Epidural Complication During Chilbirth

[Nehemiah]

I am meeting with a potential client who has a complaint against her obstetrician.  A mid-20's woman went to her local hospital in labor.  The hospital apparently only had one anesthesiologist on duty.  The OB performed an epidural for a vaginal delivery and the patient has had persistent back pain ever since.  She has seen a neurologist and an MRI has been taken.  Her neurologist told her she has arachnoiditis as a result of the epidural. Do you know if OB's are permitted to do epidurals under ACOG guidelines or by general standard of care considerations? My state presumptively applies the national standard of care.

Through an internet search I found a 2000 British study on outcomes from obstetrician-administered epidurals which found no serious complications.  It was a retrospective study looking at procedures done 1992-1995(a little over 1500 cases.)

I've worked on several OB malpractice cases and I have never seen anyone other than anesthesiologists or CRNA's insert the epidurals, but perhaps it's a turf issue rather than a qualification issue.  

I'll probably meet her before you can answer this but are there particular issues you think I should look for, either in talking with her or in reviewing her medical records when they arrive?

[Thawain]

Sounds like you have more experience than I do but my comments are as follows: I don't know if an ob/gyn is qualified to deliver the epidural.  I presume that they are on a legal basis at least. Technically and ob/gyn, being an MD, legally could perform brain surgery for that matter.
is whether the standard of care was breached. Also, you have the question of whether arachnoiditis is evidence of negligence or an unavoidable risk of the procedure.  Next, is persistent back pain going to be high enough in terms of damages to pursue the case? It will be defended all the way and cost lots of money to prosecute which leads to the #1 comment: What will an ob/gyn and an anesthesiologist have to say about this. If this lady came to me I would tell her if she wanted to pay for the outside expert evaluation to see if the standard was breached, I would go that far. But not further. And that is the only thing I would want to discuss with her. Otherwise, forget it. No future in such a case in my opinion.

My knowledge of arachnoiditis may be limited but I have encountered it before and and know that it can be nasty and permanent and results from epidural bleeding.  There was also a mass tort case going involving I believe a product called pantopaque, a contrast material used for spinal MRIs and many of those patients developed the disease.  But I think you should give my "knowledge" some credence on these points: You will not find that gyns are prohibited from doing their own epidurals and certainly in this case where no specialist was available and the woman is going into labor, you do what you have to do. No jury is going to get angry and the gyn for that and the gyn himself will be outraged and never give consent to settlement so(and I am speaking for myself of course.....you may disagree)....but unless you are prepared to go all the way, no point in  going anywhere with it. You would still have to have expert evidence  that the gyn performed the epidural negligently and this is tough because this is not a rare situation.......it just happens even in the best of  hands.......that is my understanding.  If the woman suffered paralysis then the damages would be high enough to at least search for an expert and if one is found, pay for the review. But chronic pain as bad as that may be would not be sufficient in my opinion to make the case economically viable. But I wish you luck.....and the client as well.