Sunday, October 28, 2007

For Malpractice suits try a fetal heart rate monitor

Long WSJ article about obstetricians, fetal heart rate monitors, rates of Cesarean section, and malpractice suits. It brought back memories. Twenty years ago I designed a fetal heart rate monitor. It is an electronic instrument that is now mandatory during birth and delivery. It creates a paper graph displaying the fetal heart rate in beats per minute. Normal fetal heart rate is around 140 beats per minute, and it varies up and down during birth. A prolonged drop in fetal heart rate is a bad sign (“fetal distress”). If the fetal heart rate remains low, most obstetricians will opt for a Cesarean section. As you might expect rates of Cesarean section have jumped from 7% in the 1970’s (before the instrument was in widespread use) to 25% today (where every birth and delivery room has one).

It would be nice to conclude that high technology and skillful surgery have improved the quality of life. Unfortunately that happens not to be the case. No one can point to an improvement in the infant mortality rate. The same percentage of babies die today as they did before the fetal heart rate monitor was invented. Thousands of monitors at $10,000 each and a million more Cesarean sections a year have not improved a baby’s chances of survival to age one. The obvious conclusion is that many of the Cesarean sections are unnecessary.

Malpractice suits are driving this trend. Of all the medical specialists, obstetricians are the most likely to be sued. If they don’t use the fetal heart rate monitor, that’s grounds for a suit. If they don’t call for a Cesarean section after the monitor shows fetal distress, they get sued. In fact, whenever anything goes wrong, they get sued, in which case the fetal heart monitor paper chart goes to court and experts interpret the traces for the jury. The defendant’s lawyer will summon experts to testify that the obstetrician did every thing right; the plaintiff’s lawyer will summon experts to show the opposite.

In short, a technological advance has managed to raise costs without improving anything.

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