Monday, December 10, 2018

Dr. Suneet Chauhan’s Details on Vacuum-Assisted Delivery Help Clear Doctor in Med Mal Case

The Trial: Cantrell v. Moore, a Georgia medical malpractice case in which plaintiff claims a doctor negligently used a vacuum device during childbirth, ultimately injuring the child’s shoulder and leaving her without the use of her arm.

The Expert: Dr. Suneet Chauhan, a professor of obstetrics, gynecology, and reproductive health at the University of Texas McGovern Medical School, in Houston, details vacuum-assisted delivery and the nature of “pop-offs” in such deliveries, concluding the defendant met the standard of care while using the vacuum device.

The Verdict: For the defense.


 By Gary F. Gansar, MD, FACS; Senior Medical Director, AMFS

 

In a 2017 Georgia medical malpractice trial, Dr. Suneet Chauhan delivered convincing testimony that helped clear a physician accused of negligently delivering a child with a vacuum device.

A key allegation in the plaintiff’s claim was the argument that the defendant physician had breached the standard of care by violating an alleged two “pop-off” rule when using the vacuum device to deliver the child. Pop-offs occur when the device’s suction cup literally pops off of the baby’s head after it has been applied and extraction has begun. Plaintiffs argued that the defendant continued to use the device despite the fact that it had popped off the child’s head twice, which plaintiffs claim ultimately caused the child to suffer a brachial plexus injury so severe it left her without the use of her arm.  

In this clip, Chauhan, a professor of obstetrics and gynecology from the University of Texas McGovern Medical School, answers questions regarding pop-offs that can occur during a vacuum-assisted delivery.  Because pop-offs occur 30-50% of the time, they are not considered unusual. They are caused by a range of circumstances: baby hair that is wet, scalp molding that is uneven, birth canal tissue, narrow pelvic outlets, as well as from blood and fluids that are present during the delivery. Thus, the pop-off is unrelated to anything unusual with the obstetrician’s technique. Importantly, it is, in and of itself, not dangerous to the baby or mother because the device pops off the baby’s head before any damage can be done. This vacuum assist, Chauhan notes, is needed in about 3% of cases and is commonly available in delivery suites today.

By contrast, Chuahan explains, forceps, which can also be used in difficult vaginal deliveries, can injure a child because the instrument is metal and unyielding.

When the attorney brings up the “two pop-off rule,” Chauhan is unequivocal in his response. “I am not familiar with it, and the only place I have ever heard of this rule is in this case. I have never read it. I have not taught that, and I personally don’t practice that.”

The professor says that such a rule was never used in the institutions where he has trained and taught. Moreover, he is familiar with no peer-reviewed obstetrical literature or guidelines from the American College of Obstetricians and Gynecologists supporting the alleged two pop-off rule.

When the defense attorney asks about a vacuum device manufacturer’s package insert cautioning against continuing to use the device after two pop-offs, Chauhan seems to reject the warning. He explains there is no scientific evidence in the accumulated literature to back it up. Rather than a breach in the standard of care in the use of such devices, Chauhan believes that the defendant used appropriate clinical judgement to continue using the device despite two pop-offs.

In essence, he explains, the choice in this case was to continue using the device or give up the vaginal delivery after the second pop-off and deliver via Cesarean section. The defendant doctor decided to persist with the use of the vacuum device. And Chauhan tells jurors he backs the doctor’s “exceptional thinking,” since the baby’s head was already partially delivered and the conversion would require pushing the head back into the birth canal, a maneuver that causes brain damage in 30% of attempts. Indeed, the professor says he has never attempted such a dangerous manipulation. “The safest thing to do is complete the vaginal delivery as he did, and I commend him for that.”

He further states, “Vaginal delivery at this stage is much safer for the baby, for the mother, and for the future pregnancy of the mother.” The defendant met the standard of care in his delivery, Chauhan concludes.

Finally, Chauhan dispels any claim that pop-offs in and of themselves have anything to do with shoulder dystocia, and he tells jurors there is no established association between pop-offs by themselves and brachial plexus injuries.

The professor’s testimony proved to be critical for a defense verdict in this case.

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Gary Gansar, MD, is residency trained and Board Certified in General Surgery. He previously served as Chief of Surgery and Staff at Elmwood Medical Center and on the Medical Executive Committee at Mercy Hospital and Touro Infirmary in New Orleans, LA. Dr. Gansar also served as Clinical Instructor and Professor of Surgery at Tulane University. He received his MD and served as Chief Resident at Tulane University Medical School. Dr. Gansar joined AMFS as a consulting medical expert in 2011 and has served as Medical Director since Nov. 2015. In this capacity, Dr. Gansar provides consultation, review and guidance to attorney clients.