WHEN ONLY PERFORMING THE WORK YOURSELF WILL DO

Though health care economics require physicians to use assistants and technicians to perform many important tasks in the medical office, the higher the risk of the patient’s case, the more vital it is that the physician personally perform the task or even seek further specialized assistance.

Dr. OB, an obstetrician-gynecologist, initially saw the 33-year-old female patient for obstetrical care some two months after she underwent an in-vitro fertilization. An ultrasound from two weeks prior to the initial visit showed a triplet gestation with embryos at approximately 8 and 4/7 weeks. When seen by Dr. OB on May 15, the patient’s estimated date of delivery was December 7. Dr. OB’s technician performed an ultrasound that showed three fetuses, three gestational sacs, and three fetal heart rates.

After discussing with Dr. OB the option of triplet reduction, the plaintiff consulted with a perinatologist and elected to reduce the three fetuses to twins. On June 1, the perinatologist performed the reduction procedure by injecting potassium chloride into the chest of a fetus until cardiac activity in that fetus ceased. Following the procedure, the perinatologist recommended that the patient have an ultrasound within the following two weeks as well as serial ultrasounds for growth and anatomy at 18 to 20 weeks.

When the patient returned to Dr. OB one week later, an ultrasound performed and read by Dr. OB’s technician noted cardiac activity in only two fetuses. The reduced fetus was still visible. Another ultrasound two weeks later, again read by the technician, showed three sacs and three fetuses, but cardiac activity in only two. An ultrasound performed by the technician one week thereafter focused only on “Twin A” and “Twin B.” At a follow-up visit three weeks hence, Dr. OB noted an “OK” sonogram with two fetal heart beats. Another ultrasound performed by the technician 11 days later again focused only on Twins A and B.

On September 17, Twin B was noted to have severe growth retardation. A consulting perinatologist interpreted a new ultrasound, which mentioned only Twins A and B. On October 22, Dr. OB consulted with the perinatologist because of the size discrepancy between Twins A and B. After the perinatologist performed another ultrasound on Twins A and B, Dr. OB delivered the twins via Cesarean section. While Dr. OB was examining the uterus, however, he discovered a third live fetus. Dr. OB delivered the third fetus, which had gross deformities and complete lower-extremities paralysis.

The minor infant and his parents sued Dr. OB, the physician who performed the reduction, and the medical center for negligence. The plaintiffs contended that Dr. OB repeatedly failed to detect the presence of a third fetus during the course of prenatal treatment of the mother. Had Dr. OB detected the third live fetus, the mother claimed that she could have corrected the results of the failed reduction.

By not reviewing the scans himself - or by not having the ultrasounds interpreted by a perinatologist or radiologist - Dr. OB undermined his defense in this catastrophic claim, which the parties ultimately resolved prior to arbitration.

Other physicians handling similarly high-risk situations should consider whether delegating to a technician a procedure providing such critical information is really a viable option.

Gordon Ownby is general counsel at CAP-MPT.Comments on Case of the Month should be directed to gownby@cap-mpt.com