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Training, Disclosures Are Key to Lowering Ultrasound Legal Risks


 

KAILUA KONA, HAWAII — Clinicians who offer fetal ultrasounds in their offices should ensure that those performing the scans are properly trained and that they explain to patients the limitations of the technology, to reduce the risk of being sued over ultrasound results, several speakers said at a conference on obstetrics, gynecology, perinatal medicine, neonatology, and the law.

In recent years, sonographers and ultrasound technicians who used to work exclusively for radiologists have been hired by some obstetricians to do ultrasounds in their offices. Many malpractice suits arising from misinterpretation or mismanagement of fetal ultrasound derive from inadequate staffing, training, and education, said Kimberly D. Baker, J.D.

She said too many clinicians want to have a fully equipped office technologically but are unwilling to pay for the education and training needed to maximize use of the technology. Turf wars make it more common for radiologists and other experts to criticize obstetricians or general practitioners whose use of ultrasound contributes to a legal case, said Ms. Baker, a defense lawyer in Seattle who also holds a BS degree in nursing.

“If you are going to have someone in your office who does this, you need to make sure that they are adequately trained, that their status is updated, that they are educated, and that you have a quality review process for your staff,” she advised.

Dr. Dolores H. Pretorius noted during a question-and-answer session that the American Institute of Ultrasound in Medicine offers a voluntary set of credentialing mechanisms for physicians who perform ultrasound. “I think it is helpful to have that to defend yourself,” said Dr. Pretorius, professor of radiology and director of imaging at the University of California, San Diego.

The expertise of the sonographer is especially important with multifetal pregnancies, Dr. Michael A. Belfort said in a separate presentation. “It's not easy to scan twins and exponentially more difficult with triplets” or quadruplets. I can't understand why some doctors, without specific experience in managing high-order multiples, will choose to follow quadruplets in their office with a small, low-tech ultrasound machine and no consultation with a maternal and fetal medicine specialist. I just don't think it's worth the risk,” said Dr. Belfort, professor of obstetrics and gynecology at the University of Utah, Salt Lake City.

In particular, when scanning multifetal pregnancies, it's important to get an early and accurate estimation of gestational age, determine amnionicity and chorionicity, and advise the patient of their implications.

Later in a twin pregnancy, one should consider following cervical length by ultrasound, because a woman with a cervix shorter than 25 mm at 24 weeks is more likely to deliver before 32–37 weeks than a woman with a longer cervix, Dr. Belfort advised. And definitely consider following cervical length in higher-order multiples. An anatomic survey by a maternal-fetal medicine specialist is also advisable. It's easy to miss an anomaly or scan the same fetus or parts of the fetus three times and think all three triplets are normal, he said.

One should reduce one's legal risk by explaining the benefits and the limitations of ultrasound to patients, Ms. Baker said at the meeting, sponsored by Boston University. Document in the chart that you explained the technology's limitations as they apply to the particular patient instead of relying on one-size-fits-all consent forms, she advised.

Document that you explained the technology's limitations as they apply to the particular patient. MS. BAKER

A short cervix, such as this one, in a woman with a multifetal pregnancy connotes a higher risk for preterm delivery, which ultrasound could detect early on. Courtesy Dr. Michael A. Belfort

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