Obstetrics is a field of medicine that affects us all directly even before we’re born. Ensuring the health and safety of both mother and neonate is complicated, since both don’t always have the same needs. This challenge makes the field doubly important, but also doubly dangerous; following surgeons and gastroenterologists, obstetricians are the most sued doctors,[1]and more than half of OB/GYNs have been sued for medical malpractice before reaching the age of 40.[2]In an effort to help you better understand what your clients might be facing and why, let’s go through some important facts and figures:
The Numbers
According to a closed claims study conducted by The Doctors Company, there are three patient allegations that top the rest:
- Delay in treatment of fetal distress.Accounting for 22% of maternal and neonatal claims for injuries against obstetricians, these allegations include failure to act on category II or III fetal heart rate tracings and failure to initiate emergency c-sections.[3]
- Improper performance of vaginal delivery.Often due to inadequate maneuvers, use of vacuum extraction, forceps deliveries, or complications due to the mother’s obesity, 20% of cases against obstetricians can result in brachial plexus injuries, skull fractures, and hematomas for the neonates, and pelvic lacerations, tears, and fistulas in the mother.[4]
- Improper management of pregnancy.These cases account for 17% of overall cases and include failure to test for fetal abnormalities, recognize complications of pregnancy, or address abnormal findings.[5]These can result in intrauterine death, placental abruption, neonatal infections, neonatal brain injury, and maternal preeclampsia leading to stroke.[6]
Other less common but equally important allegation types include diagnosis-related claims, delay in delivery, improper performance in operative delivery, and improper choice of delivery method.[7]
Risks to Remember
Research has shown that OB malpractice cases rarely have a single cause and are rarely the results of the bad decisions made by a single clinician; typically these issues occur due to a series of missteps by a team of medical staff members who realize too late the mistakes that were made.[8]Therefore, it is critical to understand the multitude of things that can go wrong, and how they are all connected.
Additionally, it is important to recognize that because obstetricians are very aware of the high stakes and statistical chances of being sued, their fear can decrease their effectiveness as physicians.[9]Doctors might lie to cover up medical errors of the past and pressure patients more frequently into C-sections, and high malpractice insurance rates and stress has caused a significant number of OBs to leave the field completely.[10]
Contributing Factors
In their claims study, The Doctors Company also put together a list of factors that contributed most significantly patient injury. Below are the top seven:[11]
- Selection and management of therapy(34%). This includes decisions regarding labor and delivery, failure to address and diagnose mother or neonate conditions, and poor choice in medication.
- Patient assessment issues(32%). These cases occur when physician disregard available information, fail to order diagnostic tests, ignore or overlook abnormal findings, and misinterpreting tests.
- Technical performance(18%). This refers mainly to injuries related to known risks prior to the procedure.
- Communication among providers(17%). As has been mentioned by us many times prior, communication is key; failure to keep other providers updated on a patient’s condition, communication breakdowns due to poor relationships, and failure to inform changes in a patient’s condition in a timely manner can all have lethal consequences.
- Patient factors(16%). This covers cases where the outcome of care is affected by other conditions and treatment plans that were not taken into account.
- Insufficient or lack of documentation(14%). Documentation deficiencies can be related to poor or a lack of clinical findings, review of care, clinical rationale for decisions, informed consent discussions, and documentation of adverse events.
- Communication between patient/family and provider(14%). Communication can also have critical effects when there are inadequate follow-up instructions, language barriers, and poor rapport between physicians and patients.
[1]Jena, Anupam B., Seabury, Seth, Lakdawalla, Darius, & Amitabh Chandra, “Malpractice Risk According to Physician Specialty,” The New England Journal of Medicine, http://www.nejm.org/doi/full/10.1056/NEJMsa1012370#t=articleResults
[2]“Ob/Gyns are still at high risk of being sued,” Modern Medicine Network, Oct. 1, 2010, http://contemporaryobgyn.modernmedicine.com/%5Bnode-source-domain-raw%5D/news/modernmedicine/modern-medicine-news/obgyns-are-still-high-risk-being-s
[3]Ranum, Darrell, & David B. Troxel, “Obstetrics Closed Claims Study,” The Doctors Company, 2015, https://www.thedoctors.com/siteassets/pdfs/risk-management/closed-claims-studies/9953_ccs-obstetrics_single_page_nomarks_f.pdf
[4]Ibid
[5]Ibid
[6]Ibid
[7]Ibid
[8]Rouff, Gretchen. “Report on OB Risks Provides Enhanced Patient Safety Roadmap,” CRICO Strategies, June 7, 2011, https://www.rmf.harvard.edu/About-CRICO/Media/Press-Releases/News/2011/June/Report-on-Malpractice-Errors-in-OB-Care
[9]Wenner Moyer, Melinda, “Do Doctors Really Know best? How Your OB/GYN’s Fear of Malpractice Can Affect Your Healthcare,” Huffington Post, Aug. 14, 2012, https://www.huffingtonpost.com/babblecom/how-obgyns-fear-of-malpractice-can-affect-healthcare_b_1590618.html
[10]Ibid
[11]Ranum & Troxel, “Obstetrics Closed Claims Study”