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MD allegedly drunk at delivery: $2.5M verdict
News: A pregnant woman was admitted to the hospital for the delivery of her child. The on-call physician for her obstetrical group arrived and ruptured the woman's membranes. Following this, the physician allegedly began consuming alcohol. At the time of delivery, the baby suffered a fractured humerus. The physician then performed an episiotomy on the patient. The baby's injury healed, but evidence showed that problems with his growth plate could be the cause of future complications. The mother continues to have sexual dysfunction and pain after urination. The total jury verdict against all defendants was in the amount of $2,535,600.
Background: At full term, a woman was admitted to the hospital for the birth of her baby. The on-call physician from her obstetrical group arrived at the hospital and ruptured the woman's membranes. Shortly thereafter, it was reported that the physician traveled to a nearby park and began consuming alcohol. When the baby was ready for delivery, the physician encountered shoulder dystocia. Despite the physician's manipulations, the baby suffered a fractured humerus. After delivery was complete, the physician began performing an episiotomy on the woman for fourth-degree lacerations to the perineum. After completing the procedure, the physician was witnessed to be sleeping on a nearby stool in the delivery room. The grandmother of the infant could smell alcohol on the physician and made a scene at the hospital, excitedly announcing that the physician was drunk.
The hospital brought in the physician who handles impaired practitioners, and the physician submitted to an alcohol test, which resulted in the equivalent of a .22 blood alcohol content. The hospital required the physician to surrender his privileges the next day and notified the Kentucky Board of Medicine. The child's arm ultimately healed, but other physicians believed that problems with his growth plate as a result of the delivery could result in future complications. Likewise, the mother had ongoing issues with sexual dysfunction and bowel movements. The plaintiff claimed that the physician had a habit of drinking 1/5 of vodka on a daily basis and that his impaired state contributed to the injuries described. The plaintiff also alleged that the hospital was responsible for the injuries, because the nurses failed to protect the plaintiff against the impaired physician. The plaintiff admitted evidence that the nurses knew of the physician's drinking problem three weeks prior to the delivery, but the hospital did not conduct a proper investigation and alleged that the hospital's policies for recognizing and reporting impaired practitioners were inadequate. The "investigation" consisted only of a discussion with the physician and a report to his employer.
The physician argued that he had been sober for 30 days prior to the day in question but later admitted to drinking and denied any recollection of the delivery. The physician argued that the injuries to the baby were a result of the shoulder dystocia and not the physician's actions. The hospital defended by stating that the nurses did not have prior knowledge of the physician's drinking problems and only became aware of it following the delivery and that the hospital conducted a thorough investigation following the delivery. The hospital was found by the jury to be at 20% fault for the plaintiff's injuries.
The mother was awarded $5,000 in lost wages and $1.5 million for pain and suffering. The child was awarded $300,000. On punitive damages, addressed only as to the physician, the jury awarded a total of $700,000.
What This Means to You: This case centers on the actions of an impaired physician. The patient presented to the hospital in labor for the delivery of her child and was met by her obstetrical group's on-call physician, who ruptured her membranes. While the patient labored, it is noted that the physician began consuming alcohol.
The baby was delivered, suffering a fractured humerus due to shoulder dystocia. This is an obstetrical emergency that, if not treated promptly, can result in fetal demise due to the compression of the umbilical cord in the birth canal. Shoulder dystocia occurs in about 1% of vaginal births. Following shoulder dystocia deliveries, 20% of babies will suffer some sort of injury, either temporary or permanent. The most common of these injuries are damage to the brachial plexus nerves, fractured clavicles, fractured humerus, contusions and lacerations, and birth asphyxia. A fractured humerus occurs in 4% of cases and heals rapidly.
The mother is also at risk when shoulder dystocia occurs. The most common complications are excessive blood loss and vaginal and/or vulvar lacerations. Such lacerations may involve the vaginal wall, cervix, extensions of episiotomies, or tears into the rectum.
Because of the pressure directed upward toward the bladder by the anterior shoulder in shoulder dystocia deliveries, post-partum bladder atony is frequently seen. Fortunately, it is almost always temporary. Occasionally, the mother's symphyseal joint may become separated or the lateral femoral cutaneous nerve damaged, most likely the result of overaggressive hyperflexion of the maternal legs during attempts at resolving the shoulder dystocia.
The literature does not definitively support an episiotomy unless it is necessary for the obstetrical maneuvers to deliver the fetus. It is therefore interesting that the physician performed an episiotomy on the woman after the delivery was complete. It appears she had already sustained a fourth-degree laceration and that an episiotomy would have been more appropriately performed at the time of delivery instead of after the completion of the delivery.
The case states that the woman's family noted alcohol on the physician's breath, and it would seem odd that the hospital staff did not identify this as well. It is not clear how and when the incident was reported; however, the alcohol level of .22 would lead one to believe that the hospital's administration and medical staff responded quickly to the incident. The hospital acted appropriately and reported the issue to the Kentucky Board of Medicine the following day.
The plaintiff presented evidence of habitual drinking and suggested that the nurses were aware of the physician's drinking three weeks prior to the delivery. It is alleged that the hospital did not conduct a proper investigation.
While the hospital and the medical staff may have been aware of previous instances of impairment, physicians are reluctant to report a colleague, because they do not want to do something that could end a colleague's career or have it backfire on them. Most physicians agree that if it meant that a patient could be injured or harmed in any way, they would report the impairment.
The AMA's Code of Medical Ethics is clear and states, "physicians have an ethical obligation to report impaired, incompetent, and unethical colleagues," and it lists several guidelines to follow. It recommends that before reporting an impaired physician to the state licensing board, physicians should first try to get the physician into a treatment program and/or to contact the hospital's chief of staff.
The reluctance to notifying state licensing boards is diminishing, as most boards will now refer impaired physicians who haven't injured patients to treatment programs without imposing sanctions on them. The problem is that it is often hard to spot impaired physicians before they harm patients. In academic hospitals, it is often difficult to hide an impairment. In a community hospital, it is far more difficult and much more identifiable.
In Kentucky, there is a physician recovery organization called the Kentucky Physicians Health Foundation. They have an Impaired Physicians program that originated in 1976 when the Kentucky Medical Association instituted the Impaired Physician Committee. The original committee performed on a voluntary basis as advocates for physicians who need help. In the 1980s, their focus was predominantly on helping physicians with alcohol and drug problems. The foundation continues today, and they currently monitor 125-160 physicians annually and average 40 new cases per year.
The Kentucky Board of Medical Licensure policy states that "if a licensed physician or hospital staff suspects that a physician is impaired-due to chronic alcoholism, chemical dependency, or physical/mental disability(ies)-such fact must be reported directly to the Kentucky Board of Medical Licensure within 10 days of obtaining direct knowledge of the impairment. Once the Board receives a report, they contact the physician and grant a 30-day grace period for the physician to contact the Impaired Physician Panel and to submit to an appropriate evaluation by the Foundation."
The verdict and award in this case appears appropriate. The physician knowingly took care of a patient while he was impaired. The delivery was a difficult one and involved an obstetrical emergency. While both patients survived, they may experience complications from the delivery for years.
Impaired physicians have been an issue for decades. Early identification and the reporting of impaired individuals can prevent potential death or serious harm to patients.
Kenton County (KY) Circuit Court, Case No. 06-2827.