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Liability associated with obstetric anesthesia: a closed claims analysis.
Joanna M Davies1, Karen L Posner, Lorri A Lee
1Department of Anesthesiology, University of Washington School of Medicine, Seattle, Washington 98195, USA. jodavies@u.washington.edu
Anesthesiology
|December 24, 2008
Summary
Obstetric anesthesia claims show decreased maternal and newborn deaths but increased nerve injuries and back pain. Delays in care and poor communication remain key factors in preventable newborn injuries.
Area of Science:
- Anesthesiology
- Obstetrics
- Medical Malpractice
Background:
- Obstetric anesthesia carries significant medical liability risk.
- Maternal and newborn deaths/brain damage were primary concerns in pre-1990 malpractice claims.
- The study examines changes in obstetric anesthesia liability over two decades.
Purpose of the Study:
- To analyze trends in obstetric anesthesia malpractice claims from 1990-2003.
- To compare recent claims with those from before 1990.
- To identify changes in injury types and associated factors.
Main Methods:
- Retrospective review of obstetric anesthesia claims (1990-2003) from the ASA Closed Claims database.
- Comparison of 426 claims (1990 or later) with 190 pre-1990 claims.
- Statistical analysis using chi-square, z tests, and Kolmogorov-Smirnov test.
Main Results:
- Maternal death and newborn death/brain damage decreased significantly (P=0.002, P=0.048).
- Maternal nerve injury and back pain increased (P<0.001, P=0.012).
- Anesthesia contribution and substandard care were linked to payments in death/brain damage claims.
Conclusions:
- Newborn death/brain damage, while reduced, persists as a leading claim cause.
- Delays in anesthetic care and poor communication are preventable causes of newborn injury.
- Improved communication between obstetricians and anesthesiologists is crucial.
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