Originally Posted by fourlittlebirds
Where I live it was the *hospital administration* that banned VBACs, against the wishes of several of the doctors practicing there, and I'm assuming the reason is that the malpractice insurance was being paid by the hospital?
The hospitals have their own insurance, but the doctors practicing there must have their own indiviual coverage as well.
In a lawsuit, even if it is the doctor who is CLEARLY at fault, the hospital will be named in the lawsuit as well. It's two separate insurance policies.
The only time I've heard of the hospital providing malpractice insurance for individual docs is when the docs are ONLY working at the hospital and not in private practice.
For example, if DH worked for a hospital, malpractice insurance is typically part of the salary package. If he worked for an ansesthsia group, the group itself pays for malpractice insurance. If he was in solo practice, obviously the premiums would come only from him.
Most OB's don't work for the hospital though, thus the premiums must come from their particular group/practice.
The biggest reason hospitals are banning VBACs altogether has much to do with anesthesia coverage. ACOG now says hospitals must staff both surgeons and anesthesia staff 24/7 to handle VBACs safely.
To hire an anesthetist, the hospital will pay $100-150 PER HOUR just in wages for someone to sit there waiting to see if something goes wrong or if the woman wants an epidural. Unless there are LOTS of women wanting an epi, the hospital is going to lose their butt paying that kind of money, but that's the going rate.
If they hire someone full time, they've got to hire 3 such people to cover 24/7. Salary alone ranges from $100-220K per year PER provider, and this is for anesthetists, NOT for anesthesiologists (which can easily make twice these figures per hour or per year). You can easily add in another $50-100K per year PER provider for benefits such as health insurance, 401K match, bonuses, vacation time, etc. That's a lot of money for small hospitals that don't deliver lots of babies.
Even when the recommendations were to have access to a crash section within 30 minutes, thus anesthesia folks could just carry a beeper...that runs you $25-100 PER HOUR for someone to carry a beeper. Lots of anesthesia providers, my husband included, now refuse to carry a beeper for L&D. They'll ONLY do 'in-house' call where they are actually present at the hospital (and thus getting paid a lot more money). It's not the extra money that's causing this though. Carrying a beeper for $50 an hour was super sweet, but it put DH at risk should disaster strike and he got caught in traffic or something. So many of his co-workers will now either outright refuse to cover L&D OR they will only do it if the hospital will pay for them to be AT the hospital during their call time.
This conversation usually turns to 'Why are they getting paid so much?' at this point, which is a relevant question for sure. First, consider we are paying out of pocket for that pesky malpractice insurance, so that $100-150 per hour isn't nearly as much after paying for insurance. Second, he graduated with over $100K in student loans, as do most people who have been in school for 8-12 years AFTER high school. Our student loan payments are more than many people's mortgage payments.