Doctors, families and difficult decisions: the implications of the Lawrance case.
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Biomedical subjects
Publications and source records attributed to J J Nocon.
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Section 2.01 of the Fetal Protection Act of 1999 defines "qualified patient" as one who registers a pregnancy by six weeks of gestational age. Section 2.02 requires that a patient be "qualified" before receiving financial aid. Similarly, all private third party payers require "registration" of the pregnancy by six weeks. "Registration" consists of proof of intrauterine pregnancy by ultrasound and attachment of a telemetry device to the cervix. Such a device will monitor the patient's vital signs, contractions, fetal movement and levels of various "toxins" in the maternal blood. Toxins include but are not limited to alcohol, nicotine, controlled substances as well as excess levels of salt, carbohydrates and saturated fats. Unacceptable variations in telemetry will trip an alarm at the patient's approved prenatal care center. Such an alarm will trigger a visit from an agent from the Fetal Bureau of Investigation.
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An analysis of 25 perinatal malpractice cases filed in Wisconsin between 1978 and 1984 clearly revealed that the unfavorable outcomes were preventable and caused by professional negligence. Each case was settled or adjudicated in favor of the plaintiff, and the awards totaled $25.1 million. Although cases with a total recovery of over $1 million are relatively infrequent, they are not so rare as to be considered extra-ordinary occurrences. Fifty-six percent of physicians involved failed to recognize a high-risk pregnancy or fetal distress, while 44% failed to render proper care. The most common errors involved inadequate fetal monitoring, the injudicious use of oxytocin and the failure to recognize a high-risk pregnancy, such as prematurity or postterm or multiple gestation. The purpose of this study was to examine the medicolegal issues operating in such cases in order to develop guidelines for reducing professional negligence, thereby preventing injury to women and their newborns.
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