Liability associated with obstetric anesthesia: a closed claims analysis.
BACKGROUND
Obstetrics carries high medical liability risk. Maternal death and newborn death/brain damage were the most common complications in obstetric anesthesia malpractice claims before 1990. As the liability profile may have changed over the past two decades, the authors reviewed recent obstetric claims in the American Society of Anesthesiologists Closed Claims database.


METHODS
Obstetric anesthesia claims for injuries from 1990 to 2003 (1990 or later claims; n = 426) were compared to obstetric claims for injuries before 1990 (n = 190). Chi-square and z tests compared categorical variables; payment amounts were compared using the Kolmogorov-Smirnov test.


RESULTS
Compared to pre-1990 obstetric claims, the proportion of maternal death (P = 0.002) and newborn death/brain damage (P = 0.048) decreased, whereas maternal nerve injury (P < 0.001) and maternal back pain (P = 0.012) increased in 1990 or later claims. In 1990 or later claims, payment was made on behalf of the anesthesiologist in only 21% of newborn death/brain damage claims compared to 60% of maternal death/brain damage claims (P < 0.001). These payments in both groups were associated with an anesthesia contribution to the injury (P < 0.001) and substandard anesthesia care (P < 0.001). Anesthesia-related newborn death/brain damage claims had an increased proportion of delays in anesthetic care (P = 0.001) and poor communication (P = 0.007) compared to claims unrelated to anesthesia.


CONCLUSIONS
Newborn death/brain damage has decreased, yet it remains a leading cause of obstetric anesthesia malpractice claims over time. Potentially preventable anesthetic causes of newborn injury included delays in anesthesia care and poor communication between the obstetrician and anesthesiologist.
Davies
Joanna M
JM
Department of Anesthesiology, University of Washington School of Medicine, Seattle, Washington 98195, USA. jodavies@u.washington.edu
Posner
Karen L
KL
Lee
Lorri A
LA
Cheney
Frederick W
FW
Domino
Karen B
KB
D000328:Adult; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D000776:Anesthesiology / Q000331:legislation & jurisprudence / Q000639:trends; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007345:Insurance Claim Review / Q000331:legislation & jurisprudence* / Q000639:trends; D007351:Insurance, Liability / Q000331:legislation & jurisprudence* / Q000639:trends; D008318:Malpractice / Q000331:legislation & jurisprudence / Q000639:trends; D011247:Pregnancy; D055815:Young Adult