title: Statistical models of outcome in malpractice lawsuits involving death or neurologically impaired infants.
abstract: The objective was to determine whether factors could be identified in medical and legal records that are associated with the successful defense of obstetrical malpractice cases involving the death or neurological impairment of infants. Obstetrical claims (169) closed by PROMUTUAL between January 1, 1990, and December 31, 1994, were retrospectively abstracted and analyzed to identify associations between medical and legal factors, and the medicolegal outcome. Multivariable analysis identifies that the use of pitocin, diagnosis of asphyxia, a delay in delivery, and the use of multiple defense expert witnesses decreased the chances of a successful defense. Two statistical models explaining indemnity payment were developed. The first, based on medical outcome, showed an increased indemnity payment when a case involved major neurological deficits, diagnosis of asphyxia, newborn seizures, later year of delivery, and participation of a particular defense firm. Perinatal or childhood death and the use of pitocin were indicators of a decrease in payment. The second model was based on long-term care requirements. In this model, indicators of increased indemnity payment were: nonreassuring intrapartum fetal heart rate tracing, later year of delivery, intensity of long-term care required, and participation of a particular defense law firm. Perinatal or childhood death, the use of pitocin, and settlement date increasingly removed from the occurrence date were the determinants of decreased payments in this model. Finally, the presence of major neurological deficits, the prolongation of a case, and the involvement of multiple law firms and defense witnesses increased the expense charged to and paid by the insurance company. Using the medical, legal, and financial data relevant to 169 obstetrical cases closed by one malpractice insurance carrier between 1990 and 1994, statistical models with potential predictive values for future malpractice claims involving neurologically impaired infants were constructed. These models may help determine in advance the chance a future case has for successful defense and the likely amount of expense and indemnity dollars that will be paid out to settle and defend it.
authors.affiliation: Department of Obstetrics and Gynecology, Tuft's University Medical School, Medford, Massachusetts, USA.
authors.forename: R
authors.initials: R
authors.lastname: Bors-Koefoed
authors.forename: S
authors.initials: S
authors.lastname: Zylstra
authors.forename: L J
authors.initials: LJ
authors.lastname: Resseguie
authors.forename: B A
authors.initials: BA
authors.lastname: Ricci
authors.forename: E E
authors.initials: EE
authors.lastname: Kelly
authors.forename: M C
authors.initials: MC
authors.lastname: Mondor
mesh_terms: D000293:Adolescent; D000328:Adult; D001237:Asphyxia / Q000209:etiology; D001724:Birth Weight; D001925:Brain Damage, Chronic / Q000209:etiology; D002547:Cerebral Palsy / Q000209:etiology; D036861:Delivery, Obstetric; D005260:Female; D005313:Fetal Death / Q000209:etiology; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007351:Insurance, Liability / Q000191:economics; D008607:Intellectual Disability / Q000209:etiology; D008318:Malpractice / Q000331:legislation & jurisprudence*; D015233:Models, Statistical; D009422:Nervous System Diseases / Q000209:etiology; D010121:Oxytocin / Q000009:adverse effects / Q000627:therapeutic use; D011247:Pregnancy; D012308:Risk Management; D012640:Seizures / Q000209:etiology
chemical_list: D010121:Oxytocin