Medical-legal concerns of providing high risk neonatal care in an HMO.

Prepaid health plans have particular vulnerability to perinatal malpractice litigation because of the presumed influence of cost containment systems on medical decision making. Risk management responsibility by HMOs, individual physicians, and hospitals may limit malpractice litigation. Common areas of perinatal malpractice suits include cases involving perinatal asphyxia, prematurity, failure to diagnose, and iatrogenic injuries. Defensive strategies to deter litigation in brain-damaged infants include the use of standard forms, good documentation, the appropriate use of Apgar scoring and cord blood gases, and full evaluation of low Apgar score babies in the neonatal period. Conscientious physicians and HMOs should be able to avoid malpractice suits by understanding the legal system and developing good communication and documentation skills.