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Q: Is malpractice insurance for homebirth midwives standard and what is a reasonable transfer rate? - Page 5

post #81 of 104
Quote:
Originally Posted by Imakcerka View Post

I think so brood, my main concern is that if an accident happens it's not because of negligence.  It's not because of a lack of knowledge.  Life happens and no you cannot ensure that everything will be perfect.  But don't go into with "whatever happens happens" attitude.

 

And Joycnm, you're the one disrespecting people here.  Those women are easy prey the way you describe them.  A quick paycheck and nothing more.  They deserve better.  While there is an element of trust in god involved, "man" is also involved and even Gods know man can f things up. 

That is not how JoyCNM describes them at all :/  You and Buzzbuzz are just out for a lynching of anyone you don't agree with.  Joy CPM never gave me the impression that she was after a quick paycheck and nothing more...  If ya'll want mandates so freaking bad- it seems like the UK would be the place for you to go to...  When women acknowledge that sometimes things happen it doesn't mean that they don't care- it means that they are realistic.  

post #82 of 104

No iowa, that is not the case.

post #83 of 104

In my many years of hiring homebirth midwives in California, NONE of them carried malpractice insurance. The cost is exorbitant. Around $250,000, all up front. That said, this means that the midwives are taking the bigger risk by practicing, even with an arbitration agreement in place. If you prove malpractice and the midwife is ordered to pay you financial compensation, they go after everything she owns: home, car, cash, everything.
 

post #84 of 104

Well, what you do is title your assets in someone else's name, right?  I wonder how many CPMs' names are actually on the deed to their homes, titles to their cars and on bank accounts. 

 

Also, I believe many CPMs count on being uncollectible.  In other words, most parents cannot afford lawyers' fees upfront and are instead providing their lawyer with a percentage of their judgment.  Costs of litigation being what they are, without malpractice insurance many lawyers will not be interested in pursuing the suit since the money actually received will not cover their costs.

post #85 of 104
Quote:
Originally Posted by Buzzbuzz View Post

Well, what you do is title your assets in someone else's name, right?  I wonder how many CPMs' names are actually on the deed to their homes, titles to their cars and on bank accounts. 

 

Also, I believe many CPMs count on being uncollectible.  In other words, most parents cannot afford lawyers' fees upfront and are instead providing their lawyer with a percentage of their judgment.  Costs of litigation being what they are, without malpractice insurance many lawyers will not be interested in pursuing the suit since the money actually received will not cover their costs.


I don't think most CPMs are "counting on" being uncollectible..I think most CPMs wish malpractice insurance were a feasible option for them, but since for many it is not, they "count on" their passion for the craft, knowledge base/education and commitment to continued education and are hopeful that they can avoid a situation where they find themselves being sued for malpractice.

post #86 of 104
Quote:
Originally Posted by Thyme Mama View Post

In my many years of hiring homebirth midwives in California, NONE of them carried malpractice insurance. The cost is exorbitant. Around $250,000, all up front. That said, this means that the midwives are taking the bigger risk by practicing, even with an arbitration agreement in place. If you prove malpractice and the midwife is ordered to pay you financial compensation, they go after everything she owns: home, car, cash, everything.
 

That's pretty much what would happen and has happened to an IM in the UK who was found guilty of malpractice.

Quote:
Originally Posted by Buzzbuzz View Post

Well, what you do is title your assets in someone else's name, right?  I wonder how many CPMs' names are actually on the deed to their homes, titles to their cars and on bank accounts. 

 

Also, I believe many CPMs count on being uncollectible.  In other words, most parents cannot afford lawyers' fees upfront and are instead providing their lawyer with a percentage of their judgment.  Costs of litigation being what they are, without malpractice insurance many lawyers will not be interested in pursuing the suit since the money actually received will not cover their costs.

My IM's name is on her mortgage, hers is the only name on the family car.  I'm shocked given the sums people actually pay CPM's that you think these women are doing it out of greed and practice slyly to remain unaccountable!  Obviously we're at odds with this conversation because there is no "CPM" in the UK, to practice here you have to have the same education, whether independent or NHS, there are no distance courses or apprentice deals.  A midwife is a midwife.  All the midwives here are equally thoroughly qualified.  Selecting a MW here is therefore much safer.  Which is ironic when you consider you get to keep yours and we're going to lose ours.

post #87 of 104

heres where I differ on this one.  MW's who are practicing need better financial back up.  Having everything taken away from them because someone goes after them in court is not fair.  While they have to prove negligence I doubt it's going to be that hard to do even if there was none. 

 

I stated before, there should be protections for both. 

post #88 of 104
Quote:
Originally Posted by Thyme Mama View Post

In my many years of hiring homebirth midwives in California, NONE of them carried malpractice insurance. The cost is exorbitant. Around $250,000, all up front. That said, this means that the midwives are taking the bigger risk by practicing, even with an arbitration agreement in place. If you prove malpractice and the midwife is ordered to pay you financial compensation, they go after everything she owns: home, car, cash, everything.
 

Have you read The Midwives?  It is an excellent fictional book on what happens when a midwife is charged with neglect (involuntary manslaughter, in the story's case).  Great read.

 

http://www.amazon.com/Midwives-Oprahs-Book-Chris-Bohjalian/dp/0375706771

post #89 of 104

" I'm shocked given the sums people actually pay CPM's that you think these women are doing it out of greed and practice slyly to remain unaccountable!"

 

A midwife in my area earns between $3500 and $4500 for the prenatal care and birth (usually whether or not she actually makes it to the birth).  A doula is paid between $300 and $500.  I would note that an OB in my state gets paid around $800 for the prenatal care and birth of a Medicaid patient.

 

I believe overhead costs are relatively low compared to doctors -- frequently no brick and mortar office, no or only one secretarial staff, no r.n.s on staff, some disposable supplies (and sometimes food) being provided by the patient, no malpractice insurance costs and no or extremely limited continuing education costs and licensing costs as compared to doctors. 

 

Assuming payment of $4,000 per birth and 2 patients a month, a midwife would be earning around $96,000 less her operating costs for a career that does NOT require a college degree (and until the last month or two did not require a high school degree or GED).  This assumes she does not earn additional income by offering placenta encapsulation services, moxibustion, etc., etc. I have also heard second-hand of a midwife in our community that received "referral payments" for directing her clients to certain alternative medicine providers (acupuncturist, herbal medicine supplier, placenta encapsulation specialist).

 

The median income in the United States is around $45,000.   To pretend that there is no money to be made in natural childbirth and its various accessories is simply crap.  It is a business like any other.

 

Providing that what a midwife does to protect their assets is legal, I have absolutely no issue with it.  However, people who hire an uninsured midwife must understand that she may have absolutely no assets that are reachable in a lawsuit.

post #90 of 104

My IM  very much has a degree, this being the UK.  She pays the same tax as anyone else in the UK (i've done her admin, freelance, and seen her accounts, i know what is going in the bank).

 

After tax and all of her costs she draws a VERY modest salary.  I earned more than that as a secretary for the NHS with a temping agency.  In fact i think i earned more than that when i was a university student working for the summer!  In the US uneducated malicious women might be making a living out of endangering babies, but not here.  She would earn more as an NHS midwife, but can't serve women as she likes to there.  She would earn more if she gave up practice and taught but it's not why she got into midwifery (she was a nurse for many years before).  She would earn more if she went back to nursing.  She would earn more (admittedly, just) if she went to work in MacDonalds.  She is not doing out of greed.

 

And you're right, our obstetricians get paid a salary which works out as WAY WAY less per woman than my IM.  But in my local hospital each of the ob consultants has 428 women a year booked (last years rate).  Not 10.


Edited by GoBecGo - 5/29/12 at 8:28am
post #91 of 104
Quote:
Originally Posted by Buzzbuzz View Post

 

Providing that what a midwife does to protect their assets is legal, I have absolutely no issue with it.  However, people who hire an uninsured midwife must understand that she may have absolutely no assets that are reachable in a lawsuit.

 

I think if a person hires a midwife knowing they do not have insurance, they know they are taking a chance that, in the unlikely event of medical malpractice, they may not be able to get money. You cannot get money from someone who does not have any.   A reminder if fine though, for those of us living under a rock.  smile.gif

 

GoBecGo….I am sorry you are losing your midwives.  greensad.gif

 

If you are an activist, or know any activists, it might be useful to look at models of how other countries with universal healthcare arrange malpractice insurance for their midwives.  In Ontario (Canada) it is provided through the Ontario Association of Midwives.  I am not sure how much it is - but I doubt it is exorbitant (high, but not exorbitant) 


Edited by purslaine - 5/21/12 at 12:34pm
post #92 of 104
Quote:
Originally Posted by kathymuggle View Post

 

I think if a person hires a midwife knowing they do not have insurance, they know they are taking a chance that, in the unlikely event of medical malpractice, they may not be able to get money. You cannot get money from someone who does not have any.   A reminder if fine though, for those of us living under a rock.  smile.gif

 

GoBecGo….I am sorry you are losing your midwives.  greensad.gif

 

If you are an activist, or know any activists, it might be useful to look at models of how other countries with universal healthcare arrange malpractice insurance for their midwives.  In Ontario (Canada) it is provided through the Ontario Association of Midwives.  I am not sure how much it is - but I doubt it is exorbitant (high, but not exorbitant) 

That was certainly the case for our family kathy. :)

 

I'm involved with the activism, we're looking at it every which way.  The ontario scenario (sorry!) is what we USED to have.  The problem we're up against is that any "body" that comes together to get insurance then has to start having rules about what an acceptable level of risk is, and generally some random Ob gets to dictate them (or a layperson!  I'm not kidding laypeople are on the board to judge of negligence occurred or not in the UK!), and at the moment some midwives will for example support HBAC but would be prevented from doing so if they joined a collective with affordable insurance.  Midwives who would previously judge each case on its merits would be forced instead to do blanket risking-out.  So though it wouldn't be joining the NHS, in many ways it might as well be.  Ultimately the risks which the NHS won't take are legal ones more than medical.  Autonomy is leaving midwifery, which is very very sad.

post #93 of 104

I've been reading this thread off and on for a while, but this is the post that's going to get me to comment.

 

Quote:
Originally Posted by Buzzbuzz View Post
A midwife in my area earns between $3500 and $4500 for the prenatal care and birth (usually whether or not she actually makes it to the birth).  A doula is paid between $300 and $500.  I would note that an OB in my state gets paid around $800 for the prenatal care and birth of a Medicaid patient.

 

I believe overhead costs are relatively low compared to doctors -- frequently no brick and mortar office, no or only one secretarial staff, no r.n.s on staff, some disposable supplies (and sometimes food) being provided by the patient, no malpractice insurance costs and no or extremely limited continuing education costs and licensing costs as compared to doctors. 

 

Assuming payment of $4,000 per birth and 2 patients a month, a midwife would be earning around $96,000 less her operating costs for a career that does NOT require a college degree (and until the last month or two did not require a high school degree or GED).  This assumes she does not earn additional income by offering placenta encapsulation services, moxibustion, etc., etc. I have also heard second-hand of a midwife in our community that received "referral payments" for directing her clients to certain alternative medicine providers (acupuncturist, herbal medicine supplier, placenta encapsulation specialist).

 

The median income in the United States is around $45,000.   To pretend that there is no money to be made in natural childbirth and its various accessories is simply crap.  It is a business like any other.

 

 

I think you really have no idea what costs may be behind the scenes for a MW.  Have you ever been self-employed?  Do you have any idea of the costs associated with being self-employed?  From what you typed here, the answer is obviously no. 

 

Here a LM earns roughly $4000 per birth (sliding scale though, that's the higher end).  A doula earns $1000.  An average MW or MW team might take 2-3 clients per month.  That's maximum, that's not a guarantee.  In an average year, that might mean 18-20 moms, not 24-36.  Very few MWs fill up every month.  Some MWs will have more, some will have less.  I know a few MWs who only take 1 client per month.  Around here there are always 2 trained professionals at a birth.  Sometimes that means a MW and an assistant (paid), a MW and a late-in-training apprentice (paid), a MW and a back-up MW (paid).  These people are all paid out of the MWs pocket.  My MW with my last pregnancy had an apprentice.  This pregnancy (a different MW), she'll have a back-up MW.  I don't know what it costs her, but I know they're not doing it for free.  In addition to the cost of hiring a 2nd pair of hands for the birth, there are other costs involved, both for the birth and throughout the prenatal care. 

 

The cost of the copying and binding she does for all the paperwork involved in the client packet (list of resources, birth questionnaires, new client questionnaires, birth supply lists, etc.).  Kinko's doesn't make copies for free.  Many of the MWs here hand these out at initial consultation interviews, before they're even hired, so they have to make way more than they ever get reimbursed for.  Cost of transportation to and from every visit, around here might include tolls for the bridges, includes parking meters or garages, parking tickets, and I know at least one instance where a MW had to double park to catch a precipitous birth, and then you have to deal with the cops and impound fees and all that lovely jazz.  Not to even mention that gas is about $4.50/gallon ATM, she has to have a reliable car (including regular upkeep), and decent insurance on it, so that she's never stranded.  Any visit that involves testing - test strips aren't free, neither are gloves.  If you have an internal exam (prior to labor), the cost of those supplies comes out of her pocket as well, not out of the birth kit.  Every piece of paper that you have to sign has a cost attached to it... I've had to sign several, one each time I decline a test to cover her butt that she did in fact offer it to me.  Requesting copies of records from other practitioners, not only costs for the paperwork, but then for the stamp, the phone calls to follow up, and if they fax it back, the supplies for printing it out.  On the other end, if she gets a request for records on a former client, she has to pay to copy those records and get them to the new practitioner also, and that money comes off her bottom line, since that client may have been years ago.  There's also the cost associated with billing insurance companies, which she doesn't do herself, she hires someone (who knows what they're doing) to do, on the off chance there might be a few dollars to reimburse the parents.  There are in fact continuing education costs, there are professional conferences to attend, there are books to buy, there are certifications to keep current, there is equipment to update or replace when it fails.  And then there are the birth supplies that are not provided by the parents.  Oxygen tank is a big one.  Suturing equipment, extra everything, just in case.  Sterilization fees.  There are some things where the costs get passed along to the parents, but she still has to eat them up front, like lab fees or drug fees (RhoGam comes to mind).  And then there's basic overhead, like my MW is right now switching over to paperless chart keeping.  She has to pay for that system, the software, the subscription service, the online support, the hardware.  She has to pay for her cell phone plan AND her beeper so that she's available 24/7.  And when it comes down to it, she also has to pay taxes.  Being self-employed, she has to pay a LOT of taxes.  And I'd be willing to bet that in my 39 wk pg haze I'm forgetting any number of costs.  And all of that is assuming that she didn't barter for part of her fee, take the low end of her sliding scale, and that she actually gets paid in a timely manner, which doesn't always happen. 

 

In the end, I'd be surprised if she were keeping even half of her global fee per client.  And this is for a person who answers the phone when I call at 2 am a few days pp and comes over in her pjs, regardless of how much/little sleep she's gotten.  Who easily spends 2-3 hours talking to me at every single prenatal visit, just to make sure that I'm comfortable, prepared, and have any concerns addressed.  Who likes me to keep her updated via email with what is going on with me - when I had my tooth extracted last week we kept in touch via email so that she could support me through the pain, give me advice on keeping the baby inside until I heal, without making it worse (by talking on the phone).  Heck, my MW and I discuss what books we're reading, so that we have a mutual frame of reference, and she brought me 2 books at yesterday's visit so that I have something to read while I'm waiting for labor to start.  How many doctors do you know who will make that sort of effort with a patient? 

 

I'll also point out that while the median income in the US may be around $45K, in this area, that income would barely be enough to keep a roof over your head.  They're not in it for the money.  In no way shape or form is this about the money. 

 

And yes, my MW does do encapsulation.  She's not charging separately for it, though.  Any more than she's going to charge me separately for the PP smoothie she'll make me, or the BFing support she's going to be giving me.  Even though she would be within her right to charge me extra for the encapsulation (around here it goes for $250 on it's own). 

post #94 of 104

Yeah, the taxes ALONE strip her of at LEAST 30% of whatever she brings in...if she has people working for her and she's paying payroll tax, freaking forGET about it...payroll taxes are insane for small business people.

 

MWs aren't rollin' in the money....anybody who goes into midwifery because they want to make it rich better think twice.
 

post #95 of 104
Quote:
Originally Posted by BroodyWoodsgal View Post

 

MWs aren't rollin' in the money....anybody who goes into midwifery because they want to make it rich better think twice.
 

 

Exactly. It costs a ton of money even to get to the point of being a midwife. And most people can't take out student loans for that.

 

Quote:
Originally Posted by cristeen View Post

I've been reading this thread off and on for a while, but this is the post that's going to get me to comment.

 

 

I think you really have no idea what costs may be behind the scenes for a MW.  Have you ever been self-employed?  Do you have any idea of the costs associated with being self-employed?  From what you typed here, the answer is obviously no. 

 

 

 

Thanks so much Cristeen! That post was so off-base, I was hoping someone with a clear and level head would chime in soon.

post #96 of 104

To be honest I do not know of too many midwives who have it...in NH we have an insurance mandate and still not all midwives have insurance...it is hard to afford when you are not seeing many clients. I am fortunate to have a busy practice and the ability to work in birth centers so to me it is worth it. 

post #97 of 104
Quote:
Originally Posted by motherof4sons View Post

To be honest I do not know of too many midwives who have it...in NH we have an insurance mandate and still not all midwives have insurance...it is hard to afford when you are not seeing many clients. I am fortunate to have a busy practice and the ability to work in birth centers so to me it is worth it. 




Well but the insurance mandate in NH isn't mandating that MWs carry MP insurance...it's a mandate which forces insurance companies to cover MW services.

post #98 of 104

Quote:

Responsible health providers carry malpractice insurance. Real professional do not use the expense of the insurance not to have one. I would not use a provider without one. There companies that provide insurance to HB MW.

 

I don't know any homebirth midwives who carry malpractice insurance.

 

 

Quote:

Just like DR's there needs to be a way we can feel comfortable knowing there will be repercussions for MW's that do mess up.

 

There is recourse available for parents whose midwives have practiced outside the standard of care. You can file a complaint with their licensing body in states with licensing, with the nursing board if they're a CNM or with NARM if they're a CPM.

post #99 of 104

CNMs can be reported to Board of Nursing. CNM's carry malpractice insraunce.

 

NARM  does not really suspend anyone that often.

 

Malpractice insurance protects the interest of the patient. If the child i injured as result of malpractice, who do you think should pay for care? Parents who do not have any money? Tax payers who did nothing wrong?

post #100 of 104

What if rather than malpractice it was simply a tragic outcome that no one could have prevented?  Do we sue God?  A lot of the time no one is to blame, and some of the time the person who IS to blame is untouchable because they not only have malpractice insurance but lawyers you can't even afford to phone to defend them.  So often the poor outcomes in the hospital are incredibly unlucky and one of those things, whereas the similar situation at home is a witch hunt for the evil negligent midwife.  That is why many of us are ok with "risking" an uninsured careprovider.  There are midwives (i am fantastically lucky to know one) who are very educated, very astute, and highly motivated to AVOID problems.  In the NHS hospitals i can have a Dr who is happy enough that he can correct (to the detriment of my baby and myself) most situations his negligence or constraints (such as might be enforced by his ridiculous patient lists and the dangerous staffing levels his team operate with) allows to occur.  For me the "risk" associated with booking care from someone whose general practice is to look after 8 or more women at once so i am more or less a faceless belly with a patient number then run in with a scalpel to save me when it's gone so wrong that it's the only recourse is higher than that of booking someone who can provide dedicated one-to-one care centred on normality and no intervention who might perhaps possibly one day make a mistake.

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