[Closed claims in obstetrics: A study based on French Sham insurance data]

Abstract

Objective: The aim of this study was to analyze the medicolegal claims related to obstetrics in French hospitals.

Material and methods: We did retrospective study on insurance claims provided by Sham insurances and which has been settled by a court over a 3-year period (2004-2006).

Results: We analyzed 66 closed claims that occurred between 1983 and 2005 in French hospitals (54 general hospitals and 12 academic). The average time between the declaration of the claim and the court conviction was 6 years. The average amount of compensation per claim was 500,000 €. The damage occurred during vaginal delivery (n=44), planned (n=5) or unplanned (n=4) cesarean. The more often claims are fetal asphyxia (n=24) or shoulder dystocia (n=8). The consequences are very important: cerebral palsy (16), death of the newborn (12), death of the mother (2) or brachial plexus injuries (6).

Conclusion: The causes identified by the expert are always multifactorial with generally a misdiagnosis (n=27), a decision making error (n=36), a care error by the midwife (n=21) and/or a delay in medical care (n=13). These data should help strengthen the quality approach in obstetrics.

Keywords: Closed claims; Liability; Litige; Malpractice; Medicolegal; Médicolégal; Obstetrics; Obstétrique; Responsabilité; Sinistralité.