ACOG Releases Survey Results: OB-GYNs "Ultimately Hurt Patients"

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In an honest yet damning press release today, ACOG released survey data that revealed that the changes OB-GYNs feel forced to make to their practices due to their fear of being sued ultimately hurt patients.

An OB-GYN recently reported (via e-mail) that litigation feels devastating to a physician who takes pride in their expertise and caring. Litigation is often a factor in depressive symptoms and suicide in physicians and one Texas physician is reported to have left a suicide note the day he settled a lawsuit which read, “I hope that my death will shed light on the problem of dishonest expert testimony.” 

A different survey shed light on the suffering of patients as well. More than half (903) of the original 1,573 respondents to the groundbreaking 2006 Listening to Mothers II survey also participated in a postpartum survey six months later, the results of which are detailed in the New Mothers Speak Out report available on the Childbirth Connection web site. Validated mental health screening tools found that 63 percent of mothers were likely to be experiencing some degree of depressive symptoms and 18 percent appeared to be experiencing post-traumatic stress with reference to their child’s birth.

By publicizing the widely known fact that defensive medicine is aggressive and harmful to women seeking maternity care, ACOG has taken a profound step in openly admitting and sharing data that women’s options are being severely restricted and iatrogenic injuries are occuring on a large scale due to physician fears. Could this be the first step in curtailing the sensationalized rhetoric that ACOG employs to condemn women for choosing out of hospital birth with midwives?

 

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ACOG Releases 2009 Medical Liability Survey
Results Paint Dismal Reality for Ob-Gyns and Their Patients

Washington, DC — As the negative state of the medical liability environment continues, ob-gyns across the US are forced to make changes to their practice that ultimately hurt patients, according to The American College of Obstetricians and Gynecologists’ (ACOG) 2009 Survey on Professional Liability. More than 63% of ob-gyns report making changes to their practice due to the risk or fear of liability claims or litigation; 60% have made changes to their practice because liability insurance is either unavailable or unaffordable.

“This latest survey shows that the medical liability situation for ob-gyns remains a chronic crisis and continues to deprive women of all ages—especially pregnant women—of experienced ob-gyns,” said Albert L. Strunk, JD, MD, ACOG deputy executive vice president. “Women’s health care suffers as ob-gyns further decrease obstetric services, reduce gynecologic procedures, and are forced to practice defensive medicine.

“As the debate rages on about how best to institute health care reform, it’s apparent that there is virtually no discussion addressing the need for medical liability reform. It is imperative that any changes to our current health system include meaningful federal medical liability reform,” Dr. Strunk said. “The current medical liability legal system is out of control as evidenced by the fact that over half of all liability claims against ob-gyns are dropped or settled without payment on behalf of the ob-gyn.”

This is the 10th liability survey conducted by ACOG since 1983. The entire membership of practicing ACOG Fellows and Junior Fellows (31,665) in all 50 states, the District of Columbia, and Puerto Rico were surveyed. For the first time, the survey questionnaire was available exclusively online.* The final data represent those 5,644 ob-gyns who responded to the survey. The survey covered respondents’ practice over a three-year period, from Jan 1, 2006, through Dec 31, 2008.

According to the survey, ob-gyns continue to decrease their number of high-risk obstetric patients and decrease gynecologic surgical procedures. About 8% of survey respondents reported that they had stopped practicing obstetrics altogether.

Highlights from ACOG’s 2009 Survey on Professional Liability

Obstetric practice changes
Of the survey respondents who reported making changes to their obstetric practice as a result of the risk or fear of professional liability claims or litigation, 30% decreased the number of high-risk obstetric patients that they accepted. In addition, 29% reported performing more cesarean deliveries, and 25.9% stopped offering/performing vaginal births after cesarean (VBACs). An additional 13.9% decreased the number of total deliveries.

 

 

2006

 

2009

Decreased the number of high-risk obstetric patients

 

33%

 

30%

Stopped offering/performing VBACs

 

33%

 

26%

Increased the number of cesareans

 

37%

 

29%

Decreased the number of deliveries

 

15%

 

14%

No longer practicing obstetrics

 

8%

 

8%

 

Gynecologic practice changes
Of those ob-gyns who reported making changes to their gynecologic practice as a result of the risk or fear of professional liability claims or litigation, 15% decreased gynecologic surgical procedures. Furthermore, just over 5% stopped performing major gynecologic surgery, and 2% stopped performing all surgery.

 

 

2006

 

2009

Decreased gynecologic surgical procedures performed

 

16%

 

15%

No longer doing major gynecologic surgery

 

5%

 

5%

Stopped performing all surgery

 

2%

 

2%

 

Claims experience
Nearly 91% of ob-gyns indicated they had experienced at least one liability claim filed against them during their professional careers, for an average of 2.69 claims per physician. Sixty-two percent of the total reported claims were for obstetric care, and 38% were for gynecologic care. Of those who reported claims at some point during their career, nearly 43% reported at least one claim filed against them was a result of care rendered during their residency training.

 

 

2006

 

2009

At least one liability claim filed against them during their career

 

89%

 

91%

Percentage of total claims for obstetric care

 

62%

 

62%

Percentage of total claims for gynecologic care

 

38%

 

38%

Percentage of at least one claim filed against them during residency training

 

37%

 

43%

 

There were a total of 2,796 reported claims against survey respondents that were opened and/or closed during the 2006-08 time period. Of those ob-gyns reporting any claim against them, 45% had one or more claim against them; 29% had one claim; 12% had two claims; 3% had three claims; and 1% had four or more claims. Out of the total number of claims, 62% (1,736) involved obstetric care and 38% (1,060) were related to gynecologic care.

 

Ob Claims-Primary Allegations

 

 

 

 

 

 

2006

 

2009

Neurologically impaired infant

 

31%

 

31%

Stillbirth/neonatal death

 

16%

 

16%

Delay in/failure to diagnose

 

14%

 

11%

 

Gyn Claims-Primary Allegations

 

 

 

 

 

 

2006

 

2009

Major patient injury

 

23%

 

27%

Delay in/failure to diagnose

 

29%

 

24%

Minor patient injury

 

19%

 

17%

 

Claim Outcomes
Out of the 1,698 ob-gyn survey respondents who indicated how their claims were closed, just over half (53%) were reported dropped or settled without any payment on behalf of the ob-gyn. Of this 53%, 37% were dropped by the plaintiff, 12% were dismissed by the court, and 4% were settled without payment on behalf of the ob-gyn. Of the remaining 47% that did involve payment, 31% were settled in advance of trial or before verdict, 3% were settled through arbitration or other alternative dispute resolutions, and 13% were closed through a jury or court verdict.

 

Survey Respondent Demographics
Just over half of all survey respondents were male (53%). The average age of the survey respondents was 49.2 years. The majority of respondents were in group practice (52%), followed by solo practice (22%), hospital setting (12%), and teacher/faculty (10%). Of the total ob-gyns surveyed, 46% practiced in a suburban setting, 39% were in urban settings, and 15% were in rural settings. Nearly 3 out of 4 (74.3%) respondents provided both obstetric and gynecologic care. Ob-gyns that provided only gynecologic care represented 19% of respondents; 6% of ob-gyns provided only obstetric care.

 

 

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