The anesthesiologist and the law: the criminal liability of midwives and anesthesiologists for epidural anesthetic reinjection in obstetrics.

The issue whether an anesthesiologist can be criminally condemned for a mistaken injection by the midwife of a mixture of local anesthetics with calcium chloride into the epidural space was examined by the Criminal tribunal of Dendermonde and confirmed by the Court of Appeal of Ghent. Liability was asserted not only against the negligent midwife who did the erroneous reinjection, but also against the resident anesthesiologist who followed the rules of the anesthesia department and ordered the replacement of the syringe by telephone. The midwife was condemned not because she performed the technical act of an epidural reinjection, but because she made an obvious error in making the solution by confusing of diluting solution. The anesthesiologist was condemned because she did not directly control the midwife while she was performing her task. The current medico-legal situation in Belgium is paradoxical and even greatly inconsistent in that patients with no medical or nursing qualifications perform acts under the safety limits of the patient controlled epidural analgesia (PCEA) technique, acts which nurses or midwives are not legally permitted to perform. The author suggests that the law should be changed, allowing epidural reinjections and the replacements of the syringe of continuous epidural analgesia infusion by nurses or midwives on condition that the physician remains responsible for training and selecting his collaborators and that the injected dose does not exceed the safety limits of a spinal dose of the same anesthetic.