Document Management Efforts in Asphyxia Cases.

SAN JUAN, P.R. -- Recent data suggest that only 6% of cerebral palsy cases are associated with birth asphyxia, yet when medical malpractice cases involving the disorder go to trial, plaintiffs' lawyers blame most of them on birth asphyxia, according to Luke M. Pittoni, J.D.

These "brain-damaged baby" cases are the most difficult malpractice cases to defend because they evoke so much sympathy from jurors. However, physicians can take several measures to improve their chances of successfully defending themselves, Mr. Pittoni said at a conference on obstetrics, gynecology perinatal medicine, neonatology, and the law.

First, proper documentation is a must. This is particularly true when it comes to noting the reasons that cesarean section was or was not performed, said Mr. Pittoni, a New York-based defense lawyer specializing in medical malpractice.

As recommended in a 1995 American College of Obstetricians and Gynecologists' technical bulletin, the terms "fetal distress" and "asphyxia," when referring to findings on electronic fetal monitoring strips, should be avoided because they are too conclusory. These words will come back to haunt a physician in court if they were used glibly in the medical record to justify a cesarean section, according to Dr. Pittoni, who advised using the term "nonreassuring status" instead. Plaintiffs' attorneys frequently blame cerebral palsy on birth asphyxia, but the actual cause of the disorder is unknown in most cases.

It is best to focus on actual findings instead, noting such things as a prolonged second stage, late decelerations, and nonreassuring patterns. The physician's thought process should be documented as it occurs, so the process can be clearly explained later.

If more physicians would order cord blood gas tests and do fetal scalp blood pH testing in questionable situations, ...