Roles of medical consultants and expert witnesses in cerebral palsy litigation: a review.
What is the role of the medical consultant and expert witness during the litigation process associated with cerebral palsy (CP)? To address this question, a review was undertaken of the world literature published on CP between 1861 and 2004. The appropriate Medical Subject Heading terms were selected and used in a search of the MEDLINE, ACOGNET and Cochrane Library databases. Also, a manual search was performed. A total of 3,168 articles on CP were reviewed. Of them, 143 met the inclusion/exclusion criteria. Analysis of the pertinent articles revealed that this is the first article to address the role of the medical consultant. The literature on CP is predominantly observational studies. At best, they can be qualified as grade C in the ranking of evidence-based medicine. A clinical study on CP cannot be well designed methodologically because of ethical and technical problems. There is no literature available to determine the role of the consultant in CP cases. The appraisal of suboptimal obstetric care should not be omitted or dismissed when present. Preconceived conclusions about causation based simply on the poor outcome of a child should be avoided. A well-documented hypoxic-ischemic brain insult during the antenatal period does not automatically exclude intrapartum suboptimal obstetric care. Lack of uniformity in policies among U.S. hospitals on umbilical cord and newborn blood gas analysis (<1 hour of neonatal life), fetal membrane microbiologic cultures and placental histology creates difficult tasksfor medicolegal reviewers. Lack of vital diagnostic elements will limit the objectivity of a consultant and expert witness. The human emotional aspect plays a significant role in reaching a jury verdict for plaintiffs, regardless of the weakness of a case.
Ostrzenski
Adam
A
Department of Gynecology and Obstetrics, University of South Florida, Fort Lauderdale, Florida, USA. aostrzenski@msn.com
Ostrzenski
Bartosz A
BA
Gleason
James P
JP
Burkhart
Robert W
RW
D000328:Adult; D001238:Asphyxia Neonatorum; D001720:Birth Injuries / Q000150:complications*; D002547:Cerebral Palsy / Q000209:etiology*; D019317:Evidence-Based Medicine; D005104:Expert Testimony; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008318:Malpractice; D010819:Physician's Role; D011247:Pregnancy; D011256:Pregnancy Outcome; D011787:Quality of Health Care; D012017:Referral and Consultation; D012307:Risk Factors; D014470:Umbilical Cord / Q000473:pathology