Know your Pitocin policy, lawyer advises.(Obstetrics)

LAS VEGAS -- From a legal standpoint, your hospital guidelines for the preparation and administration of Pitocin are a double-edged sword in the case of a bad birth outcome, Stephen Crandall advised at a conference on fetal monitoring sponsored by Symposia Medicus.

"If you have a policy in place, you better have meant it," said Mr. Crandall, a Mayfield Heights, Ohio-based plaintiff's attorney who specializes in health care law.

During court depositions in trials involving a bad birth outcome, he said, nurses frequently describe their hospital's Pitocin (oxytocin) policy as "just a guideline," Mr. Crandall said. "We hear that all the time." If a Pitocin policy is in place but not followed, "it's a difficult road" to say that there was no deviation from the standard of care, he added.

The other problem he sees is that nurses and other members of the labor and delivery team are unaware that a Pitocin policy exists in their institution. In some court cases, he said, "we take a nurse's deposition and we ask her things about the Pitocin policy in place. They don't even know what the policy is. That can't happen. Nine times out of 10, the nurses that we depose don't know what they should know. It's very difficult to defend a case like that."

A second common area of medicolegal risk is poor charting and communication among members of the labor and delivery team, said James Kelley, a plaintiff's attorney who practices in the same firm as Mr. Crandall. "If you see potentially concerning signs or an absence of reassuring signs from a nursing standpoint or a physician standpoint, you have to take action," Mr. Kelley said. "If you make a call, you have to document that call. Remember the context: Most states allow 19 years for a child to file a lawsuit. If it's not in the chart, you're not going to remember [that call by the time the case goes to trial]. And I can assure you that who you say you called and told about what went wrong isn't going to remember that call either, if it's not in the chart."

If you're reading worrisome signs from the electronic fetal heart ...