetricians/gynecologists, a specialty that ranks among the highest liability medical professions. Although epidemiologic studies indicate that only a small proportion of cerebral palsy (10–20%) is due to birth asphyxia, negligent obstetrical care is often alleged to be the etiologic factor, resulting in contentious medical-legal conflicts. Defense and plaintiff expert opinions regarding the etiology and timing of injury are often polarized, as there is a lack of established methodology for analysis. The objective results provided by umbilical cord and newborn acid/base and blood gas values and the established association with the incidence of cerebral palsy provide a basis for the forensic assessment of both the mechanism and timing of fetal neurologic injury. Using established physiologic and biochemical principles, a series of case examples demonstrates how an unbiased expert assessment can aid in both conflict resolution and opportunities for clinical education.

Cerebral palsy litigation after fifty years: A hoax on you.

The worldwide cerebral palsy (CP) litigation crisis is predicated on the hoax that electronic foetal monitoring (EFM) predicts and prevents CP. There are decades of research disproving this hoax, yet EFM continues to be performed in the vast majority of labours in developed countries with resultant harm to mothers and babies alike through unnecessary caesarean sections with all of the attendant complications and ramifications of that procedure. This article reviews the history and evolution of EFM, explores the reasons for its misuse, discusses how obstetricians have abandoned their ethical mandate by failing to obtain informed consent for EFM, and proposes a realistic, practical solution that would effectively change the standard of care.

The use of an Intrapartum Cardiotocograhic Score Index (ICSI) in Cases of Cerebral Palsy Jurisprudence

The history of cerebral palsy litigation at Court leaves much to be desired for many reasons including the scientific aspect particularly in reference to the causation of cerebral palsy. One cannot ignore the 1960s when science held that the preponderance of cerebral palsy is the result of oxygen deficiency in labour. The wrong teaching soon left the science classroom and pervaded the Courts where quick- thinking lawyers extrapolated the teaching to wrongly benefit their clients’ cases with great alacrity. These cases often were and are studies in human suffering and misery. However, truth must out and justice be served irrespective of all factors. One cannot assuage suffering by perverting the course of justice such that someone alleviates a wretched existence by being made a scapegoat and paying for it.

Continuous Electronic Fetal Monitoring during Labor: A Critique and a Reply to Contemporary Proponents.

A half century after continuous electronic fetal monitoring (EFM) became the omnipresent standard of care for the vast majority of labors in the developed countries, and the cornerstone for cerebral palsy litigation, EFM advocates still do not have any scientific evidence justifying EFM use in most labors or courtrooms. Yet, these EFM proponents continue rationalizing the procedure with a rhetorical fog of meaningless words, misleading statistics, archaic concepts, and a complete disregard for medical ethics. This article illustrates the current state of affairs by providing an evidence-based review penetrating the rhetorical fog of a prototypical EFM advocate.

Equivocal Court Cardiotocography Weighting in Cerebral Palsy Litigation

Equivocal Court Cardiotocography Weighting in Cerebral Palsy Litigation

Cerebral palsy litigation: change course or abandon ship.

The cardinal driver of cerebral palsy litigation is electronic fetal monitoring, which has continued unabated for 40 years. Electronic fetal monitoring, however, is based on 19th-century childbirth myths, a virtually nonexistent scientific foundation, and has a false positive rate exceeding 99%. It has not affected the incidence of cerebral palsy. Electronic fetal monitoring has, however, increased the cesarian section rate, with the expected increase in mortality and morbidity risks to mothers and babies alike. This article explains why electronic fetal monitoring remains endorsed as efficacious in the worlds’ labor rooms and courtrooms despite being such a feeble medical modality. It also reviews the reasons professional organizations have failed to condemn the use of electronic fetal monitoring in courtrooms. The failures of tort reform, special cerebral palsy courts, and damage limits to stem the escalating litigation are discussed. Finally, the authors propose using a currently available evidence rule—the Daubert doctrine that excludes “junk science” from the courtroom—as the beginning of the end to cerebral palsy litigation and electronic fetal monitoring’s 40-year masquerade as science.

Life expectancy estimation in cerebral palsy – a paediatrician's approach

Paediatricians involved in providing reports for cerebral palsy litigation are often asked to give an opinion on life expectancy and this article outlines the approach taken by one paediatrician. The article describes how statistical data is available, particulary from America, to guide the clinician and the Court. This data acts as the starting point. The two factors that affect life expectancy most of all in the data are mobility and feeding ability, hence tables and survival curves are provided within the publications cited so that additional years of survival can be assessed for individuals in the different functional groups. The article describes how it is the clinicians' role to assess the individual's functional capabilities and any relevant clinical issues and ‘interpret’ the data accordingly.

Cerebral Palsy Litigation—Reply

Cerebral Palsy Litigation—Reply

Editorial: Cerebral Palsy—the International Consensus Statement

When AVMA was founded in 1982, few cases of cerebral palsy were litigated; those which were invariably lost. The reason for both was the lack ofskillson the part of claimant lawyers. As these skills developed, both the number of cases and the success rate increased. Towards the end of the 1980s, claimants were having so much success that the obstetricians began to panic. It became clear that they, or their legal advisors, were developing two methods of counteracting what they saw as a near epidemic and a threat to the profession itself The first was the concept ofdefensive medicine; notice was given that, because of the fear of litigation, obstetricians were carrying out unnecessary Caesarean sections, to the detriment ofmothers and to the health service. The second method was to move the goal posts. Until then, the main issue in the cerebral palsy litigation had been that ofnegligence. The defendants were finding that the new skills of the claimants' lawyers, together with the support ofexpert witnesses who had become far more experienced and were prepared to criticize their colleagues when their practice was clearly not acceptable, meant that negligence had become far easier to prove. As a result, the issue ofcausation clearly a far more complex one began to be raised more frequently. So much so that in recent years, most cerebral palsy actions are disputed, not always on negligence, but often solely on causation. Around that time, a number of learned scientific articles began to appear in the medical literature, particularly in the United States, showing just how difficult it was to prove causation. The more cynical amongst those representing patients regarded this as an interesting coincidence. Indeed, an editorial in an early edition of the A VMA Medical and Legal Journal