ACOG survey: one in seven quit obstetrics from 1999 to 2003; These ob.gyns. say the risk of liability claims or lawsuits forced them out

OB/GYN News, August 15, 2004 by Jennifer Silverman

One in seven fellows with the American College of Obstetricians and Gynecologists has stopped practicing obstetrics because of the risk of medical liability claims, an ACOG survey found.

Of the fellows surveyed, 14% said that the risk of liability claims or lawsuits forced them to stop doing obstetrics, a statistic that continues to grow. In a comparable professional liability survey conducted in 1999, only 8.9% of ACOG fellows reported that they no longer practiced obstetrics as a result of the risk of malpractice.

"This crisis is getting more serious by the day," ACOG President Dr. Vivian M. Dickerson said in a statement. "It's threatening [not only] today's ob.gyns., but also the future of our specialty."

Princeton Survey Research Associates designed and conducted the survey, which covered the time period 1999-2003. The response rate was 45.5%: Of the 4,919 surveys that were mailed, 2,185 completed, usable surveys were returned, an ACOG spokesman said.

Ob.gyns. have an average of 2.6 claims filed against them during their careers. During the time period covered by the survey, obstetric claims accounted for 61% of claims against ob.gyns. The top four primary obstetric allegations in 1999-2002 were infant neurologic impairment (34%); stillbirth or neonatal death (15%); other major infant injury (7%); and delay in diagnosis or failure to diagnose (7%).

Gynecologic claims accounted for 38% of claims against ob.gyns. during the same time period. Of these, delay in diagnosis or failure to diagnose accounted for 29% of the claims, and major patient injuries accounted for 25%.

In addition to dropping obstetrics, ACOG fellows made the following changes as a result of the risk of liability claims:

* Decreased the amount of high-risk obstetric care (22%).

* Stopped offering or performing vaginal births after cesareans (15%).

* Decreased the number of gynecologic surgical procedures performed (12%).

* Halted major gynecologic surgery (6%).

Liability insurance costs and availability are other drivers for limiting or halting these procedures, the survey stated.

On the resolution of claims, the news was somewhat brighter. Of cases that do proceed to court, ob.gyns. win 8 out of 10 times. Almost half of the claims against ob.gyns. are dropped by plaintiff's attorneys, dismissed, or settled without payment.

These outcomes "support our contention that there are so many frivolous lawsuits out there," Dr. Thomas Purdon, past president of ACOG, said in an interview. Many cases that do have merit have a low dollar potential, "and the personal injury lawyers seem only to be interested in the potential big dollar-award cases. How does that help the average patient?"

On average, it costs an insurance company or the physician $35,000 to defend a malpractice suit, he said. In 1999-2002, the average length of time from the occurrence to the closing of the claim was 4 years, according to the ACOG survey.

ACOG is employing several strategies to get a reform bill through Congress, such as targeting those state officials who are up for reelection but who are not sensitive to this issue. "A number of Democratic senators have been stonewalling tort reform," Dr. Purdon said, referring to the history of comprehensive tort reform bills that get approved by the House, but die in the Senate.

The college is also looking for judicial remedies from the states, such as asking courts to mandate special certification for expert witnesses.

Colorado has dramatically reduced claims through its "early offers" program, in which insurers and physicians offer help and financial assistance to patients. The hope is that other states will adopt similar programs. "Some say that this is admitting guilt, but that's an old argument that's worn out its usefulness," Dr. Purdon said.

Reducing the need for practicing defensive medicine could result in "a savings of $40 billion," Dr. Purdon said, an amount that could be used to fund health insurance efforts.

The Bush administration has long endorsed caps on malpractice lawsuits, although presidential candidate Sen. John Kerry (D-Mass.) claims that caps would fail to reduce premium costs for physicians or to lower the cost of health care. Instead, he supports alternatives, such as prohibiting individuals from bringing a malpractice action unless the claim is determined to be reasonable by a qualified specialist.

Senate Majority Leader Bill First (R-Tenn.) is supporting the creation of "expert medical courts" that would include scheduled compensatory damages to provide rapid relief to injured patients and limits on punitive damages.

BY JENNIFER SILVERMAN

Associate Editor, Practice Trends