Are Birth Injuries Likelier to Occur at Smaller Hospitals?
Research shows that bigger hospitals offer better care than smaller hospitals and patients in low income areas are more susceptible to medical negligence. Gaps in care significantly impact pregnant women: Women who give birth in hospitals labeled by researchers as being “low-performing” have a much higher chance of experiencing birth injuries and other complications than women who use “high-performing” hospitals for labor and delivery.
Birth injuries are injuries a baby sustains during or near the time of birth. Listed below are some common birth injuries:
- Hypoxic ischemic encephalopathy (HIE). HIE usually involves damage to the basal ganglia, cerebral cortex or watershed regions of the brain, but it sometimes includes periventricular leukomalacia (PVL)
- Neonatal encephalopathy
- Septic shock
- Permanent brain damage
- Seizure disorders
- Cerebral palsy (CP)
- Intellectual disabilities
- Developmental delays
- Learning Disabilities
- Motor disorders
WHAT THE RESEARCH SHOWS ABOUT MEDICAL MALPRACTICE & BIRTH INJURIES
The following factors are associated with medical errors:
- Inexperienced physicians and nurses
- Procedures newly started at a hospital
- Poor communication among the medical team
- Inadequate nurse to patient ratios
- Improper documentation in the medical records and illegible handwriting
The first four factors are magnified at military hospitals, and the New York Times just published an article uncovering the risky practices of these hospitals (completely separate from the crises occurring at VA hospitals). In fact, the NYT obtained an internal Pentagon document that discusses a plan to convert many small and underused military hospitals into birthing centers or outpatient clinics.
Converting low-performing hospitals into birthing facilities is indeed a frightening thought, especially since military hospitals are already under fire for negligent practices in their labor and delivery units. An obstetrician who resigned from his position at a military hospital because he felt the hospital had a “culture of complacency” told the NYT that lab results at the facility could not be trusted, physicians’ pagers didn’t work, and incompetent nurses were assigned to monitor the fetal heartbeat monitors. This obstetrician tried to bring attention to the large amount of errors occurring at the hospital, but he was essentially told to mind his own business and was then ordered to apologize in writing to the entire staff.
BIRTH INJURY & MEDICAL MALPRACTICE CASES IN GOVERNMENT HOSPITALS
Ignoring negligent labor and delivery practices is very troubling. Approximately 50,000 babies are delivered every year in military hospitals, and there have been some very shocking cases of labor and delivery negligence that caused serious birth injuries and even death of some of the newborns.
In one tragic case, the wife of a sergeant, April, had a pregnancy labeled high-risk and went in for a check-up. Her baby was immediately placed on a fetal heart rate monitor, but nurses lost track of the baby’s heart rate for over an hour. No physician was present at this time and nobody was aware that the baby was in distress. When the head of obstetrics (a physician who had completed his residency 5 months earlier) finally recognized the problem, he decided to transfer the mother and baby to a civilian hospital. Recognition of the baby’s distress came far too late; the baby girl died before the transfer could take place.
Two weeks later, in a meeting with the hospital commander, April’s husband demanded to know why his wife’s obstetrician had not performed an emergency C-section the instant his baby’s distress was recognized. Shockingly, the obstetrician said, “If we tried to do a C-section for every baby that went into distress, there would be no babies delivered vaginally.” The government settled April’s malpractice claim for $250,000.00.
There have been numerous claims settled by the government in recent times. Mothers are experiencing permanent injuries due to negligent management of maternal hemorrhages caused by complications such as placental abruption and uterine rupture. Very young children are dying, including a little boy who would not stop vomiting and was repeatedly sent home and told to drink Gatorade. Shortly after being sent home the last time, the 6 year old died due to severe dehydration caused by a problem with his stomach. A Stanford University specialist who reviewed the boy’s record from the military hospital found that mistakes in his care directly led to his death. The government paid $250,000.00 for malpractice, the maximum allowed by California law.
MEDICAL MALPRACTICE & BIRTH INJURIES CAUSED BY MEDICAL NEGLIGENCE
Recent studies regarding hospital negligence throughout the U.S. is not promising. Approximately 440,000 deaths occur every year as a result of preventable medical errors, and millions of people survive these errors but are left with severe injuries. Research also shows that physicians seldom report other physicians’ errors, and state medical boards almost never take any action against physicians who have had hospital or clinical privileges removed due to negligent behavior. Few hospitals are implementing policies to correct the epidemic of preventable medical errors, and when testifying in front of a Senate Subcommittee, a Harvard professor told the panel that hospitals are no safer now than they were 15 years ago.
Indeed, a hospital stay can be dangerous. It is important to carefully choose a hospital and physician. Sadly, military personnel often don’t have a choice. Members in active duty are required to use military hospitals unless the military hospital does not offer the needed procedure. Recently, the military has ordered tens of thousands of military beneficiaries who are using civilian services to switch to a primary care physician at a military hospital. If these servicemen and their family members don’t switch, they will have to pay a lot more out of pocket for insurance that covers civilian care.
Patients are at an increased risk of experiencing medical errors at small and underused hospitals, such as military hospitals. In addition, the NYT uncovered the fact that military hospitals have grossly inexperienced physicians and nurses due to the fact that they are always rotating to different positions, with senior physicians and nurses ending up with desk jobs. Lack of personnel experience further increases the risk that patients at military hospitals will suffer injury caused by preventable medical errors. The most recently available data shows that maternity care is one of the poorest performing areas in military hospitals.
HOW TO AVOID MEDICAL NEGLIGENCE & BIRTH INJURIES
Many military service people do not have a choice of where to receive medical care, and many cannot afford the expenses associated with visiting civilian hospitals and clinics. It is important to be part of the lobbying effort that advocates for eliminating the military hospital system and allowing patients to choose which hospital they wish to utilize. Physicians that had government support for medical school should be able to find training in hospitals throughout the country and not just at underused military hospitals.
In the meantime, people should fully evaluate potential military physicians, and this is especially important for expecting mothers who are at a high risk of suffering harm at a military hospital.
Listed below steps everyone can take to help ensure a safe hospital stay.
Tips for Staying Safe in a Hospital
- Make sure medical personnel wash their hands when entering the patient’s room.
- Make sure items that are used on multiple patients, such as a stethoscope, are wiped off with an alcohol swab before being used on the patient.
- Make sure the patient is given the correct medication and dose.
- Record and report mistreatment or neglect.
- Bring a voice recorder, phone or camera.
- Write down the names of the patient’s caregivers.
- Review medical records for mistakes.
- Employ the use of a “patient sitter” and “nanny cam.”
- Prior to consenting to a procedure, ask the physician or technician how many times she has performed the particular procedure.
If the patient is not fully awake and aware of her surroundings, it is a good idea to have someone sitting next to her as often as possible. In fact, a patient sitter is always a good idea. The sitter can help implement the steps above. When choosing a hospital, make sure the facility will allow a patient sitter to be present at all times. Patient sitters can ensure that caregivers wash their hands, don’t pull on devices that can pull out lines that are in or on the patient’s body, and thoroughly read the chart of the patient. Lack of hand-washing and failure to read a patient’s chart (especially after a shift change) are well documented causes of preventable harm to a patient.
Patients must remember that they are in charge. They have a right to read their charts and medical records at any time, and people given permission by the patient also may read the records. If a patient wants a patient sitter, she has the right to have one. Hospitals may make this difficult, especially during non-visiting hours, which is why it is important to discuss this with the medical center before admission. Patients should feel free to ask as many questions as they want. For example, it is important to ask the treating physician or staff member performing a procedure how many times she has performed the particular procedure, test, or surgery.
Tips for Staying Safe During Labor and Delivery
As can be seen by the McLean case, the ability to perform a prompt C-section if the baby becomes distressed is crucial. In addition to this, astute fetal monitoring must take place so that distress is recognized the instant it occurs. This means that personnel skilled at fetal heart tracing interpretation must be present at all times. The staff cannot simply rely on the monitors’ alarms because these often fail or go unheard.
When a baby is in distress, which is signified by a non-reassuring heart tracing, it means she is experiencing oxygen deprivation. A prompt delivery must take place – usually by C-section – in order to avoid permanent brain damage. When babies experience a lack of oxygen to the brain for too long, they can develop a form of brain damage called hypoxic ischemic encephalopathy (HIE), which often leads to cerebral palsy, seizures, developmental delays, intellectual disabilities and periventricular leukomalacia (PVL).
Listed below are some questions that mothers should ask potential obstetricians.
- Are you skilled at fetal heart rate tracing interpretation, and how many years of experience do you have?
- Will my baby have continuous electronic fetal heart rate monitoring?
- Is there at least one other person involved in my labor and delivery that is skilled at fetal heart rate tracing interpretation?
- If my baby becomes distressed, do you have the ability to deliver her very quickly by emergency C-section?
- How many years of experience do you have in performing emergency C-sections?
- Is there an additional physician immediately available in the event that multiple dangerous conditions occur simultaneously, such as my baby and I having difficulty at the same time?
- Is there proper resuscitation equipment immediately available in case my baby needs to be resuscitated right after delivery?
- Will all procedures used during my delivery be fully explained to me along with their alternatives? This includes the use of forceps, vacuum extractors, Pitocin, Cytotec and the option of C-section delivery.
Conditions that can cause distress and birth injuries include the following:
- Uterine rupture. This occurs when the uterus (womb) becomes torn, which can cause the unborn baby to enter the mother’s abdomen.
- Placental abruption. In this condition, the placenta tears away from the uterus, either partially or fully. If the tear is at the umbilical cord, the baby could be totally cut off from her oxygen supply.
- Placenta previa. This is when the baby covers the birth canal opening (the cervical os) either totally or partially. If this condition is present at delivery, the baby must be delivered by C-section.
- Umbilical cord compression. When this occurs, the baby’s cord exits in front of her, which can cause the cord to be impinged upon (squeezed) by the baby’s body and the mother.
- Nuchal cord. This is when the baby’s umbilical cord is wrapped around her neck.
- CPD and macrosomia (large baby). CPD occurs when the baby is too large for the size of the mother’s birth canal / pelvis.
- Premature rupture of the membranes (PROM). PROM is when the mother’s water breaks before she is in labor. This can cause premature birth and chorioamnionitis.
- Breech or face presentation. These conditions occur when the baby is not in the normal, head-first position. In breech presentation, the buttocks are in a position to exit the birth canal first, and in face presentation the baby’s face presents first.
- Chorioamnionitis. This is an infection of the placenta and fetal membranes, and if not properly managed during delivery, the infection can travel to the baby’s brain and cause permanent brain damage.
- Misuse of a vacuum extractor and forceps during delivery. These are risky delivery instruments that attach to the baby’s head. They increase the risk of head trauma and brain bleeds. Sometimes these instruments actually slow down the delivery process, such as when they are being used by an unskilled physician. Furthermore, the instruments frequently are used when the physician should have quickly performed an emergency C-section.
- Anesthesia mistakes and medication errors. Improper use of medications can cause oxygen deprivation and heart rate problems in the baby.
- Use of Pitocin and Cytotec. These drugs can cause contractions to be too strong and frequent, which can severely deprive a baby of oxygen.
- Oligohydramnios. This is when the amniotic fluid is low, which can cause umbilical cord problems and other serious complications.
- Preeclampsia. This is when the mother has high blood pressure, which can cause a decrease in the supply of oxygen-rich blood going to the baby.
- Vaginal birth after c-section (vbac). This greatly increases the risk of uterine rupture.
- Fetal stroke.
- Twin and multiple baby births.
AWARD-WINNING BIRTH INJURY LAWYERS HELPING VICTIMS OF MEDICAL NEGLIGENCE WHO HAVE CONDITIONS SUCH AS HIE, CEREBRAL PALSY & SEIZURES
When labor and delivery are not properly managed, a baby can develop brain bleeds and become severely oxygen deprived. Babies can end up with cerebral palsy, hypoxic ischemic enecephalopathy (HIE), periventricular leukomalacia (PVL), intellectual and developmental disabilities, seizure disorders, and hydrocephalus. Babies can also become brain damaged if an infection in the mother is not properly managed and it travels to the baby’s brain after birth.
If your child was diagnosed with a birth injury, such as cerebral palsy, a seizure disorder or hypoxic ischemic encephalopathy (HIE), the award-winning birth injury lawyers at ABC Law Centers can help. We have helped children throughout the country obtain compensation for lifelong treatment, therapy and a secure future, and we give personal attention to each child and family we represent. Our nationally recognized birth injury firm has numerous multi-million dollar verdicts and settlements that attest to our success and no fees are ever paid to our firm until we win your case. Email or call Reiter & Walsh ABC Law Centers at 888-419-2229 for a free case evaluation. Our firm’s award-winning birth injury lawyers are available 24 / 7 to speak with you.