Although neonatal care has seen remarkable improvements, including better quality of care, medical malpractice in neonatology is still of concern. Common areas of malpractice include the delivery room, jaundice, hypoglycaemia, and late preterm infants.

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In their article “The most common patient safety issues resulting in legal action against neonatologists” Fanaroff and Goldsmith outline frequent errors by healthcare professionals that may result in medical malpractice lawsuits and how these could be prevented. Filing lawsuits is a means to obtain compensation for medical injuries of the parents’ newborn; however, these are oftentimes expensive and lengthy. While the article focuses on the US context, it provides interesting insights into medical malpractice in neonatology and how to approach it.

A survey by the American Academy of Paediatrics in 2017 suggested that 21% of paediatricians were involved in at least one medical malpractice lawsuit. Even though the number has been 12 percentage points higher at its peak in 1990, there still remains space for improvement.

Common malpractice lawsuits in neonatology involve delivery room management and resuscitation (e.g. delay in resuscitation), neonatal jaundice and hypoxic-ischemic encephalopathy (e.g. failure to recognize risk factors and initiate therapy), late preterm infants (e.g. not being treated as preterm, early discharge and lack of follow-up care) as well as patient safety (e.g. lack of communication, medication errors).

To minimize the risk of malpractice, the authors recommend a number of strategies including developing and maintaining competence through continuing education (e.g. attending conferences, reading relevant literature and textbooks) and following national guidelines. Furthermore, it is suggested to take documentation of medical procedures seriously, especially given that lawsuits are often filed years later. Moreover, detailed communication with both parents and healthcare team members is important to ensure the safest possible care. In case of a medical error, honest disclosure is preferred by families and patients and can ultimately lower the likelihood that patients seek legal action. Therefore, healthcare organisations have started to adopt ‘communication and resolution’ programs to talk about adverse events with parents and overcome the habit of silence of previous years.

Fanaroff and Goldsmith state that errors are mostly due to multiple issues of the hospitals system. Therefore, the blame for medical errors should not be put on the healthcare personnel but on the breach in the system. This increases the likelihood for staff to come forward and be honest about mistakes, which in turn improves the ability of hospitals to integrate better safety measures and prevent future malpractice.

In conclusion, there have been many improvements in neonatology over the past years, but multiple malpractice risks remain. Improved safety systems in hospitals, staying up to date with latest developments in neonatal practice and effective communication are some of the ways to prevent malpractice and possible following lawsuits.

Read the full article here: PubMed.

Full list of authors: Jonathan M. Fanaroff, Jay P. Goldsmith

DIO: 10.1053/j.semperi.2019.08.010