May 19, 2010

Cost of Living: No Wrongful Life

New York Appellate Division, Second Department: DeChico v. Northern Westchester Hospital Center et. al.

Gianluca DeChico was born with schizencephaly, “a rare and sever congenital brain defect.” On her own behalf and on behalf of her child, Gianluco’s mother sued all involved with her prenatal care for the “extraordinary costs of the child’s medical care,” basing her case on the failure of her health care providers 1) to fully explain the implications of prenatal sonograms showing a ventricle defect on one side of the baby’s brain, 2) to conduct further tests, and 3) to fully advise mom about the abortion option.

Defendants moved to dismiss. The lower court denied their motion for summary judgment. Defendants appealed.

The Appellate Division reversed and dismissed the case against movants. As the court observed, “It is well settled that no cause of action may be maintained on behalf of an infant plaintiff for wrongful life, ‘i.e., that he or she would never have been born but for the negligence of the defendant…” Accordingly, that part of the child’s action which sounded in wrongful had to be dismissed. A child cannot sue for being born, no matter what his condition. The child can, however, sue for injuries or conditions caused as a result of medical negligence. In this case, however, based on the time line and the allegations made, “any negligence on the part of the defendants did not proximately cause the complained-of damages.”

While the court would not recognize the child’s claim for wrongful life, it acknowledged a cause of action on the mother’s behalf for the costs to be incurred in raising a child with a disability (wrongful expenses rather than wrongful life). In order to prevail on such a claim, mom had to prove a duty owed, breach of that duty, and that the breach caused the injuries, i.e., she had to show medical negligence (malpractice) which deprived her of the opportunity to avoid incurring such expenses. Mom’s argument was that those expenses would have been avoided by an abortion. But even this argument had it limitations. According to the court, she had to show that the doctors denied her the opportunity to terminate her pregnancy “within the legally permissible time period or that the child would not have been conceived but for the defendants’ malpractice.” That, she could not do.

Nothing the doctors did caused the condition. No other tests would have changed the outcome. And the advice given was sufficient, particularly in light of New York’s Criminal Code. As the court observed:

It is undisputed that at the time of the April 21, 2004, ultrasound, the gestation period was 27 weeks and six days, plus or minus 18 days (i.e. at least 25 weeks). Pursuant to Penal Law § 125.05, it is unlawful for a physician, pregnant woman, or other person to terminate a pregnancy after the twenty-fourth week of gestation, unless necessary to preserve the life of the mother.

Given when the condition was discovered, how far along the pregnancy was and the proscriptions of New York’s abortion law, “any negligence by the defendants in connection with treatment, testing, or advice after the April 21, 2004 ultrasound cannot be said to have proximately caused the complained-of injuries, namely, the continuation of the pregnancy and birth of the child.” Movant’s did what they had to do. They did not have to send mom out of state for an abortion or even tell her late term abortions were available elsewhere. They are judged by the standard of care in New York where abortion was not an option this late in the pregnancy and doctors could not be faulted for failing to circumvent New York’s legislative constraints by sending mom elsewhere.

Sometimes life can be cruel and the negligence of others can cause grievous injury. Other times life can be cruel and mysterious: bad things just seem to happen. In the latter case, the courts are grossly inadequate to unravel the mystery and set things right. Perhaps the biblical writers of old said it best and offer the only solace available:

As you do not know the path of the wind,
or how the body is formed in a mother's womb,
so you cannot understand the work of God,
the Maker of all things.

Ecclesiastes 11:5

August 1, 2008

Medical Malpractice: A Peer in the Headlights

U.S. Court of Appeals for the Fifth Circuit: Lawrence R. Poliner, MD V. Texas Health Systems

For years there’s been a national debate about the impact of medical malpractice actions: Should damage awards be capped? Are lawsuits putting doctors out of business? Should juries even have the right to decide if a doctor committed malpractice? Or should doctors receive preferential treatment in our legal system so they can practice medicine without thinking about malpractice actions?

Freeing doctors from potential lawsuits might sound good in theory, but it raises some serious questions about how safe we would be as potential patients.

The Fifth Circuit had to deal with a variation on this question: Can Peer Review Committees (hospital committees made up of doctors who evaluate less-than-optimal care by other doctors at the hospital) be sued for money damages based on their findings? Dr. Poliner was reviewed by such a committee. His medical judgment treating a number of patients had been previously questioned and criticized. His treatment of “patient 36” caused a peer review committee to temporarily restrict his hospital privileges. That decision went down like Castor oil. Doctor Poliner sued the hospital for defamation, intentional infliction of emotional distress and various contract claims.

A trial jury sided with the aggrieved doctor. It awarded him over $200 million in damages. The verdict was subsequently reduced to $33 million by the judge. The Fifth Circuit Court Appeals reversed and ruled in favor of the defendants. It held that under federal law, peer reviewers had immunity and could not be sued by the doctor. More importantly, it found “That the ad hoc committee concluded that Poliner gave substandard care in half of the cases reviewed, and considering the seriousness of the diagnostic error with Patient 36... Defendants were fully warranted in concluding that failing to impose further temporary restrictions ‘may result’ in an imminent danger.”

Back to the first point: There’s been a lot of debate about malpractice cases. Now we know that hospitals have an absolute right to review their doctors and take action. Good. They should. Like the court said, robust peer review helps root out incompetent physicians, protects patients and prevents malpractice. But what about the cases they review when there's “substandard care” and they don’t take action against a doctor? The next patient may well be at serious risk, and someone other than the patient is willing to take it.

That unknowing patient at potential risk could be any of us. If we get injured (and medical mistakes can cause very big injuries), we don’t have the right to fire the doctor or restrict his practice. What we have is the right to bring a medical malpractice action. Take that away and we’re left to what peer reviewers do or don’t do when they’re confronted with substandard care by one of their own.

Sounds like a prescription for trouble.