A maternal death is an extraordinary tragedy. Until recently, it was all too common. In 1900, almost 1% of pregnant women died in and around childbirth. The advent of modern obstetrics has dropped the maternal mortality rate by 99% since then, so most people have no direct acquaintance with a woman who died in childbirth.
Most maternal deaths are due to serious complications of pregnancy, or serious underlying medical problems, such as heart disease, that are exacerbated by pregnancy. Like any obstetrician, I’ve been involved with several maternal deaths, though never as the primary physician. Each one has been a searing experience, but in retrospect, an unavoidable event.
All but one, that is.
The patient died because of a series of unfortunate anesthetic complications, compounded by inadequate medical response. I cannot tell you when, where or how, since the case is so unusual that any details might lead to identification and compromise of privacy.
Because maternal deaths are now so rare, my state, like most states, mandates an official investigation. The investigation is conducted by the hospital, and evaluated by the Department of Health. As a participant at a critical juncture in this woman’s care, I was interviewed extensively by a senior member of the obstetrics department and a member of the hospital administration.
I was very angry at the care the patient received from the anesthesiologists, because I believed that her death had been entirely avoidable. I did not hide my anger during the interview, going to so far as to say that I felt that the anesthesiologists had essentially killed the patient. The people who interviewed me seemed uncomfortable with my conclusions and with my anger. They repeatedly suggested alternative explanations for the unfortunate incident, but I was not swayed. Others might reach different conclusions, I acknowledged, but this was my conclusion.
Several years later I was contacted by my medical malpractice insurance carrier and advised that a malpractice case had been filed against the anesthesiologists. This was not surprising. Virtually every maternal death is followed by a malpractice suit, even when the death was unavoidable. As a participant in the patient’s care, I would be deposed by the patient’s lawyer. Consistent with its obligations, the malpractice insurer had hired a lawyer to defend me during the deposition.
Shortly thereafter, I heard from the lawyer’s office. The deposition was scheduled in several weeks, and I was given an appointment with the attorney for “deposition preparation” a few days in advance of the deposition itself.
At our meeting, the lawyer seemed both competent and affable. First, he wanted to hear the story directly from me, in as much detail as I could recall. I carefully recounted the events of that day. When I finished, the attorney was frowning.
“Do you realize,” he asked, “that your recollection is very different then the testimony you submitted at the time?”
“No, it isn’t,” I replied. “It’s exactly the same story.”
“Well,” he continued, waiving a sheaf of papers, “I have your testimony right here, and that’s not what you said.”
I was stunned. I knew that was exactly what I had told the interviewers. If anything, I had been much harsher back then, because I was closer to the event and very angry about what had happened.
I held my hand out for the papers, and re-read my testimony. By the time I finished, I must have been ashen.
“This is not what I said! This is nothing like what I said.”
The lawyer was dubious.
“No one is going to believe that,” he warned. “Unless you have proof, it’s as if it never happened.”
On the day of the deposition, we met in a conference room where the patient’s lawyer, the anesthesiologists’ lawyers, the hospital lawyer and the court stenographer were waiting. Everyone seemed friendly and relaxed. This was just a small, routine part of the case. I was only one of a dozen doctors they planned to depose, and not even a subject of the lawsuit.
I had been told to plan for a deposition that was several hours in length, but it didn’t take nearly that long. After recounting my memories of the day in question, I was met with the inevitable accusation.
“But that’s not what you said when you testified for the official investigation,” the patient’s lawyer said sharply, holding up the official report.
“Actually,” I replied, “that is what I said. The report you are holding is not my testimony.”
Every lawyer in the room was now alert. The deposition was not longer the routine task they had expected.
The patient’s lawyer looked very eager.
“Do you have proof?” he demanded.
“Yes, I do have proof,” I replied.
My husband is a lawyer, and he makes me keep everything I have ever signed. Shortly after the official interview, the interviewers had sent me a transcript of my testimony, beneath which was a place to sign acknowledging that this was a true representation of what I had said. My husband had insisted that I make a photocopy for my records before I sent it back.
After my meeting with my lawyer, I had gone home and dug it out from the bulging file cabinet. I had given the photocopy to my lawyer before we entered the conference room, and now he produced it and handed it to the patient’s lawyer.
Despite the somber nature of the proceedings, the patient’s lawyer looked gleeful. The lawyers for the anesthesiologists and hospital looked shell shocked. The lawyers handed my photocopy around. Not only did it have my signature at the bottom, but it also had the signatures of the senior department member, and the hospital administrator who had interviewed me. The document that the hospital had represented as my testimony had no signatures at all.
The patient’s lawyer was so happy, that it took several minutes for him to pull himself together and continue the deposition. The rest of the questions focused on my original testimony and my discovery that the testimony in the hospital report had been altered.
If I had been angry about what happened to the patient, I was even angrier after learning of the deception. The hospital had deliberately lied to protect its staff members. They lied to cover up medical negligence, with the assumption that the doctors in question would continue to practice at the same hospital, free to make similar mistakes.
The hospital had been remarkably foolish. In a malpractice case, an attempt to alter the record is practically an admission of guilt. There was no limit to the millions of dollars that a jury would be willing to award in a case of avoidable death of a young mother where the hospital had attempted to hide the truth. The lawyers for the anesthesiologists and the hospital knew this, too.
My lawyer called me several days later.
“There isn’t going to be a trial,” he said. “The hospital offered the patient’s family an 8-figure settlement, and they have accepted.”
