Claims for compensation after alleged birth asphyxia: a nationwide study covering 15 years.
OBJECTIVE
To analyze compensation claims with neurological sequela or death following alleged birth asphyxia.


METHODS
A cohort study.


METHODS
A nationwide study in Norway.


METHODS
All claims made to The Norwegian System of Compensation to Patients (NPE) concerning sequela related to alleged birth asphyxia, between 1994 and 2008. A total of 315 claims of which 161 were awarded compensation.


METHODS
Examination of hospital records, experts' assessments and the decisions made by the NPE, the appeal body and courts of law.


METHODS
Characteristics of deliveries resulting in intrapartum asphyxia and causes of substandard care categorized in eight groups.


RESULTS
In the 161 compensated cases, 107 children survived (96 with neurological sequela), and 54 children died. Human error was a frequent reason of substandard care, seen as inadequate fetal monitoring (50%), lack of clinical knowledge and skills (14%), noncompliance with clinical guidelines (11%), failure in referral for senior medical help (10%) and error in drug administration (4%). System errors were registered in only 3%, seen as poor organization of the department, lack of guidelines and time conflicts. The health personnel held responsible for substandard care was an obstetrician in 49% and a midwife in 46%.


CONCLUSIONS
Substandard care is common in birth asphyxia, and human error is the cause in most cases. Inadequate fetal monitoring and lack of clinical knowledge and skills are the most frequent reasons for compensation after birth asphyxia.
Department of Obstetrics and Gynecology, Nordland Hospital, Bodø, Norway; Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Science, University of Tromsø, Tromsø, Norway.
Stine
S
Andreasen
Bjørn
B
Backe
Pål
P
Øian
D001034:Apgar Score; D001238:Asphyxia Neonatorum / Q000145:classification / Q000150:complications* / Q000401:mortality; D015331:Cohort Studies; D035881:Compensation and Redress / Q000331:legislation & jurisprudence; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D005323:Fetal Monitoring; D006801:Humans; D007231:Infant, Newborn; D007345:Insurance Claim Review; D008297:Male; D008318:Malpractice / Q000706:statistics & numerical data*; D019300:Medical Errors / Q000706:statistics & numerical data*; D009422:Nervous System Diseases / Q000209:etiology*; D009664:Norway; D011247:Pregnancy; D058996:Quality Improvement / Q000458:organization & administration; D012189:Retrospective Studies
Asphyxia; fetal monitoring; human error; obstetrics; system failure