Cerebral Palsy: Medico-Legal Issues

In evaluating aspects of the current epidemic of Cerebral Palsy (CP) litigation, the article stresses the worrying incongruity between crippling insurance premiums vis-à-vis the controversial fact that only 10% of medical defendants are actually found liable of malpractice. Furthermore, while science increasingly stresses congenital, non- medically liable causation of CP, litigation is increasing. The article calls for wide-spectral reflection and system rectification. In analysing the jurisprudential process in a typical CP trial, a mind-shift involving scrutiny of the antenatal care, besides the ubiquitous childbirth process, is proposed. For those Court cases (commonly) focusing on birth, desperately searching for liable fetal hypoxia/acidosis ( statistically a minor but admittedly preventable causation of CP) with blinkered analysis of Electronic Fetal Monitoring(EFM) tracings, the article calls for a balanced and scientifically justified perspective. While it also throws light on several pitfalls plaguing EFM, inherent, attention is also drawn to the currently legally vulnerable situation of confirming fetal hypoxia/acidosis in the presence of non ? reassuring CTG monitoring. The article evaluates the standard traditional but now evidence - challenged Fetal Blood Sampling versus more promising and modern methods such as ST Analysis (STAN) which, however, still lacks official recognition. A strong plea is made for use of updated EFM nomenclature as well as a universal EFM abnormality classification in CP litigation. A number of UK Court case laws are quoted to illustrate important jurisprudential arguments. The article concludes with some points of advice both to individual medical practitioners and obstetric Units and calls for Collegiate and inter- Collegiate CTG advisory Committees and their liaison with representatives of the Judiciary and related bodies.