The AANA Foundation closed malpractice claims study: obstetric anesthesia

The purpose of this study was to evaluate the anesthesia care provided during obstetric adverse events. Malpractice claims filed against nurse anesthetists for care involving obstetric anesthesia (n = 41) were extracted from the American Association of Nurse Anesthetists Foundation Closed Claim database. The events represented in the claims occurred from 1990 to 1996 and represented anesthetics provided by both anesthetists and anesthesiologists. Risk factors for adverse outcomes identified in this study included advanced maternal age, ethnicity, and obesity. Patients requiring emergency cesarean sections under general anesthesia were found to be at considerable risk for sentinel events. The most common adverse outcome in the obstetric closed claim database was neonatal death (n = 11 [27%]), followed by maternal death (n = 9 [22%]) and complications resulting from regional anesthesia (n = 8 [20%]). The leading cause of maternal death and brain damage was a failure to secure a patient airway. The mode of delivery in 95% (n = 19) of the 20 claims in which death was the outcome was surgical. In the claims representing maternal death, 89% (8) of the 9 claims represented surgical deliveries under general anesthesia. These maternal death cases were designated emergent in 56% (5) of the claims. The anesthetic care was deemed appropriate in 56% (23) of the claims. The median payment for appropriate care ($2,866.00) was less than for care determined to be inappropriate ($45,000.00).