There are many activities in a physician’s office that can be delegated to non-physicians. Patients know this and expect the physician to be diligent in the hiring, training, and supervision of these individuals.

They will also expect that when an activity is attributed to the physician, he or she will have actually participated in that aspect of the medical care rendered.

A 20-year-old patient presented to Dr. OB for prenatal care of her first pregnancy. Her history was unremarkable and her visits during the pregnancy gave no indications of any predisposing factors.

At 18 weeks, Dr. OB’s technician performed an ultrasound to survey the fetal anatomy. The report noted the position of the placenta, amniotic fluid, the fetal head, and the size of various anatomic landmarks, including the femur. All measurements were consistent with the gestational age. The technician described the findings in a form that contained a large signature block of Dr. OB, though it was not actually signed by the physician. The form nowhere indicated the role of the technician.

The patient made regular visits to Dr. OB throughout her pregnancy. She had no complications and had no other ultrasounds performed. At term, she had a non-stress test performed at the emergency room. Dr. OB evaluated the patient’s monitor strips and sent her home. She presented three days later for vaginal delivery.

The baby was delivered without complication, but suffered from phocomelia, the absence of upper limbs.

When the case was reviewed following the baby’s suit for “wrongful life,” it wasn’t entirely clear that the standard of care for an ultrasound at 18 weeks required still pictures of a fetus’ upper extremities. However, the report’s assertion that “active movement of the fetal extremities was seen,” as well as the poor quality of the study itself, would have presented the arbitrators with a difficult challenge to overcome.

Further, the report looked like it was made by Dr. OB, even though he never reviewed the ultrasound that was recorded on the sheet with his signature block. With this additional inconsistency in such a high-value case, Dr. OB’s attorney had no choice but to seek a resolution of the matter with the baby’s lawyer before the matter went to arbitration.

Given a bad outcome in an obstetrical case, the ultrasound will likely be the first place a patient-plaintiff’s expert witness will look. An obstetrician who routinely sends his or her studies to a perinatologist for review may be in the best position to avoid becoming a legal target.

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