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Medico Legal Issues in Obstetrics

Of the 2891 applications completed during the period 2005-2015 where anesthesiology was the main culprit, 106 completed requests were related to obstetric anesthesiology (3.7% of all anesthesia cases). Patient characteristics are presented in Table 1. Most patients received neuraxial anesthesia and only 8 patients (7.5%) underwent general anesthesia. Cases under general anaesthesia were associated with significant morbidity of patients (median NAIC code 7) and resulted in significant costs (4 were treated in the upper range and 2 in the middle range). The average duration of all cases included in this study was 1.4 years from occurrence to claim and 1.8 years from claim to settlement. Cases with higher legal fees and compensation were associated with higher NAIC codes and took longer to close (P $1,000,000. The median legal fees for all birth anesthesia cases were $4536 (range 0 to $991,378). In comparison, of the 2785 cases of non-obstetric anesthesia, 1036 cases were resolved, and the median amount of all cases closed was $70,722 (range of $50 to $9,454,877).

In this cohort of non-obstetric cases, 97 cases received a payment of $≥ $1,000,000. The CBS database was used for the period of 1. January 2005 to December 31, 2015 for completed claims where obstetric anesthesia was the primary service. The primary department is defined as the clinical department of the provider most responsible for patient care at the time of the event. This attribution is made regardless of who is named as the defendant and is based on information available in medical records. All cases were included in the final analysis and reviewed by the study authors (V.P.K., E.Y.B., U.R.R.). Variables reported included year of loss, submission and closure of case, patient age, mode of delivery, type of anesthesia, and injury class using the National Association of Insurance Commissioners (NAIC) severity code. The type of injury was classified as maternal death/brain injury, neonatal death/brain injury, maternal nerve injury, and severe and mild maternal injury based on available case information. Minor and serious maternal injuries included all cases that did not belong to the previous damage classes. There was 1 case where there was both maternal brain injury and neonatal death, and the mode of delivery, type of anesthesia, case disposition and payment of this case were analyzed in each respective class.

The decision on the case was classified as “rejected”, “abandoned/rejected” or “closed”. These included claims settled out of court and claims brought before the courts. The payment included the amount paid to the applicant as well as the cost of legal services. The amount was adjusted to 2017 values using the Consumer Price Index.19 Payments were classified into the upper >$1,000,000), medium ($5,000 to $1,000,000) and low ($<5,000) ranges. The settlement period was calculated between the year of the claim and the year of the claim of the claim. The standard of care and time of care were determined by the coders and the 3 authors (V.P.K., E.Y.B., R.D.U.) based on the available abstract. Samavedam S. Medico-legal aspects of obstetric intensive care. Indian J Crit Care Med 2021;25(Suppl 3):S279–S282.

Another important aspect that often occurs when caring for a critically ill pregnant woman is the conflict between fetal and maternal well-being. This must be understood in accordance with the rights of the fetus, as well as the autonomy of the mother. It is generally accepted that a “living being that results from the fertilization of a human egg by a sperm and develops in a woman`s womb, or that is physically separated from a woman`s body but is able to survive outside the womb to some extent,” defines a fetus. Such a fetus has civil and legal rights. According to the Indian legal system, a woman has a constitutionally unlimited right to abortion during the first trimester of her pregnancy. During the second trimester, this right may be limited by the risk to the mother`s health.