See: http://www.forensic-psych.com/articles/artMedMal.html
A Plaintiff's Verdict: Meador v.
Stahler and Gheridian -
The $1.5 million award to a
Massachusetts
woman and her family in Meador v. Stahler and Gheridian3 made news as a rare
instance of a malpractice judgment based on an allegedly unwanted and
unnecessary cesarean section rather than a failure to perform such an operation.
The plaintiff, Mary Meador, did not claim that the procedure was negligently
performed or that the rare and disabling physical complications that resulted
from it (which left her largely bedridden and unable to work or meet her family
responsibilities for several years) were foreseeable. Instead, she claimed that
the defendant obstetricians had misrepresented the risks of the alternative
procedure (vaginal birth after prior cesarean) and ignored her persistent pleas
for this alternative. Moreover, she alleged, they compelled her passive assent
to the surgery in an emotionally coercive manner while she was progressing
normally in labor, despite their having previously agreed to such a trial of
labor. -
Because the consequences of the cesarean were unforeseeable, and
because Meador had signed a consent form for the surgery (to be used in case of
emergency), this case did not meet the technical requirements specified under
Massachusetts
law4 for an action based on informed consent. Instead, the case was brought on
the theory that the physicians' failure to obtain the patient's informed consent
constituted substandard, negligent medical care. The forensic psychiatrist's
expert testimony emphasized that the pro forma signing of a consent form did not
constitute true informed consent, especially in light of the physicians' alleged
disregard of the patient's expressed wishes and their inaccurate representation
of the risks and benefits of the approach she preferred.
- The psychiatrist
also explained to the jury how Meador's life history left her vulnerable to
experiencing the denial of informed consent as a highly traumatic event. Having
coped since childhood with serious illnesses in her family, Meador had viewed
doctors and nurses as nurturing figures who helped her gain control of
potentially tragic situations. She had learned that choice was still possible
even amidst illness and death. She had even been inspired to become a nurse
herself and to teach this discipline to others. Thus, when she experienced a
sudden loss of choice and control during childbirth, she reacted with intense
fear and horror and felt she had been betrayed by health professionals, whom she
now feared and mistrusted. In this way she lost her accustomed strategy for
coping with life. Moreover, having helped hold her original family together in
the face of tragic illness, Meador saw the family she had created torn apart by
her sudden and devastating loss of control in a medical situation. The jury's
recognition of the importance of the emotional facts of the case was highlighted
by its awarding almost one-third of the total damages for loss of consortium.
-
Thus, it was not simply the physically disabling consequences of the
surgery, but the loss of personal decision-making power concerning her body, her
health, and the birth of her child, that caused Meador to suffer from
Post-Traumatic Stress Disorder. Similarly, her husband's experience of loss of
consortium was exacerbated by the physicians' failure to consult him to
interpret his wife's wishes during labor. Instead of having participated in a
true informed-consent process, he was left to feel powerless and helpless. In
this way, forensic psychiatric testimony established a persuasive causal link
between the lack of informed consent and the physical and emotional damages
suffered by the patient and her family.
Cheers,
C
Subject: [MCMgtCte] FW: Article re.
caesars....
The Midwife Strikes Back.... This is
timely with NCAD next weekend but I
must say Andrew P has his facts wrong. A woman sued an
OB for an unnecessary
cs in the US and this year
won!
Cheers,
Subject: Article re. caesars....
http://www.news.com.au/story/0,10117,16490659-421,00.html
One third of Australian births to be
caesars
By Adam
Cresswell
05-09-2005
From:
The Australian
THE number of
women giving birth by caesarean section is rising fast,
and
could soon hit a record of 32
per cent of deliveries - far higher than in
countries such as Britain and New
Zealand.
There are more than 250,000 births a year nationwide, and
emerging hospital
data indicates the
increase in caesarean rates since the mid-1990s may be
accelerating.
Sally Tracy, associate professor of midwifery practice
development at the
University of Technology
Sydney,
told The Australian yesterday the
calculations were based on trends in hospitals and the
experiences of
midwives in
practice.
"Judging from the
trends in tertiary hospitals, the caesarean rates are
just
soaring," she
said.
"Midwives are saying
things to me like, 'I can't keep working - every single
woman on my shift has had a caesarean section'. They feel
totally powerless
to do anything
about it." Not only are caesarean rates much higher than
in
many other countries, they are
also rising far more quickly.
Professor Tracy presented the figures at a conference in the
coastal NSW
city of Newcastle on
Friday.
The last official
national statistics on caesareans date from 2002, when
27
per cent of the 255,092 babies
born that year were delivered by the surgical
procedure, which involves cutting through the wall of the
uterus and
delivering the baby
through the opening.
In
Britain last year, the caesarean rate
was 23 per cent, and Professor
Tracy
said the New
Zealand rate was
similar.
The reasons for the
sharp increase in Australia were difficult to
establish
conclusively, Professor
Tracy said, but more than 80 per cent of women who
had a caesarean for their first child went on to have
caesareans for their
subsequent
children. "They are coming back and not necessarily
being
encouraged to have a vaginal
birth," she said.
"It's the
whole madness of technology - the biggest risk factor for any
of
these things is to have private
obstetric care."
A study
published in the US journal Obstetrics and Gynecology
this year
found women given epidural
pain relief were more than five times more likely
to have a fetus in the posterior position - a difficult
position for vaginal
birth, making
caesarean delivery much more likely.
Professor Tracy said midwife care was known to be associated
with fewer
epidurals and
interventions, and an expansion of midwife care could be
check
the rising caesarean rate. A
study published in the British Journal of
Obstetrics and Gynaecology in 2001 found 1089 women randomly
assigned to
community midwife care
or standard hospital care were 40 per cent less
likely to have a caesarean if they were treated by midwives,
she said.
"If you look at
countries like Canada, the
UK and New Zealand,
they do not
have a very big presence
of private health insurance, and they don't seem to
have the same high rate of caesarean
sections."
Andrew Pesce,
consultant obstetrician at Westmead
Hospital in Sydney,
told
the conference litigation was a
factor in the caesarean rates.
No obstetrician had ever been sued for doing a caesarean,
while some of the
largest medical
negligence payouts - including the $11 million Calandre
Simpson case in 2001 - followed claims the doctor should have
performed a
caesarean section
earlier, Dr Pesce said.
