Should you conduct placental evaluations?
Experts tout them as powerful legal tool
Legal experts say placental reviews may be the tool they've been looking for in obstetrical malpractice cases.
Because developmental problems often are not detected until weeks or months after childbirth, some hospitals are adding placental reviews to their obstetrical protocols to help defend against allegations of negligence in lawsuits. Lawyers and consultants say these evaluations can be the difference between a multimillion-dollar verdict and a defense victory.
"One of the most important defenses the lawyer uses is to try to get an understanding of what happened during the gestational life of the fetus. The placenta has been described as the diary of the gestational life," says Jim Tuschman, JD, a partner in the Toledo, OH, law firm of Jacobson, Maynard, Tuschman & Kalur.
Joel Epstein, president of Fetal Development Evaluations (FDE) in Toledo, OH, a consultant in the field of placental evaluations, agrees. "Gestation is a 40-week period of time," he says. "Lots of things that can happen during that period are related to maternal health, baby health, or genetics. Yet if there is a poor outcome, the allegations of plaintiffs' lawyers almost always focus on the delivery and the events surrounding the perinatal period. Placental evaluations determine if in fact there were events in the gestational period that could not have been seen regardless of good medical care and delivery."
A placental evaluation can show whether the mother had used drugs during pregnancy, whether there was an infection, or whether there was a diminished blood supply to the uterus. These offer alternative theories to a plaintiff's allegations of negligence, Epstein says.
Despite its potential value to legal and risk management experts, many hospitals do not conduct these examinations. "Right now most hospitals evaluate placentas on an idiosyncratic basis," Epstein says. "Most doctors wait for the bad outcome and then say, look at the placenta."
Currently, many hospitals routinely keep placentas for 48 hours before disposing them, says Epstein. They are only analyzed if a poor outcome surfaces within that 48 hour period, he adds.
Up to 50% of births have indicators that call for placental evaluations, says Epstein. (See related chart on p. 38.) To make these reviews effective risk management tools, Epstein says hospitals must adopt a systematic approach. Risk managers should work with experts in the field to create policies on clinical indicators that trigger placental reviews, on the transportation and storage of the placenta, and on the pathologists' reports, he says.
Tuschman says many pathologists also are not trained to read placental tissues. He advises risk managers to have their pathologists appropriately trained prior to instituting a program. He says pathologists also need to be trained in completing reports that will be helpful for defense purposes.
Epstein's company can train pathologists or will do the evaluation at their own facility. FDE also has created a standard form for pathologists to use when conducting these examinations. The forms can be sent to a national database his company is creating for use in lawsuits.
The pathologists' reports also can be an effective tool in preventive medicine. Dale Creech, JD, general counsel of Miami Valley Hospital in Dayton, OH, says his hospital has created a database of its pathologists' reports. He says the findings have helped staff learn which patients may be prone to high-risk deliveries.
While Creech says his hospital's placental evaluation program will be a highly effective defense tool when and if it is tested, he cautions risk managers to consult obstetricians, pathologists, and nurses before implementing any procedures at their hospitals. He found that some members of the medical staff at Miami Valley, particularly pathologists, had concerns about the impact of placental evaluations on their workload and on their reimbursement from third-party payers.
"Make sure the pathologists know that they will be actively involved and will be busier," Creech says. He has found that most maternity patients' insurers will reimburse for these evaluations.
On the other hand, obstetricians have welcomed the placental reviews, Creech reports. "They always feel like they are left hanging out to dry with the bad-outcome cases."
Creech says many insurers also will provide obstetricians a discount in their malpractice evaluations if their hospital has a policy on place for placental evaluations. *
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