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Book Review   |    
Damages: One Family's Legal Struggles in the World of Medicine
Sara C. Charles, M.D.
Psychiatric Services 1998; doi:
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by Barry Werth; New York City, Simon & Schuster, 400 pages, 1998, $25

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On February 25, 1983, Donna Fitzgerald drove to a coffee shop on Interstate 95 near Washington, D.C., to join a 27-year-old trucker, Tony Sabia, whom she had met some minutes earlier on her CB radio and whom she would soon marry. Thus begins the tale of an American tragedy that features a brain-injured surviving twin; parents overwhelmed by circumstances beyond the scope of most; an obstetrician-gynecologist sued for attending a mother she had never before seen; a hospital, insurance companies, mediators, and experts, each with their own interests; and a bevy of lawyers who come and go for almost a decade. It is a sad but gripping story repeated in myriad variations throughout our country. No one, however, has previously written the human story—and the stage on which the players perform—with such sensitivity, detail, and evenness.

On April 1, 1984, the now Donna Sabia went into labor. She had been followed at the Norwalk (Conn.) Hospital clinic alternately by nurse-midwives and obstetricians. Dr. Maryellen Humes, who was on call that weekend and had never seen Donna, was awakened and informed by nurse-midwife Barbara McManamy that Donna's labor was progressing and that one twin was breech. After a storm of activity, the first baby, delivered by Barbara McManamy, overseen by Dr. Humes, was surprisingly limp, with an Apgar score of 1. As it was too late to do a caesarean, Dr. Humes quickly delivered the second twin, who was dead and already showing macerated skin. The surviving infant, Tony, eventually was found to have seizures, blindness, microcephaly, mental retardation, and feeding problems, and he required total care.

Almost three years later, a lawsuit was filed in Bridgeport Superior Court containing eight pages of allegations against Norwalk Hospital, "its servants, agents, and employees," and Dr. Maryellen Humes.

Barry Werth, a journalist and successful author, traces the progress of the case meticulously, using real names. He interviewed most of the participants, and he explored the thoughts they had about the experience at the time and in retrospect. For example, after Dr. Humes' insurer settled the suit against her out of court for $1.3 million, Michael Koskoff, the plaintiff's lead attorney, observed that "she wasn't responsible for the injury," that it occurred "through no fault of her own." He did not want Dr. Humes to evoke sympathy among the jurors, and he felt that with her out, the case was "cleaner" and had a more unified focus. Because the emphasis had shifted to the hospital's prenatal care, "she'd just have been in the way." Dr. Humes herself described the litigation as "the most difficult experience of my life."

Anyone who has any affiliation with the health care system—practitioners and policy makers as well—should read Damages. It is an accurate, engrossing, and, unfortunately, true story of what can happen when unforeseen events occur. Few books have described as well the inefficiency, self-interest, and plain tragedy that the current malpractice system, which requires an accusation of fault, supports. It is the best argument yet for devising some other system for compensating negative events that occur in the health care sector.

Dr. Charles is professor of psychiatry (emerita) at the University of Illinois at Chicago.

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