by Aaron McCullagh October-01-2014 in Healthcare Law

On 18 September 2014, members of the Hayes Healthcare Team attended at a Special Study Day on Foetal Monitoring organised by the Clinical Indemnity Scheme (CIS) of the State Claims Agency and Dr Peter McKenna, Consultant Obstetrician / Gynaecologist at the Rotunda Hospital. The event took place in the Rotunda Hospital. Presentations were given by specialists from the Rotunda, Coombe Women & Infants University Hospital and the National Maternity Hospital. Sue Moriarty, Head of Claims in CIS also presented.

Of particular interest in the context of clinical negligence litigation was the reliability of cardiotocograph tracing in the Clinical setting. Dr Peter McKenna, Consultant Obstetrician / Gynaecologist at the Rotunda Hospital provided a very interesting talk on the history of cardiotocograph (CTG) tracing and where it is today. In particular, he commented on the high numbers of abnormal tracings that are seen every day and that do not result in any injuries to the baby. He referred to a case study where there was a non-reassuring CTG with a normal foetal blood sample. While the CTG was non-reassuring, the fact that the foetal blood sample was normal provided reassurance to the clinical team. However, on delivery, the baby’s cord was wrapped twice around its neck. Dr McKenna in hindsight believed that the baby should have been delivered earlier.

Professor Tom Matthews, Consultant Paediatrician, made reference to a trial in the National Maternity Hospital of CTG versus manual auscultation during labour. Both trials revealed similar rates of cerebral palsy. Professor Matthews was of the view that CTGs should no longer be used to monitor the foetal heart rate. He advised that the relationship between abnormal CTGs and hypoxia is poor and noted that 99.8% of abnormal CTGs do not result in significant hypoxic brain damage.

Sue Moriarty of the CIS noted in her presentation that the current largest liabilities for the State Claims Agency are obstetrical clinical negligence claims. She advised that in 2002/2003 cerebral palsy claims were settling for a lump sum of €2 million to €2.5 million. However, in 2013, the State Claims Agency settled four lump sum cases in the range of €4 million to €6.3 million and also settled another case for the sum of €8.5 million. An encouraging sign from a legal costs perspective is the greater take-up of mediation of clinical negligence claims. In particular, two maternal death cases have settled at mediation in recent years while four cerebral palsy cases settled at mediation in 2013.

Overall, this was a most interesting conference, of relevance to clinicians, risk managers and lawyers with helpful learnings for all attendees.

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