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In this case, the plaintiff was a nurse who had three children before the pregnancy that was the basis of the lawsuit. She had delivered her third child by caesarian section. Based on that experience, she did not want to deliver her fourth child by c-section. The doctor agreed to attempt vaginal delivery unless it was medically necessary to perform a c-section.
A review of the plaintiff's medical records showed that her previous c-section was with a low transverse incision, which would make the vaginal birth an acceptable option under the ACOG guidelines. Based on this data, the doctors did not think the plaintiff would need a c-section.
After an uncomplicated pregnancy, the plaintiff was told by the physician at a checkup three weeks before her due date that she should not deliver the baby vaginally. The physician told the plaintiff that he was concerned about the current medical condition of the fetus and he thought there was a need to deliver by c-section. After unsuccessfully seeking another obstetrician, the plaintiff was admitted to the hospital, for a c-section delivery.
During the admission, the plaintiff was seen by another obstetrician who was on-call that day. At trial, the defendant doctor testified that it was not medically necessary to perform a c-section on the plaintiff. However, this doctor stated that the plaintiff was offered the option of vaginal delivery and refused. This doctor's testimony conflicted with testimony from a nurse from the hospital who stated that no such discussion had taken place.
The plaintiff's medical experts also testified that a caesarian section was not medically necessary because the doctor's concerns about the medical condition of the fetus were allegedly unfounded. Furthermore, the plaintiff's experts said the c-section sparked the plaintiff's hollow visceral myopathy which they alleged was dormant and only manifested itself because of the unwarranted c-section.
The plaintiff suffered medical complications after the delivery. She had a series of gastrointestinal operations and had part of her intestinal tract removed.
The physicians had argued at trial that the hollow visceral myopathy that the plaintiff suffered from would have eventually become active, regardless of the decision to perform the caesarian section.
This case highlights a new concern for obstetricians. Previously, the election of caesarian section as a medically necessary procedure often shielded the physician from liability. The focus of malpractice actions has always been on the failure to perform a c-section when faced with a potentially hostile intrauterine environment. Now with this recent trial verdict, a Massachusetts jury has decided that physicians can be held liable for choosing to perform a c-section.
It is important, however, to recognize the limitations of this verdict. In this case, there appeared to be substantial evidence that the c-section was not medically necessary. In fact, one of the defendant doctors testified to that affect. So the plaintiff had an easier argument that the complications that resulted from the procedure could have been avoided. This decision does not appear to expose obstetricians to liability for performing emergency c-sections that are, in fact, medically necessary.
An important element in this case is the plaintiff was vehemently opposed to delivery by c-section given her bad experience during her third pregnancy. The testimony in this case presented a patient who did not want a c-section, who may not have needed to have a c-section and who suffered medical complications as a result of the c-section. This verdict appears to assign liability in those cases where the patients fulfill all of these conditions.
In the past few years, obstetricians have been most concerned about patients bringing lawsuits for failure to perform a c-section. With this recent Massachusetts decision, physicians must now be cautious in restricting c-sections to only those which are medically necessary.
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