High-quality maternity and neonatal care is critical not just to individual families but to society as a whole: obstetrician-gynecologists (ob-gyns) help ensure that babies are born healthy and work o optimize mothers' health, as well as to advance quality health care for women of all ages.
Ob-gyns are among the most frequently sued medical specialists. According to a 2009 survey, 90 percent of board-certified members of The American College of Obstetricians and Gynecologists (ACOG) have been sued. On average, ob-gyns can expect to be sued on 2.7 occasions in a professional lifetime. One third of ob-gyns sued have been sued four or more times. Forty-three percent reported suits for care provided during residency training.
Rather than reflecting rampant negligence and maltreatment of patients, these numbers reflect that even the best care cannot guarantee a perfect birth outcome. Ob-gyns get sued for less-than-perfect outcomes--instances in which no one may be at fault but family medical costs can quickly skyrocket.
Our current medical liability system fails to provide appropriate and timely compensation to persons injured, fails to deter real negligence, and impedes efforts to correct medical errors and improve patient safety. Under the current system, medical justice is unreliable for both patients and physicians, and patient care is harmed.
Access to ob-gyn care has been diminished. This means less prenatal care as doctors decrease high-risk obstetrics (30 percent), reduce deliveries (14 percent), and stop obstetrics altogether (8 percent)--avoidance behaviors reported by 63 percent of ACOG members who responded to a 2009 survey. Access to preventive care is also diminished as fewer gynecologic surgeons are available to treat women with pelvic pain, infertility, or cancer.
In Southeastern Pennsylvania,19 hospital maternity units have closed since 1997 due to medical liability concerns and costs. In Philadelphia, only the city's six teaching hospitals continue to deliver babies. Statewide, there has been a net loss of 43 hospital ob units over the last several years. Yet safe hospital deliveries and increased availability of prenatal care are among the very factors that contributed to a greater than 90 percent reduction in national infant and maternal mortality during the twentieth century.
Assurance behaviors, another element of defensive medicine, result in additional laboratory and imaging studies and consultations. Both increase health-care costs and may subject patients to the risks of false-positive test results. Liability costs, including defensive medicine, are by one estimate $56 billion, or 2.4 percent of the nation's annual health-care tab.
Reliable justice would help improve the physician-patient relationship and medical care overall. Two grievous birth outcomes in particular--neurologic impairment, including cerebral palsy, and shoulder dystocia--can have a devastating effect on a patient and her family, as well as on an ob-gyn's relationship with her patient, her own family, and her profession. Neither of these outcomes is likely related to the obstetrician's actions or inaction. But multi-million-dollar jury awards often follow.
Despite dramatic improvements in maternal and neonatal morbidity and mortality, the rate of cerebral palsy remains unchanged. Epidemiologic studies show that less than 10 percent of cases can be attributed to events occurring during labor and delivery. Yet the costs of caring for and educating these children are substantial, and malpractice lawsuits are often the only source of financing, regardless of an absence of fault.