Ob/Gyn Medical Malpractice Insurance

OBGYN Malpractice Insurance
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In today's highly litigious environment, the availability of affordable medical liability insurance too often hinders the ability of OB/Gyns to practice medicine and, in many more cases, causes them to practice defensive medicine that ultimately drives up healthcare costs for all Americans.

Obstetrics specifically is a medical specialty with high professional liability exposure. Because parent-patients hold high expectations for excellent outcomes, every aspect of an adverse obstetric outcome has become an opportunity for a legal review of the care provided. In the face of an adverse outcome, families will almost always ask, “Was it bad luck or bad medicine?”

A survey on medical liability issues conducted in 2006 by the American College of Obstetricians & Gynecologists revealed that approximately 90 percent of the obstetricians in the United States had been sued at least once. Of the approximately 10,000 obstetrician respondents, the average number of lawsuits over a career is between two and three. This explains in part why malpractice insurance premiums for obstetricians are amongst the most costly of any specialty, plus the fact that many verdicts reach the multi-million-dollar mark.

Malpractice insurance premiums for OB/Gyns vary widely from state to state, many times from county to county within a single state, based on historical claims data and jury verdicts. Florida is the highest premium state, with base premium rates as high as $238,728 in 2008 for Miami and Dade Counties, followed by states that include Illinois, New York, Pennsylvania and Massachusetts. Minnesota is the country's lowest OB/Gyn premium state, with base premium rates as low as $17,166 in 2008, followed by states that include Wisconsin, Nebraska, North and South Dakota as well as North and South Carolina.

Advocacy by organizations like the American Medical Association (AMA) and the American College of Obstetricians & Gynecologists (ACOG) to pass meaningful tort reform legislation that would lower medical liability insurance rates is likely to be an ongoing effort with incremental advances, but crucial to individual OB/Gyns ability to control their individual premium is the ability to reduce adverse outcomes through risk management procedures.

Effective Risk Management Can Reduce Adverse Outcomes

The most common causes of adverse obstetric outcomes include communication failure and poor teamwork within the delivery room. In fact, one claims analysis showed that 43 percent were considered avoidable had better communication and teamwork prevailed in the delivery room.

The most common causes of adverse obstetric outcomes include communication failure and poor teamwork within the delivery room. In fact, one claims analysis showed that 43 percent were considered avoidable had better communication and teamwork prevailed in the delivery room.

Some tips to improve communication well as foster a greater sense of teamwork within the delivery room include:

• Implementing a diagnostic-style set of risk management skills to be followed by all team members, obtaining informed consent, using meticulous documentation and intervening promptly when adverse events occur;
• Require continued education for all physicians, nurses and ancillary healthcare providers on risk management procedures;
• Improve cohesive execution through cooperative teamwork and communication skill training;
• Enforcing compliance with already established policies and procedures as well as professional standards of practice;
• Conduct drills to prepare for the management of rare obstetrical emergencies.

It is equally important to be prepared for when adverse outcomes do occur in the delivery room. No one likes to assume they will one day encounter an adverse outcome, but it is generally agreed that when adverse outcomes do occur, lawsuits are often precipitated by the perception of poor communication and poor management. Important communication issues between obstetrician and patient include:

• Communication between physicians and patients makes a difference in the way patients perceive care. Patients judge quality of care by their own interaction with the members of the healthcare team. Due diligence in acquiring informed consent as well as proper handling of the disclosure of adverse events is critical.
• Communication with patients should always be open, professional and unrushed.
• Body language should reflect open communication. Defensive postures such as crossing your arms across your body or moving toward the door while sharing adverse outcomes with a patient should be avoided.

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