As many as 700 women along the West Coast were not told that an institute financed by the insurance industry kept their placentas after giving birth in order to protect doctors and hospitals from potential lawsuits, according to a newspaper report.
Some learned about the Cascadia Placenta Registry only after they had filed lawsuits.
The Oregonian reported in its Sunday editions that Cascadia appears to be the only such organization nationally, and medical experts — including ethicist Arthur Caplan at the University of Pennsylvania School of Medicine — criticized Cascadia for failing to inform patients.
Legal experts, however, said there was no apparent violation of state or federal laws. The registry collected placentas from patients in Oregon, Washington and California.
Angela Desbiens, who is suing a Portland hospital, said she and her husband, Scott, were shocked when they learned about Cascadia.
“I feel so deceived,” Desbiens told The Oregonian. “You just assume the doctors and the hospital are going to do the right thing.”
She and her husband are among those caught up in the battle between doctors and lawyers who use placental exams as a legal weapon when parents go to court to assess blame for injuries or deaths at birth.
Hospitals, doctors and insurance companies have fought back to find ways to prove that problems often occur before labor and delivery.
Their defensive strategies arise from skyrocketing malpractice insurance rates that have driven some hospitals and obstetricians out of the business of delivering babies. Settlements or verdicts can reach millions of dollars in cases where injured children need a lifetime of round-the-clock care — including cases of brain damage due to lack of oxygen to the fetus.
“It’s a huge lottery,” said Dr. James Affleck, former chairman of NORCAL Mutual Insurance Co., a doctor-owned malpractice insurer from California and one of Cascadia’s primary underwriters.
“Errors are made, and families should be compensated,” he told The Oregonian.
But Affleck said in some cases it’s quite clear, such as cerebral palsy resulting from brain damage, the injuries are not due to malpractice.
“But you have such a sympathetic witness with the damaged child that emotional awards are made out of proportion to fault or the damage done,” he said.
Shortly before her baby was due, Angela Desbiens was told that excess amniotic fluid in the womb put her baby’s life at risk. A week later, she felt her fetus stop moving and made panicked calls and visits to her obstetrician’s office before she went to the hospital on her own. Although everyone assured her all was well, a doctor determined the fetus was in distress two days later and Desbiens underwent an emergency C-section to deliver her daughter at Providence St. Vincent Medical Center.
McKenna Desbiens, now 6, suffered a seizure shortly after birth, the first sign of a profound impairment that has left her unable to walk, talk or eat without a feeding tube.
Providence, meanwhile, prepared for a potential court fight. Within days, the hospital sent her placenta to Cascadia, where a pathologist analyzed the tissue and drafted a report contending that McKenna’s cerebral palsy was caused by blood flow problems, not improper care.
It wasn’t until Desbiens sued Providence, four years after the birth, that she first read the report and learned what had become of her placenta, the organ that transports blood, oxygen and nutrients to a fetus.
“I couldn’t believe it,” Desbiens said. “We were never asked. It’s such a violation of privacy.”
Desbiens was not alone. Placentas from as many as 700 women from hospitals throughout Oregon, California and Washington were sent to Cascadia from 1996 to 2003.
Several Oregon hospitals and their parent corporations helped finance Cascadia and sent placental materials there, including Providence Health System, Legacy Health System, Adventist Health, PeaceHealth, Kaiser Permanente Northwest and Good Shepherd Health Care System. Many of the women whose placentas were sent to Cascadia were unaware of the practice.
“It seemed very underhanded to me that the hospital was trying to protect itself and not the patient,” said Ann Morton, who discovered after she sued Sacred Heart Medical Center in Eugene, Ore., that her placenta had been studied by Cascadia. Her son, 31/2, has cerebral palsy; Cascadia’s report blames an infection, Morton said.
Lawrence Wobbrock, a Portland personal injury lawyer, said he’s looked at dozens of Cascadia’s reports over the years. “Not one of my clients ever saw the reports, and the doctors never told them about the reports,” Wobbrock said.
Officials at Providence and the other Oregon hospitals involved defended using Cascadia, saying the placental analyses were conducted for “patient care.” Consent forms signed by patients when they were admitted gave the hospital authority to perform any necessary pathological exams, the hospital officials said.
Although hospitals commonly conduct tissue examinations for patient care purposes, the fact that Cascadia was created and financed by malpractice insurers and providers sets it apart. Among doctors, lawyers, pathologists and medical experts contacted by The Oregonian, only one could cite a similar organization in Ohio that is now defunct, said Dr. Carolyn Salafia, a nationally known perinatal pathologist in New York.
Caplan, one of the country’s leading medical ethicists, said he had never heard of an institute that operated as Cascadia does.
He said it’s not enough to rely on a patient’s general consent when collecting tissues for purposes of a potential lawsuit.
“If you’re going to take things from patients — extract DNA or use them as potential sources of defense in litigation — subjects have an absolute right to know that and must consent or not,” Caplan said. “To have insurance companies collecting this stuff is very problematic.”
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