Malpractice Claims Cite Doctor’s Use of Forceps to Speed Delivery

The birth and brief life of Diana Perkins has focused attention on the use of forceps in the delivery room, a practice that can save a baby’s life--or end it.

New York state officials have found Dr. Ronald Loffredo, an obstetrician here, to have been negligent in nine of 12 deliveries, including Diana’s, over three years. In each case, forceps were used.

Loffredo and his attorney are preparing to fight damage claims brought by Diana’s parents, the only family to sue.

Diana was born May 20, 1986. She died three days later.

Loffredo was accused of failing to determine that she was too large for vaginal delivery, and thus neglecting to perform a Cesarean section. He also was found negligent for not having assessed the baby’s position before he used forceps, for administering a uterine stimulant “in a potentially obstructed labor,” for using excessive force in the delivery and causing unnecessary trauma to both mother and child.

Loffredo no longer practices at Saratoga Hospital, and the state Board of Regents, which oversees medical practice, in July suspended his license for one year. Once the suspension runs out, Loffredo will remain barred from delivering babies or performing gynecological surgery until he has completed a retraining program.

In the fall of 1988, his admissions privileges at Saratoga Hospital were revoked after a 28-year-old woman under his care died just days after giving birth to a healthy baby.

Loffredo still has support among his longtime patients, some of whom picketed the hospital and have raised about $50,000 for his legal expenses.

“This has been ruinous, absolutely ruinous!” Loffredo said in an interview.

He defended his actions in the Perkins case and criticized Saratoga Hospital as having allowed itself to be goaded by the state Health Department. Loffredo said the hospital exonerated him after conducting its own investigation of the Perkins case, but state health officials later forced a review of its findings.

“None of the cases was brought about by patient complaints,” said Loffredo, who is suing the Health Department and Saratoga Hospital.

“This process is being driven by a bureaucracy,” his attorney, Frederick Killeen, said.

Use of obstetrical forceps, which date to 18th-Century Europe, has long been questioned. The instrument, which resembles hinged salad tongs, is used to speed up delivery if the mother’s life is in danger or if the umbilical cord is wrapped around the fetus’s neck. Forceps also are used to rotate the baby if it is turned away from the normal birth position.

The shallow steel or aluminum blades fit the contours of the baby’s head and the birth canal, but even in highly skilled hands forceps can cause permanent injury to mother and child, experts acknowledge. Forceps can leave permanent indentations on the skull, as well as cuts and bruises on the infant’s face, ears and scalp.

When actor Sylvester Stallone was born, forceps severed a nerve on the left side of his face, causing a slur in his speech.

Loffredo’s use of forceps allegedly left bruises on Diana Perkins’ neck and one earlobe. Loffredo, a soft-spoken man who built his practice in Saratoga Springs after training in forceps at Rochester General Hospital, said the baby suffered “minor scrapes” but was not traumatized.

According to a 1980 survey by the National Center for Health Statistics in Baltimore, forceps were used in 17.4%, or 625,000, of 3.6 million live births. No accurate records were kept before that, said Ken Keppel, spokesman for the agency.

The use of forceps has declined dramatically in most areas of the country, partly because of high medical malpractice premiums, said Dr. Maurice Drusin, director of obstetrics at New York Hospital-Cornell Medical Center.

“It’s been linked to all kinds of problems which have nothing to do with forceps at all,” said Drusin, who is expert in high-risk deliveries.

Loffredo, 40, estimated that he used forceps in 25% to 35% of about 1,500 births he assisted during his 10 years as an obstetrician.

David Stewart, executive director of the National Assn. of Parents and Professionals for Safe Alternatives in Childbirth, said that some doctors don’t have the patience to wait out lengthy labors.

“We’re not against any kind of technology when it’s used appropriately and for a good cause. Our organization objects when it becomes routine,” he said.

“Doctors are not trained to handle normal birth,” he said. “Forceps is a piece of the whole pathological orientation doctors have.

“A good midwife has alternative ways to handle a difficult birth. A good midwife never uses forceps.”

Stewart and his Missouri-based organization say that 90% of the obstetricians in the United States should be replaced with midwives.

Kate Ruddon of the American College of Obstetricians and Gynecologists in Washington, D.C., called the suggestion that obstetricians are impatient and use forceps to speed up deliveries “utterly absurd.”

“The data on infant mortality speaks for itself,” Ruddon said. She cited statistics showing that the U.S. infant mortality rate has declined, to 9.9 deaths per 1,000 live births in 1987 from 47 in 1940.

In February, a West Virginia jury awarded $15.25 million to a couple who claimed that their obstetrician should have performed a Cesarean section to prevent brain damage to their child and instead used forceps, which caused a brain hemorrhage.

In Anaheim, Calif., Dr. Charles Wesley Turner Jr. came under scrutiny for using forceps to hasten the delivery of a girl so that she could be on nationwide television as perhaps the first baby of the year in the region.

A healthy Myra Kristine Palmer (6 pounds, 12 ounces) was delivered seconds after midnight, quickly cleaned, wrapped in a blanket, stuffed into a Christmas stocking and rushed to a religious service being televised in a studio next door.

“We had the mother push at 11:59,” Turner said. “I put the forceps on and pulled the infant out. We had her at 15 seconds after midnight.

“I used the forceps because I wanted to have the first baby of the new year,” Turner said.

The California attorney general’s office filed charges of gross negligence and incompetence against Turner on Aug. 6. Prosecutors say his license should be suspended or revoked.

Both the doctor and Myra’s father, Gary Palmer, insist that Brigitte Palmer went into labor prematurely and was sufficiently dilated to begin delivery.

“There was nothing done that was wrong in this case,” he said. Turner, 64, said he used forceps in more than 5,000 of about 18,000 deliveries he has performed in 43 years.

Palmer, 27, whose wife and daughter have had no complications since the birth, said he trusts Turner, who also delivered Palmer’s first daughter.

“He’s doing his best,” Palmer said. “I’d go to him for anything, from the common cold to major surgery.”