Maternal Sepsis in Oregon Medical Malpractice Claims

When an infection after childbirth becomes an emergency

An infection during pregnancy, labor, or after delivery can become life-threatening. Doctors call this maternal sepsis. The World Health Organization defines maternal sepsis as "a life-threatening condition defined as organ dysfunction resulting from infection during pregnancy, childbirth, post-abortion, or postpartum period."¹

This article explains how certain infections can lead to sepsis, why timely recognition matters so much, and how a delay in care can become a medical-malpractice or wrongful-death claim under Oregon law. It is written for families trying to understand what happened, not to tell any one reader whether they have a claim.

Infections that can lead to sepsis

Chorioamnionitis, in the strictest sense, describes an "inflammatory or an infectious" disorder of the chorion, amnion, or both, which are the membranes that surround the baby. An expert workshop panel proposed replacing the term with "intrauterine inflammation or infection or both," abbreviated as "Triple I." Providers suspect it when a mother has a fever along with signs such as a fast fetal heart rate or a high white-blood-cell count. It can cause serious harm to the mother, including sepsis, endometritis, and, in rare cases, death.²

Endometritis is an infection of the lining of the uterus. It is the most common cause of fever after delivery. It is 5 to 20 times more common after a cesarean birth than after a vaginal birth.³

Retained products of conception are one of the birth events that StatPearls lists as "associated with increased risk of infection," along with others such as prolonged rupture of membranes, prolonged labor, and manual removal of the placenta.⁴

The warning signs of these infections overlap. In endomyometritis, one of the postpartum infections StatPearls reviews, "fever is often the first sign, with uterine tenderness and foul-smelling lochia as additional signs." Lochia is the vaginal discharge that normally follows birth; the warning sign is that it smells foul.⁵

Why timing is everything

Sepsis can move fast. The Centers for Disease Control and Prevention explains that sepsis is the body's extreme response to an infection and that, without timely treatment, it can rapidly lead to tissue damage, organ failure, and death; the CDC adds that detecting sepsis early and starting immediate treatment is often the difference between life and death.⁶

The same StatPearls review notes that "Normal physiologic changes in the postpartum patient may make it challenging to recognize sepsis in a recently-delivered patient promptly." It also states that "Delays in recognition and management contribute to poor outcomes, with a majority of sepsis-related deaths considered preventable."⁵

The standard of care in Oregon

Oregon law measures a physician's care against a professional standard. Under ORS 677.095(1), "A physician licensed to practice medicine or podiatry by the Oregon Medical Board has the duty to use that degree of care, skill and diligence that is used by ordinarily careful physicians in the same or similar circumstances in the community of the physician or a similar community."⁷

In a maternal-sepsis case, the questions can center on recognition and response. Did the care team notice the warning signs that a careful provider would have noticed? Did they act on those signs within a reasonable time? These are medical questions, and a qualified medical expert can compare what actually happened to what a careful provider would have done in the same situation.

How a delay becomes an Oregon claim

Not every infection is malpractice. A lawyer evaluating a maternal-sepsis case looks at two separate questions: whether the care fell short of the standard of care, and whether that shortfall made a difference to what happened to the mother.

Oregon also sets deadlines for these claims. Under ORS 12.110(4), an action for injuries "arising from any medical, surgical or dental treatment, omission or operation shall be commenced within two years from the date when the injury is first discovered or in the exercise of reasonable care should have been discovered." The statute adds an outer limit: "However, notwithstanding the provisions of ORS 12.160, every such action shall be commenced within five years from the date of the treatment, omission or operation upon which the action is based or, if there has been no action commenced within five years because of fraud, deceit or misleading representation, then within two years from the date such fraud, deceit or misleading representation is discovered or in the exercise of reasonable care should have been discovered."⁸

In Gaston v. Parsons, 318 Or 247 (1994), the Oregon Supreme Court held that "injury," as used in ORS 12.110(4), "consists of three elements: (1) harm; (2) causation; and (3) tortious conduct." The court held that the period "begins to run when the plaintiff knows or in the exercise of reasonable care should have known facts which would make a reasonable person aware of a substantial possibility that each of the three elements (harm, causation, and tortious conduct) exists."⁹

Claims against a public body, such as a publicly owned hospital, follow the Oregon Tort Claims Act instead. Under ORS 30.275(9), with limited exceptions and "notwithstanding any other provision of ORS chapter 12 or other statute providing a limitation on the commencement of an action," such an action "shall be commenced within two years after the alleged loss or injury." The Act also has its own notice requirements.¹⁰

When negligent care causes a mother's death, the claim is brought as a wrongful-death action. ORS 30.020(1) applies "When the death of a person is caused by the wrongful act or omission of another," and the personal representative of the person who died may bring the action for the benefit of the surviving family. The statute provides: "The action shall be commenced within three years after the injury causing the death of the decedent is discovered or reasonably should have been discovered by the decedent, by the personal representative or by a person for whose benefit the action may be brought under this section if that person is not the wrongdoer. In no case may an action be commenced later than the earliest of: (a) Three years after the death of the decedent; or (b) The longest of any other period for commencing an action under a statute of ultimate repose that applies to the act or omission causing the injury, including but not limited to the statutes of ultimate repose provided for in ORS 12.110 (4), 12.115, … and 30.905."¹¹ Because the five-year limit in ORS 12.110(4) runs from the date of the treatment or omission, not from the death, the outer deadline in a case involving medical care can fall earlier than three years after the death.

These cases turn on their own facts. Families who want to understand whether a delay in care played a role can speak with an Oregon medical-malpractice attorney, who can arrange for the medical records to be reviewed by a qualified medical expert.

This article is educational

This article describes Oregon law in general terms. It is not legal advice and does not create an attorney-client relationship.

Time limits matter. Most Oregon personal-injury and auto-accident claims must be filed within two years of the injury or accident. Medical malpractice claims must be filed within two years of when you knew or reasonably should have known of the negligence, with an outer limit of five years from the act itself (with a fraud exception). Wrongful death claims must be filed within three years of the date of death. Claims against public bodies (cities, counties, state agencies, public hospitals) require a notice of claim within 180 days. Missing these deadlines typically ends a case.

If you think you may have a claim, call Huegli Law at 971-317-6436 for a free case review. Todd Huegli is licensed in Oregon and consults on cases in Oregon only.

Footnotes

1. WHO Statement on Maternal Sepsis — Global Sepsis Alliance. https://globalsepsisalliance.org/news/2018/1/9/who-statement-on-maternal-sepsis ↩

2. Evaluation and Management of Women and Newborns With a Maternal Diagnosis of Chorioamnionitis: Summary of a Workshop (NIH/PMC). https://pmc.ncbi.nlm.nih.gov/articles/PMC4764452/ ↩

3. Endometritis — StatPearls, NCBI Bookshelf (NIH). https://www.ncbi.nlm.nih.gov/books/NBK553124/ ↩

4. Postpartum Infection — StatPearls, NCBI Bookshelf (NIH). https://www.ncbi.nlm.nih.gov/books/NBK560804/ ↩

5. Postpartum Infection — StatPearls, NCBI Bookshelf (NIH). https://www.ncbi.nlm.nih.gov/books/NBK560804/ ↩ ↩²

6. CDC Urges Early Recognition, Prompt Treatment of Sepsis. https://archive.cdc.gov/www_cdc_gov/media/releases/2017/p0831-sepsis-recognition-treatment.html ↩

7. ORS 677.095 — Duty of care (ORS chapter 677). https://www.oregonlegislature.gov/bills_laws/ors/ors677.html ↩

8. ORS 12.110 — Actions for certain injuries to person not arising on contract (ORS chapter 12). https://www.oregonlegislature.gov/bills_laws/ors/ors012.html ↩

9. Gaston v. Parsons, 318 Or 247 (1994) (Caselaw Access Project). https://static.case.law/or/318/cases/0247-01.json ↩

10. ORS 30.275 — Notice of claim (ORS chapter 30). https://www.oregonlegislature.gov/bills_laws/ors/ors030.html ↩

11. ORS 30.020 — Action for wrongful death (ORS chapter 30). https://www.oregonlegislature.gov/bills_laws/ors/ors030.html ↩