[Lkg4dmcrc]

I am just wondering why we (as in most people in society) believe and tout the medical malpractice claims against OBs to justify interventions and C-sections. The Bureau of Justice Statistics released a report in March showing that most claims don't get paid, most paid claims are very little money, and there really are not that many suits being filed. Entire report here...

http://64.233.167.104/search?q=cache...ient=firefox-a

I constantly hear- "well if people were not so sue happy against OBs, then they wouldn't have to do things to protect themselves". People seem to believe this without actually knowing all the facts. If you look at all the tables and stuff in the report, you will find the following information.

Between 2000-2004, only 32 malpractice suits were filed in Nevada for Birth Trauma. This is out of over 1200 suits filed or 2.6% of all malpractice suits filed. Only 15 received payment. During that 4 year period, there were over 130,000 births in Nevada- that is .002% of births. Some of the other suits for infection and other stuff may have been related to birth thus a few more cases. However, this belief that there are sue happy people around regarding birth just doesn't fly. I would bet that this trend holds true all across the US. Also, there are tons of articles and alerts about OBs needing to leave Nevada because of "sue happy patients".

Some might say that doctors are covering their butts so much that people are not able to sue. That would make sense if more cases were actually filed- but the fact is very few cases are filed at all.

Thoughts? Why do we continue to perpetuate this belief?

 

[aylaanne]

I was under the impression that it wasn't necessarily sue-happy patients, but suit-fearful malpractice insurance companies that were making it hard for OBs and CNMs to keep in business. I have felt for a while that the liability hype was just the mental justification of a crooked system. The real motivator is money. Hospital, intervention-filled birth pays better.

I would think that insurance companies would be going crazy in favor of natural birthing methods in hospitals and birth centers. It's all so fubared.

 

[courtenay_e]

Doctors DO tend to practice defensively, because, even if not many suits are filed, losing one, even where not much money is paid out, could cause the doctor to not to be able to afford to practice medicine any more. Not because of the actual monetary cost of the claim paid out, but because of the INCREASE in their cost to carry malpractice insurance. Just like if you get into an accident that's your fault, the insurance company raises your rates? This happens with docs if they're involved in a law suit. And, especially in certain states(where the cost of insurance is high to BEGIN with), this could mean that they can simply no longer afford to practice medicine. I live in Michigan, where this is very much the case. We live in a state that has the fifth highest cost for medical malpractice insurance overall. The OB's tend to practice VERY defensively here. If they lost a law suit they probably wouldn't be able to afford the increase in malpractice insurance costs, and would have to quit.

 

[courtenay_e]

Yes, I know that around here, there was a hospital that had midwives practicing, but they were fired because they had such a low epidural rate, and the hospital saw that as "losing $3,000" for every birth the midwives attended! *sigh*

They really DO make less for the non-interventive births...and I think, truely, that the administration sees that as very important, ESPECIALLY in for profit institutions. However, and maybe I'm a pollyanna, but I really don't believe that the majority of doctors who go into practice to be an OB go into it thinking, "I'm going to be interventive no matter the cost to mother and baby!" THey go into birth because either they want to be part of that miracle every day, or some variation therein...and then they are TAUGHT that this is the way that women must have babies. They are indoctrinated by the culture they are part of. It makes me sad that, at a couple of teaching hospitals I work in, if certain doctors know that we're going to have a natural birth, they'll ask the mother if she minds having a few residents watch, because it MAY VERY WELL BE THE ONLY natural and non-interventive birth they EVER see. That is frightening to me...but heartening, too...that there ARE members of that culture who recognize how important it is to pass on the knowledge that natural birth is the NORMAL way to have babies, and is nearly a "lost art" to be practiced in hospital attended births.

 

[BetsyS]

Malpractice does change the way we practice.

I have a friend that is a CRNA. He was unfortunate enough to place an epidural in a mama that had pretty bad complications. I can't remember details, but I do know that John Edwards was her lawyer (this was in North Carolina), and that she got a settlement upwards of $5 million. She sued anyone that ever had any contact with her, so my friend was included.

After that, his malpractice rates went up so much that he was unemployable except for the practice he was currently in. He had been commuting something like 3 hours each way for better money, to put his children through college, with the plans to change jobs when they finished school. Because of that malpractice suit, he had to continue to work at the same job. He was a great CRNA, just caught in a bad case. He didn't do anything wrong, but it was a big group settlement, where everyone had to agree to pay part of the $$ (well, mostly their insurance carriers).

It limited his life. And, you bet he practiced much more defensively after that and was unwilling to bend rules for anyone. If you find enough practitioners that are caught in those situations, it makes it hard to find any sort of practitioners that will change "standard procedures" for one woman, even when those standard procedures aren't the best. The practitioners feel like their a$$ is more covered in court because at least it was a standard.

 

[aylaanne]

Quote:

Originally Posted by courtenay_e However, and maybe I'm a pollyanna, but I really don't believe that the majority of doctors who go into practice to be an OB go into it thinking, "I'm going to be interventive no matter the cost to mother and baby!" THey go into birth because either they want to be part of that miracle every day, or some variation therein...and then they are TAUGHT that this is the way that women must have babies.

I had friends in my undergrad who were planning on going to med school, and they were considering OB or Anesthesia, because those were two of the highest-paying specialities. I think it has more to do with the paychecks than the indoctrination.

 

[courtenay_e]

Yes...it does for some, you're right. But not for all of them. I have worked with a lot of docs whom I'm SURE do it either out of a sense that they are GODs and where better to work than in birth when you're a god...and some who like the money...but not so many who like the money where I work, because, as I said earlier, it costs a LOT to work here as an OB, so much so, in fact that many OBs quit working as OBs and only do the GYN part, to lower the insurance costs. Even most of the docs I dread working with, though, have said that they do it because they love to be there for the miracle of birth. I guess that's true even when they have horribly changed the face of that miracle...

 

[Belleweather]

Most legal suits for ANYTHING don't end up being tried and are usually settled for very little money. The problem with malpractice suits for OBs is that the ones that go to trial and are won can often come back with huge verdicts - both because the jury is allowed to consider the lifetime medical and long term care needs for the baby in making the award and because plaintiff's lawyers have started using some shady techniques to play on the Jury's sympathies. (John Edwards is FAMOUS for this, and was the one who really IMHO took it way over the line... he once brought a tape recording of "the baby's voice", begging to be sectioned and saying she was in distress into the court room and was allowed by the judge to play it for the jury.) Even if most cases settle, insurers are going to be justifiably wary of a verdict that could come back in the range of hundreds of millions -- which is why most of these cases end in a settlement rather than a trial.

 

[wifeandmom]

Quote:

Originally Posted by BetsyS Malpractice does change the way we practice. I have a friend that is a CRNA. He was unfortunate enough to place an epidural in a mama that had pretty bad complications. I can't remember details, but I do know that John Edwards was her lawyer (this was in North Carolina), and that she got a settlement upwards of $5 million. She sued anyone that ever had any contact with her, so my friend was included. After that, his malpractice rates went up so much that he was unemployable except for the practice he was currently in. He had been commuting something like 3 hours each way for better money, to put his children through college, with the plans to change jobs when they finished school. Because of that malpractice suit, he had to continue to work at the same job. He was a great CRNA, just caught in a bad case. He didn't do anything wrong, but it was a big group settlement, where everyone had to agree to pay part of the $$ (well, mostly their insurance carriers). It limited his life. And, you bet he practiced much more defensively after that and was unwilling to bend rules for anyone. If you find enough practitioners that are caught in those situations, it makes it hard to find any sort of practitioners that will change "standard procedures" for one woman, even when those standard procedures aren't the best. The practitioners feel like their a$$ is more covered in court because at least it was a standard.

This.

And all it takes is ONE such case to scare practitioners into defensive medicine.

The OP mentioned *thirty two* lawsuits filed in the time period mentioned. Any *one* of those could ruin the career of any and every person involved in the care of that patient.

My DH is in the medical field, and you bet your butt he practices within the current standard of care. Period. The end. No exceptions, regardless of his personal opinion of whatever the standard might be. It's the only hope you have of avoiding a malpractice suit that could ruin your entire career.

I recently read an article on NEJM that said the average OB in America has 3 malpractice claims filed against them over the course of their career. One is all it takes.

 

[kittywitty]

Quote:

Originally Posted by wifeandmom This. And all it takes is ONE such case to scare practitioners into defensive medicine. The OP mentioned *thirty two* lawsuits filed in the time period mentioned. Any *one* of those could ruin the career of any and every person involved in the care of that patient. My DH is in the medical field, and you bet your butt he practices within the current standard of care. Period. The end. No exceptions, regardless of his personal opinion of whatever the standard might be. It's the only hope you have of avoiding a malpractice suit that could ruin your entire career. I recently read an article on NEJM that said the average OB in America has 3 malpractice claims filed against them over the course of their career. One is all it takes.

Absolutely. When I worked in the hospital, every doctor had had a file against them for something or other. Very few of those, IMO had reason to take it to court and investigate. People make mistakes, we just expect absolute perfection in our medical system and noone to die or be injured, when really we are rolling dice.

It is quite sad that these malpractice suits make *everyone* pay, so it does come back to your quality of care and your money paying for it with higher healthcare costs.

I was just told yesterday that in this town, if they think my baby is over 8 lbs., they will do a c-section, period. No choice because of liability. I have already given birth to 2 8+ lbs. I think that I can handle another, thank you. But it doesn't matter. Looks like I might have to have an *oops* UC.