In the Delivery Room, Baby AND Doctor are at Risk

The phone call that ultimately would alter the path of Kevin Kearney's medical career brought him to a hospital delivery room on Maryland's Eastern Shore on an August evening 16 years ago. The obstetrician arrived to find an 18-year-old woman, well into labor and buckling under the weight of a 42-week pregnancy. She begged for a Caesarean section. Kearney drew on his decade as an obstetrician, gently counseling her, "Have it on your own."

Cascading from that decision was a marathon delivery marred by complications: The baby became so tightly wedged in the birth canal that Kearney was forced to launch a desperate struggle to dislodge him. The delivery would leave permanent injuries. Aug. 24, 1988, marked the birth of Donnette Dennis's first son, Richard. It also marked the start of a legal battle that reverberates today, as political leaders in Annapolis ponder medical malpractice reform.

Like so many cases across the country, in which bad outcomes in the delivery room lead to a courtroom, the desire to assess blame for Richard Turner Jr.'s damaged right arm and scarred right eye became grist for litigation. On one side was Kearney, a Johns Hopkins University-trained obstetrician and gynecologist who was one of the last remaining specialists performing high-risk deliveries in rural towns from Ocean City to Easton. On the other was Dennis's attorney, John Schochor, whose Baltimore firm has filed more malpractice cases over the past two decades than any other law office in Maryland.

Today, years after the jury reached its verdict, those on both sides of Dennis v. Kearney say the case holds valuable insights for politicians in Annapolis. Both Kearney and Schochor have spent time this year lobbying Maryland's leaders over the fast-rising malpractice insurance rates that have prompted, by the estimate of Maryland's medical society, 26 of the state's 750 obstetricians to close their practices. Gov. Robert L. Ehrlich Jr. (R) has predicted that a new wave of closures will follow a 33 percent rise in the cost of malpractice insurance that takes effect Wednesday.

In letters and during private meetings with key lawmakers, Kearney argued for limits on jury awards in malpractice suits. In sessions with Ehrlich, Schochor called for doctors to reduce what he said are the staggering numbers of medical errors being committed by a handful of the worst offenders. Both positions trace, in part, to a split-second decision made in that delivery room 16 years ago.

Some details

It was on a summer evening in 1988 that the call came to oversee Dennis's delivery. Kearney glanced through her charts and said he saw little to warrant a Caesarean. This being her first baby, he surmised, it might take time. But the labor dragged on for hours. When the baby's head finally started to emerge, the birth stalled, this time by a rare complication called shoulder dystocia -- which occurs when the shoulder becomes locked in the birth canal. "You don't forget the moment these sort of catastrophic events occur," Kearney said later. "Shoulder dystocia, it's what you live in fear of, literally."

The longer the baby was stuck, the more risks mounted. With his umbilical cord compressed and his lungs unable to expand, Dennis's baby could not breathe. Move too slowly, Kearney knew, and the infant's brain would be starved of oxygen. Twist the wrong way, and risk damaging the nerves running through the shoulder to the chest and arms. As he plotted a course, "minutes felt like hours."

He first tried to get the baby out by force. Nurses pushed back hard on Dennis's legs and pressed downward on her abdomen. And Kearney pulled -- hard -- on the baby's head, first using forceps, then his hands. Nothing. Kearney's next maneuver: to reach under the baby's armpit with one finger, and use it like a hook to yank one arm through the birth canal. That freed up room for the baby to emerge. In a matter of seconds, Richard Turner was born. Kearney visited Dennis the next morning. By then, he had seen the lack of tone in Richard's right arm. "He just told me what had happened in the delivery room, that he was sorry for what he had done," she said. "He was sorry about what happened to Richard's arm."

Kearney said he left the hospital heartbroken. He doesn't remember apologizing to Dennis but said that if he did, it wasn't to convey that he "goofed." In fact, he felt certain he handled the procedure correctly. It may be the most vexing aspect of shoulder dystocia, he said. If the baby is born with an injury, there is no way to know whether it occurred during delivery or during the baby's descent. The only certainty, Kearney believes, is that the doctor handling the delivery will be sued. Say the words "shoulder dystocia," Kearney said, "and you'll see a smile cross the face of any plaintiff's attorney." .....

Kearney did not let the court's ruling disrupt his practice. Over the next several years, in fact, his caseload grew. And so did his legal exposure. He began doing more Cesarean sections out of an abundance of caution. Still, he was sued six more times, including a second case involving shoulder dystocia, which he settled. By contrast, the average OB-GYN is sued 2.6 times over a career, according to the American College of Obstetricians and Gynecologists. His insurance bills crept up.

Then in December 2003, his carrier wrote to say that the company was getting out of the malpractice insurance business and that he would be dropped. "I tried everywhere to find new insurance, but they kept giving me these outrageous quotes," Kearney said. One company offered to cover him for $150,000, more than double the region's average rate. Another set the premium at $200,000 "because I had notches in my gun." For six weeks, Kearney tried to resolve this crisis as 150 pregnant patients waited in limbo. Reluctantly, he dialed each one, arranged to transfer their charts and pledged to track their progress. At 56, he had delivered his last baby.

Though his small gynecological practice will keep him afloat until retirement, he has become bitter. He's taped a bright orange bumper sticker to the front door of his office. It says: "Become a doctor: Support a lawyer." ....

Not only are obstetricians closing their practices, but the specialty is no longer the draw it once was. Of the 128 students graduating from the University of Maryland Medical School in 2003, none chose obstetrics. And though the previous three generations of Kearney's family have delivered babies, his son plans to specialize in orthopedics

More here.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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