$36.5 million. Still wonder why C-section rates are so high? “The jurors found Doelger failed to interpret strips from a monitoring device that indicated the fetus was in distress, court records show. The difficult delivery continued so long, the fetus suffered from a dangerous increase in blood acidity; the child should have been delivered by Caesarean section long before it was, the jurors concluded.

The hospital was deemed liable, the jury said, because its nurses failed to alert Doelger to the distress signals, the records show.

‘Had the Caesarean been performed even 30 minutes earlier, Nicholas would be fine today,’ she said. ‘It was just tragic that it happened that way.’”

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  • Elliott

    A c-section was done and did nothing to immunize the doctor or hospital from liability. So yes, I still wonder.

  • Anonymous

    Did they screw up or not? Apparently they ignored signs of fetal distress.
    Isn’t the baby’s injury the fault of the negligent handling of available information?

    Why would nurses fail to inform a doctor that the monitor was showing fetal distress? Did they just adjust the pitocin drip to see if it would take care of itself? Why the delay? If there isn’t any good medical reason for it, they screwed up and hurt that baby.

  • Samnson Isberg

    Maybe I’m repeating myself here – but this story is by it self not very illuminating. Again all the facts that could enlighten us as to what the cause of this tragedy is are suppressed, and only the emotional tidbits of a severely handicapped infant on the one hand and a huge amount of dollars on the other are brought forward. The only factoid we are given is that the CTG was non-reassuring – which is more than worthless. What were the acid-base status in the umbilical cord? What were the MRI scans of the brain? What kind of cerebral palsy does he have? Did he show signs of liver damage? What is his family history? Was Oxytocin or Cytotec used?
    The artiucle tells us virtually nothing, so what can we learn from this piece of journalism? Nothing.

  • Anonymous

    “The artiucle tells us virtually nothing, so what can we learn from this piece of journalism? Nothing.”

    Well Dr. Elliot certainly can determine the liability here. What a gifted doc he is!

  • Anonymous

    Elliot didn’t say that negligence caused the baby’s injuries. He wasn’t speaking to that point at all.

    He was trying to point out that a C-section *was* actually done in this case, and that it didn’t immunize the doc or hospital from being found liable.

  • Anonymous

    To Anon 1:57
    I think Doc Elliott would have recommended vaginal delivery.
    Obviously,C-section was indicated but it wasn’t performed early enough.
    My reading is that Doc Elliott doesn’t know what he’s talking about.

  • Anonymous

    Dr. Doelger is the local physician here, and one of the best. This verdict will have an absolutely devastating impact on the Hartford OB/GYN community. I bet C-section rates will skyrocket, as no one wants to be the next guy or gal to go through this. The worst part is that there is no feeling that finally the bad doc is punished, the feeling is more that this is like a Russian roulette – can happen to anyone, and the fact that you’re a good doctor won’t protect you.

  • Anonymous

    Even the best doctors make mistakes. Just like even the best drivers fail to look in the rear view mirror. Should the child not get compensation because the guy normally does everything right but may have failed to do so this time?

    And no one knows what will happen to rates, since not a dollar has been paid yet.

  • Anonymous

    You doctors are vituperative lunatics.

    All Eliot did was question KevinMDs connection between malpractice suits and c-sections. Given that a c-section was performed here, KevinMD’s suggestion that this lawsuit will increase the use of C-section is, well, illogical.

    What I find disturbing frm the commenters is their reflexive resort to professional authority to shut people up. Eliot doesn’t have an MD –so how dare he question us.
    To the degree medicine is science, it must function by clearly demonstrable principles–not professional judgments. If what doctors say does not make sense, is contradictory, or poorly supported (very often the case–as here KevinMD’s illogical connection), people should take them to task.

    Finally, who cares whether Dr. Doelger is Marcus Welby or Mengele? When a patient goes to a doctor, he is entitled to a certain standard of care–regardless of whether a doctor is having a bad day . If the doctor falls below, the doctor pays. Seems fair to me.

  • Kevin

    I was responding to the statement “if the C-section was done 30 minutes earlier Nicholas would be fine today”.

    This implies that there may not have been a lawsuit if the doc had just rushed to do a C-section instead of giving a chance for a natural delivery.

    So yes, lawsuits like these would just inflate C-section rates since no doc would risk a lawsuit by holding off on a C-section – even for 30 minutes.

    Kevin

  • ismd

    Anonymous 9:49 AM,

    “To the degree medicine is science, it must function by clearly demonstrable principles–not professional judgments.”

    You clearly have never made a medical decision. Doctors make judgments all the time, utilizing our knowledge and experience and applying them to the particular decision that needs to be made. There a’int no way to practice cookbook medicine.

    “You doctors are vituperative lunatics.”

    I would hope that these posts could maintain a degree of civility, so kindly knock off the name calling please. And,yes, I hope that my fellow physicians would do the same.

  • Elliott

    The idea that an earlier C-section prevents malpractice suits leads to the argument which is NOT reductio ad absurdum that all births should be C-sections. The problem with that is that there is little evidence that this will lead to better outcomes for babies. I assume that it would lead to worse outcomes for mothers, but haven’t really looked it up.

    So, assuming doctors do increase their c-section rates for fear of missing some not-generally-applicable, unique-to-this-case-only 30 minute window then they will face malpractice suits for the bad outcomes that result from that strategy. So basing your malpractice avoidance strategies on anything other than bad outcome avoidance is a losing proposition. Until doctors internalize that idea, then opportunities for dialog are limited at best in my opinion.

  • Kevin

    Elliott,
    Again, your points simply underscores the absurdity of our broken system.

    You delay a C-section for even 30 minutes = lawsuit.

    You do too many C-sections = increased risk of surgical complications = lawsuit.

    It’s a zero-win game. That’s why I didn’t go into OB.

    Kevin

  • Anonymous

    To ismd:
    “Doctors make judgments all the time, utilizing our knowledge and experience and applying them to the particular decision that needs to be made. There a’int no way to practice cookbook medicine”

    True; however, to the extent a doctor is recommending a non-evidenced based treatment or is essentially balancing probabilities the value of which neither he nor anyone else, I’m not sure such doctor’s views are worth much deference at all.

    Or, rather, I can do the research on my particular condition and with a background in statistics and decision theory can come up with plans that are as reasonable or unreasonable as a doctor relying on his “experience”–which is nothing more than prejudice confirmed by anecdote.

    And, that’s the problem with doctors–they too often demand professional deference, not on the basis of scientifically demonstrable claims, but on their particulazed view of things.

  • Elliott

    Kevin, it’s not a zero-win game. You get financially rewarded, you get respect, you get the satisfaction of helping people. Those are the rewards, but yes, there are risks. You face the risk of lawsuit, you face the risk of bad outcomes that you could do nothing about, you face the risk of bad outcomes where you suspect you did something wrong. My feeling is that doctors concentrate too much on the risk side of the equation and ignore the very real rewards that they recieve (or have an entitlement attitude towards them). This leads to sub-optimal solutions like malpractice caps.

  • ismd

    Elliott,

    It sure is a zero-win game. Financially rewarded? Respect? Those went out the window with the bath water. Other than for my parent’s generation, there appears to be little respect for any profession, law and medicine included.
    As fas as your statement “that doctors concentrate too much on the risk side of the equation and ignore the very real rewards that they recieve (or have an entitlement attitude towards them)” – that statement is just plain dumb. When physicians are at the mercy of a legal system that allows anyone to sue for anything, and that allows bad outcomes to equal bad medicine even in the face of incurability, is it any wonder that we concentrate on the “risk side of the equation”? And we don’t have an a feeling of entitlement – just the feeling that we should be paid for our time and effort in a fair manner.

  • Elliott

    ismd, the literature on happiness (google “Does money buy happiness” or some equivalent) is full of the studies that show that it’s relative wealth that seems to matter more than absolute wealth in terms of determining happiness. Why do I mention this? In absolute terms, physicians are still the most highly paid and highly respected profession. That’s current data. The relative benefits they receive are less than a generation past, but they are still on top. The absolute financial benefits are still greater than a generation past (although physician income has been somewhat stagnant more recently).

  • Anonymous

    Kevin & ismd,

    Your profession still retains more respect from its clients than any other, so spare us the poor me routine on that point. And you’re still the most highly compensated of all professions by a long shot, so let’s not poor mouth that side of it too much either.

    Here’s the thing with you guys though. You complain and complain, but you offer nothing concrete. If there was malpractice in this case, is this child’s quality of life for the rest of his life not worth more than $250,000? This verdict would be high no matter what simply because of the costs of care. What do we carry insurance for if not to pay for our mistakes? Should no one ever make a claim because the rest of us might have increased rates? Do you just pay insurance because you like to drive by their home office and say “I helped build that”? Or “the CEO wouldn’t be driving that Lexus if it weren’t for my premium dollars?”

    What do you propose that would compensate more people that deserve it? That you could actually get through a legislature. One of the best criticisms of the current system is that the majority of victims of actual malpractice don’t get compensated. So what do you propose to do about that if you really are intersted in justice? Remember, your allies the insurers are going to turn on you when you start talking about compensating more people.

    You’re not at “the mercy” of a system that allows anyone to sue for anything anymore than every person that enters a contract in this country, or drives a car, or has any interpersonal contact with others. Please, stop with the pity party. It’s unseemly.

    The justice system actually serves you pretty well – because you WIN most of the time. Yet you really don’t understand it nor do you make any effort to. And most of you wouldn’t even stand up and testify for a plaintiff even if the malpractice was CLEAR. Don’t lecture about justice when you won’t help others get it.

    What doesn’t serve you well is the insurance system. Yet you have no understanding of it nor do you show any willingness to understand it because demonizing lawyers is just too easy. And passing “reform” on the back of the weakest members of society is much easier than battling the insurers who set your rates. Even if that “reform” promises you literally nothing.

    Nor do you show any interest in reforming your own behavior to reduce your risk, despite study after study, many by doctors, explaining very clearly how to do so. Yet you want to blame everything on everyone else.

    CJD

  • Anonymous

    “Do you just pay insurance because you like to drive by their home office and say “I helped build that”? Or “the CEO wouldn’t be driving that Lexus if it weren’t for my premium dollars?””

    On the other hand, does the trial lawyer deserve $14.6 million (40% of $36.5)in this case? When the court computed how much the care would cost, were they computing how much it would cost to take care of the lawyer? And if you lawyers are so sincerely concerned about the victims, why don’t we see any of that contingency fee going to helping these victims? I see the trial lawyer driving a brand new Lexus and I can say my premium helped pay for that.

  • ismd

    “The justice system actually serves you pretty well – because you WIN most of the time. Yet you really don’t understand it nor do you make any effort to.”

    Gee – maybe the reason we win most of the time is that the case had no merit to begin with, but was allowed to proceed.And what of the cases we’re dragged into that get dropped before trial or even deposition? Give us credit – we understand the system alot better than you think. It’s you who have no clue what’s its like to practice medicine in this country.

    “And most of you wouldn’t even stand up and testify for a plaintiff even if the malpractice was CLEAR. Don’t lecture about justice when you won’t help others get it.”

    For someone who demands facts all the time to back up our statements, I challenge you to prove that ridiculous statement. And while we’re not to demonize lawyers, you have the chutzpah to demonize doctors? Spare me the crap, will ya?

    “Your profession still retains more respect from its clients than any other”. Again, prove it insteaof spouting feel good (to you) nonsense.

  • Anonymous

    “On the other hand, does the trial lawyer deserve $14.6 million (40% of $36.5)in this case? When the court computed how much the care would cost, were they computing how much it would cost to take care of the lawyer? And if you lawyers are so sincerely concerned about the victims, why don’t we see any of that contingency fee going to helping these victims?”

    Well, we’ve finally gotten to the root of the problem for this anonymouse. Jealousy, nothing more, nothing less. Someone makes more money than him and he doesn’t like it.

  • Anonymous

    “Gee – maybe the reason we win most of the time is that the case had no merit to begin with, but was allowed to proceed.And what of the cases we’re dragged into that get dropped before trial or even deposition? Give us credit – we understand the system alot better than you think. It’s you who have no clue what’s its like to practice medicine in this country.”

    You’re right, I have no clue what it’s like to practice medicine. I know just about as much about that as you do about how a lawyer who tries cases manages his practice, decides what cases to take, decides how to put evidence on, finds experts, etc.

    As for what I can prove, try and hire a physician to testify against any other physician. How about you, would you do it?

    I’m not sure where you think I “demonized” you, though. I didn’t intend to.

    You’re right though, I can’t provide objective proof that you’re respected. I’m sure there is a survey somewhere, and if I find it I’ll post it.

    CJD

  • Elliott

    http://www.harrisinteractive.com/harris_poll/index.asp?PID=599

    I’m wrong. Doctors have dropped in the last 5 years. They do this survey every year. I (mis)remember doctors always being at the top of the list.

  • Anonymous

    “Well, we’ve finally gotten to the root of the problem for this anonymouse. Jealousy, nothing more, nothing less. Someone makes more money than him and he doesn’t like it.”
    CJD, I’m not jealous. I agree with compensating those patients who deserve it. Again you are are resorting to your favorite thing attacking “ad hominem” , instead of answering the question or addressing the issue. And you want one of the bloggers to stop calling you sodomite. Now I see, who starts this name calling thing.

  • Anonymous

    Anonymous, the only issue you addressed was the amount of money the lawyer made, and you just assumed that. So what did you want me to discuss.

  • Anonymous

    “One of the best criticisms of the current system is that the majority of victims of actual malpractice don’t get compensated. So what do you propose to do about that if you really are intersted in justice?”

    CJD that criticism is a two part statement. First, the majority of those injured by malpractice are not compensated and second the majority of cases result in no payment to the plaintiff. This system is not good for patients or doctors…only the lawyers. I’ll say it again, there are other systems in the world (ie the swedish system) where more patient’s are compensated for malpractice and frivilous cases go nowhere. Additionally 40-60% of the money does not go to you the lawyer and administative costs (ie lawyers are cut out of the system). NONBIASED experts evaluate the cases for merit unlike this country were hired guns (for the plantiff and defense) square off in some kind of sick duel based on who is paying their tab. Frankly I would rather have nonbiased experts in my field determine whether I committed malpractice then the lowest common denominator that gets on jury’s in this country.

  • Anonymous

    “First, the majority of those injured by malpractice are not compensated and second the majority of cases result in no payment to the plaintiff.”

    You’ll have to back up the second one with some stats. Maybe you mean the majority of cases that are TRIED to a jury. Of course, that undercuts the “juries are ignorant” theory that is so gleefully bandied about.

    “This system is not good for patients or doctors…only the lawyers.”

    Another 1/2 right statement. If the plaintiff’s lose as often as you say, then perhaps you mean only the insurance companies’ lawyers, who get paid regardless of outcome – kind of like physicians!

    “I’ll say it again, there are other systems in the world (ie the swedish system) where more patient’s are compensated for malpractice and frivilous cases go nowhere.”

    Sweden will be relevant when you are willing to give the health care safety net of socialized medicine. For now, though, it doesn’t mean much. What’s more, no proposal that has had any traction in any legislature has done anything to compensate MORE people. Your insurer allies aren’t really after that, are they?

    “NONBIASED experts evaluate the cases for merit unlike this country were hired guns (for the plantiff and defense) square off in some kind of sick duel based on who is paying their tab.”

    Would you testify for a plaintiff? If not, why not? This “all experts are whores and we’re interested in justice” nonsense is getting old. If you guys were really interested in providing unbiased experts, you’d volunteer to testify for the plaintiff more. As it is, finding a doctor who will testify against another one even in clear cases is incredibly difficult. Almost impossible if it’s the same locality or insurer.

    Your last comment about the “lowest common denominator” illustrates the arrogance that so turns people off about doctors. These are the same people who find in your favor more often than not.

    CJD

  • Anonymous

    Lets take your BS one step at a time CJD:

    A: Yes I meant “Tried”

    B: “Another 1/2 right statement. If the plaintiff’s lose as often as you say, then perhaps you mean only the insurance companies’ lawyers, who get paid regardless of outcome – kind of like physicians!”

    Read for comprehension CJD. The majority of “tried” cases result in no payment to the plantiff but clearly significant issues for the doc. The majority of truly injured patients by malpractice are not compensated, yet if a malpractice attorney wins one large award (think hard CJD can you say john edwards), end of story.

    C:”Sweden will be relevant when you are willing to give the health care safety net of socialized medicine. For now, though, it doesn’t mean much. What’s more, no proposal that has had any traction in any legislature has done anything to compensate MORE people. Your insurer allies aren’t really after that, are they?”

    Believe it or not CJD not all of us doc’s are against some sort of “universal care”. This is not an academic argument to me (unlike you). The uninsured are people I take care of all the time. In my line of work it is not “pro bono”, it is just another day on the job. Individual state programs have huge gaps that are only getting larger. That stated unlike you I have WORKED in a county hospital. I have WORKED in a VA (with the federal tort system). The main issue I have seen with both of these type of institutions is the LACK OF ACCOUNTABILITY on the part of staff and at time the docs. I have had VA tech’s tell me they are not coming in for a CT scan. Have you ever tried to get a federal employee fired? As any doc on this website who’s been there knows VA time is MUCH different (and slower) than the real medical world. For universal care to work in this contry we need the efficiency of well run private hospitals and not some broken down VA or county hospital. Please don’t lecture me on something you have no clue as to what you are talking about.

    D:”Would you testify for a plaintiff? If not, why not? This “all experts are whores and we’re interested in justice” nonsense is getting old. If you guys were really interested in providing unbiased experts, you’d volunteer to testify for the plaintiff more.”

    What part of “nonbiased experts” do you not understand? The experts comment as to the legitimacy of a given claim. They do not testify “for the plantiff” or “for the defense”. Before you respond, why don’t you look up the system otherwise you just sound like an uninformed idiot.

  • Anonymous

    “A: Yes I meant “Tried””

    Then that doesn’t mean much. Do you never have an honest disagreement with a colleague? If a third party were to consider both your positions thoroughly, and conclude the colleague was right, does that mean your position was “frivolous”? Of course not.

    “The majority of truly injured patients by malpractice are not compensated, yet if a malpractice attorney wins one large award (think hard CJD can you say john edwards), end of story.”

    Besides making no sense, it means little coming from a physician. Why? Because you have made no proposal to increase the compensation to more victims. Zero, none. You talk at length about justice, but the only bills that hit the legislature are all about limiting those same people’s access to recovery. In short, your talk is cheap.

    “Believe it or not CJD not all of us doc’s are against some sort of “universal care”. This is not an academic argument to me (unlike you).”

    It’s not an academic argument to anyone. Think about more than yourself. We’re all consumers and funders of health care. So you’ve worked in a VA or County Hospital. That has nothing to do with why citing Sweden as a model fails.

    Your Sweden comparison doesn’t work because a victim of med mal doesn’t need money to still get health care. A victim of med mal that will require future care will be paying out of their pocket in the US. So again, unless you’re willing to give people the social safety net, why should they make it harder to hold you accountable for their mistakes? Are you going to pay their future medical bills out of the goodness of your heart?

    “What part of “nonbiased experts” do you not understand? The experts comment as to the legitimacy of a given claim. They do not testify “for the plantiff” or “for the defense”.”

    Who picks these “nonbiased experts”? Would you be one? Do you consider yourself unbiased? Of course not. No one lacks bias. Think about it.

    CJD

  • Anonymous

    The fact is the science on this is pretty clear. The American College of Ob/Gyn did an exhaustive survey of over 1,000 studies published regarding CP and its causes.

    They concluded that the VAST MAJORITY (e.g. 95%) of CP cases are caused by defects in development at a very early stage in development, and have nothign to do with labor/delivery procedures. In other words, most kids with CP would have had it REGARDLESS of whether or not a C-section was performed.

    Now supposedly the court is supposed to defer to established standard of care and medical science to decide these cases. If that were so, then you would expect CP cases to drop dramatically. After all, ACOG is THE RECOGNIZED EXPERT GROUP IN THE FIELD.

    But thats not what happened. In fact, 3 years after the ACOG report, CP lawsuits have INCREASED, not decreased.

    Of course the lawyers chime back with BS like “well that just means the lawyers are only taking the 5% of good CP cases”

    I’ve got one word for that which I wont repeat on this forum.

  • Anonymous

    It must be really frustrating to have your nonsense gutted by the facts, or in your case, the lack thereof.

  • Anonymous

    “It’s not an academic argument to anyone. Think about more than yourself. We’re all consumers and funders of health care. So you’ve worked in a VA or County Hospital. That has nothing to do with why citing Sweden as a model fails.”

    CJD I am done discussing this subject with you. You have little understanding of the american medical system (I am sure paying an HMO/PPO bill makes you an expert) and based on this comment you reading comprehension in general is questionable at best. Frankly you are little more than an internet flamemaster who wants nothing more than to keep the status quo.
    I am a PROPONENT of some sort of universal care and a swedish type malpractice system. But for this to happen there needs to be an accountable system in place and not some type of US VA system. Additionally, for some sort of Universal care to work there will be clear rationing of health care like European nations. This is something Americans may find hard to stomach. Again, your comments about bias clearly show me you have not bothered to read what I recommended. Is this so hard?

  • Anonymous

    CJD hallucinates:

    “As it is, finding a doctor who will testify against another one even in clear cases is incredibly difficult.”

    Not in the two cases I was involved in. I remember well the ad that the plaintiff’s “expert” put in the ambulance-chasers magazine offering his services. He signed his ad “Dr. X, Will Travel”. Ambulance chasers can find “experts” to testify to whatever they want as long as the cash is there.

  • Anonymous

    How many of you “good” doctors who post here would testify for a plaintiff? Didn’t think so.

    “I am a PROPONENT of some sort of universal care and a swedish type malpractice system.”

    Less talk, more action, my friend. And spare me the nonsense about who understands the health care system. I know at least as much about the health care system as you do the legal.

    If CP cases have increased, has CP increased? You guys don’t have even the most rudimentary understanding of statistics.

    CJD

  • Anonymous

    Anonymous sez: “I am a PROPONENT of some sort of universal care and a swedish type malpractice system. But for this to happen there needs to be an accountable system in place and not some type of US VA system….” What a comic comment. As my mother used to say, ‘If wishes were horses, we’d all take a ride.’ So there needs to be an accountable system? Okay, design one. Make it work.

    Not going to happen, you say? Then stop basing a perfect solution on an impossible premise.