Nguyen J, Muniraman H, Cascione M, Ramanathan R
Division of Neonatal Medicine, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
UCLA School of Law, University of California Los Angeles, Los Angeles, CA, USA.
J Perinatol. 2017 Oct;37(10):1148-1152. doi: 10.1038/jp.2017.113. Epub 2017 Jul 27.
Maternal-fetal medicine physicians (MFMp) and neonatal-perinatal medicine physicians (NPMp) caring for premature infants and their families are exposed to significant risk for malpractice actions. Effective communication practices have been implicated to decrease litigious intentions but the extent of miscommunication as a cause of legal action is essentially unknown in this population. Analysis of communication-related allegations (CRAs) may help toward improving patient care and physician-patient relationships as well as decrease litigation risks.
We retrospectively reviewed the Westlaw database, a primary online legal research resource used by United States lawyers and legal professionals, for malpractice cases against physicians involving premature infants. Inclusion criteria were: 22 to 36 weeks gestational age, cases related to peripartum events through infant discharge and follow-up, and legal records with detailed factual narratives.
The search yielded 736 legal records, of which 167 met full inclusion criteria. A CRA was identified in 29% (49/167) of included cases. MFMp and/or NPMp were named in 104 and 54 cases, respectively. CRAs were identified in 26% (27/104) and 35% (19/54) of MFMp- and NPMp-named cases, respectively, with a majority involving physician-family for both specialties (81% and 74%, respectively). Physician-family CRAs for MFMp and NPMp most often regarded lack of informed consent (50% and 57%, respectively), lack of full disclosure (41% and 29%, respectively) and lack of anticipatory guidance (36% and 21%, respectively).
This study of a major legal database identifies CRAs as significant causes of legal action against MFMp and NPMp involved in the care of high-risk women and infants delivered preterm. Physicians should be especially vigilant with obtaining genuine informed consent and maintaining open communication with families.
照顾早产儿及其家庭的母胎医学医生（MFMp）和新生儿围产医学医生（NPMp）面临重大的医疗事故诉讼风险。有效的沟通方式被认为可以降低诉讼意图，但在这一人群中，作为法律诉讼原因的沟通不畅程度基本上尚不清楚。分析与沟通相关的指控（CRA）可能有助于改善患者护理和医患关系，并降低诉讼风险。
我们回顾性地查阅了Westlaw数据库，这是美国律师和法律专业人员使用的主要在线法律研究资源，以查找针对涉及早产儿的医生的医疗事故案件。纳入标准为：孕龄22至36周、与围产期事件相关直至婴儿出院及随访的病例，以及带有详细事实叙述的法律记录。
检索得到736条法律记录，其中167条符合全部纳入标准。在29%（49/167）的纳入病例中发现了CRA。分别有104例和54例案件中提到了MFMp和/或NPMp。在分别提到MFMp和NPMp的案件中，CRA分别出现在26%（27/104）和35%（19/54）的案件中，两个专业的大多数CRA都涉及医生与家属的沟通（分别为81%和74%）。MFMp和NPMp涉及医生与家属的CRA最常涉及缺乏知情同意（分别为50%和57%）、缺乏充分披露（分别为41%和29%）以及缺乏预期指导（分别为36%和21%）。
这项对一个主要法律数据库的研究表明，CRA是针对参与高危早产妇女和婴儿护理的MFMp和NPMp提起法律诉讼的重要原因。医生在获得真正的知情同意以及与家属保持开放沟通方面应格外警惕。
