• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
Your Practice
CMECNE

You’ve Been Served, Part Four: An ObGyn Defendant Wins the Case – Guidelines Matter 

image_pdfFavoriteLoadingFavorite

Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. Describe the role of plaintiff expert witness
2. Discuss professional medical guidelines in determining standard of care

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.

The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.

Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Jan 25 2023, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.

Read Disclaimer & Fine Print

Part One | Part Two | Part Three | Part Four

In another entry (see ‘Related ObG Topics’ below), the necessary qualifications to be an expert witness were discussed. In this entry, we look at the expert witness from a different perspective, that of the ‘plaintiff’ expert witness. The job of the plaintiff expert is to convince a jury and a judge that a medical standard of care was not followed, and because it was not followed, the plaintiff’s patient was injured or died.

In Gallardo and D.R.G. v. United States of America, the plaintiff’s mother alleged that the obstetrician (1) did not properly interpret the fetal monitoring strip; (2) had the plaintiff continue to push in the presence of tachysystole and uterine hypertonus even though acidosis was evidenced by prolonged decelerations, minimal to absent variability, persistent late decelerations and tachycardia; and (3) did not perform a timely cesarean section.  The infant was diagnosed with cerebral palsy.  After a trial, the district court found in favor of the defendant physicians.

Both plaintiff experts agreed that the defendant obstetrician failed to properly interpret the electronic fetal monitor (EFM) strip and erred by not performing a cesarean section, but for different reasons. The first expert opined that based on the fetal heart tracing, a cesarean section should have been done when the baby was experiencing ischemic episodes during which it was not receiving enough oxygen. He also opined that the mother was allowed to engage in too much pushing, and that a cesarean section should certainly have been performed as the baby was exhibiting bradycardia based the EFM strip.

The second expert testified that it was not until the second stage of labor, i.e. the pushing phase, when the EFM strip began to indicate the development of severe fetal acidosis. Therefore, it was unreasonable for the obstetrician to have the mother push with almost every contraction because it left the baby with little or no time to recover and, consequently, the baby rapidly became acidotic.

Defense experts opined that electronic fetal monitoring has an extremely high false positive rate coupled with an extremely low positive predictive value for cerebral palsy, let alone hypoxic-ischemic encephalopathy and the severity of acidosis. The maternal history of two vaginal deliveries also classified the mother as low risk for cesarean section.

The district court chose not to accept the plaintiff expert testimony as defining the controlling standard of care because it was inconsistent not only with the opinions expressed by defense expert, but more importantly because it was inconsistent with the positions taken by ACOG in various publications. Specifically, EFM strips have questionable predictive value when it comes to cerebral palsy and should not be used in isolation to determine management. In addition, the divergent opinions of plaintiff experts as far as the proper course and timing of possible interventions that the defendant obstetrician should have followed also doomed plaintiff’s case. The court concluded that “[t]he standard of care in the face of persistently non-reassuring EFM strips in February 2007 could include a wide range of approaches.” Therefore, the obstetrician’s actions were reasonable given the wide-ranging standard of care.

Learn More – Primary Sources:

Gallardo and D.R.G., v. United States of America No. 12–1325, United States Court of Appeals, Tenth Circuit

ACOG Practice Bulletin 106: Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles

Neurological Fallacies Leading to Malpractice: A Case Studies Approach

Litigation related to intrapartum fetal surveillance

Take a post-test and get CME credits

TAKE THE POST TEST

Now You Can Get ObG Clinical Research Summaries Direct to Your Phone, with ObGFirst

ObGFirst® – Try It Free! »

image_pdfFavoriteLoadingFavorite

< Previous
All Your Practice Posts
Next >

Related ObG Topics:

So You Want to be an Expert Witness?
You’ve Been Served! Part One
Practice management info for your women's healthcare practice
You’ve Been Served! Part Two: Next Steps After Getting Court Papers
You’ve Been Served! Part Three: Intro to the Deposition

Legal Disclaimer Click To Expand

This website (the “Website”) is a service made available by The ObG Project LLC, its partners, affiliates or subsidiaries (“Provider”). This Website provides general information related to the law and is designed to help users safely cope with their own legal needs. This website does not provide legal advice and Provider is not a law firm. None of our customer service representatives are lawyers and they also do not provide legal advice. Although we go to great lengths to make sure our information is accurate and useful, we recommend you consult a lawyer if you want legal advice. No attorney-client or confidential relationship exists or will be formed between you and Provider or any of our representatives.
This website is not intended to be a source for legal advice, and thus the reader should not rely on any information provided in this website as such. Readers should not consider the information provided to be an invitation for an attorney-client relationship, and should always seek the advice of competent counsel in the reader’s home jurisdiction. Provider may provide links to third party websites. These links are provided only as a convenience. Linked websites are not reviewed, controlled or examined by Provider and Provider is not responsible for the information, advertising, products, resources or other materials, of any linked site or any link contained in a linked site. The inclusion of any link does not imply endorsement by Provider. In addition, please be aware that your use of any linked site is subject to the terms and conditions applicable to that site. Please direct any questions regarding linked sites to the webmaster of that site.

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site