Hospital Acquired Conditions, Patient Safety

Obstetric Malpractice Shapes The Way Doctors Practice – But It Can Be Prevented

The following is an excerpt of an article co-authored by Angela W. Russell, Partner, Wilson Elser Moskowitz Edelman & Dicker LLP and Michael Wong, JD, Executive Director of Physician-Patient Alliance for Health & Safety (PPAHS). It first appeared on Healthcare Business Today on July 28, 2017. Read the full article here.

Accidents can happen.

In the case of hospital care, the stakes are high, with errors potentially resulting in serious adverse events or even death. In the field of obstetrics & gynecology, these incidences can have a deeply personal impact, affecting the lives of mother, baby, family, and attending clinicians. It’s not surprising, then, that in the most catastrophic cases, the costs of obstetric malpractice suits can be astronomical.

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While it can be crass to speak about human life in the context of cost, the reality is that sensitivity to legal risk has had an impact on the way that doctors practice. A 2012 survey conducted by the American Congress of Obstetricians & Gynecologists (ACOG) revealed that over half (51%) of OB-Gyn respondents made a change to their practice in a three-year period as a direct result of liability costs or availability. Some of these changes include increasing the number of C-section deliveries, reducing or stopping major surgeries, and even stopping their gynecology practice altogether.

At ACI’s Annual Advanced Forum on Obstetric Malpractice Claims in June 2016, we discussed several case studies that reflect the “jumbo” verdicts that shape the obstetric malpractice landscape.

In one 2013 Pennsylvania case, a baby was diagnosed with cerebral palsy after a lengthy labor. The lawsuit that followed alleged that the care provided by the OB-Gyn team and hospital didn’t meet the standard of care; a closer examination shows that there were several complicating factors that could have been prevented. […] Had this case been flagged as a high-risk patient, with the appropriate staff and equipment made available, could the outcome have been different?

The pressing question, then, is what actions should clinicians take to reduce adverse events & save lives, thereby reducing the effect of medi-legal costs on their practice? The key is to control the five drivers of risk:

  1. Observing protocol
  2. Identifying high-risk patients
  3. Ensuring documentation is complete
  4. Implementing effective hand-off communication
  5. Proactively disclosing adverse events with patients & families

An analysis of closed claims data of the American Association of Nurse Anesthetists conducted by Karen Crawford, CRNA, PhD, “The AANA Closed Malpractice Claims Study: Obstetric Anesthesia” provides three additional suggestions where can clinicians focus their efforts to prevent adverse events for baby and mother.

  1. Have the right equipment present and make sure caregivers know how to use it
  2. Monitor patients with accepted standards of practice
  3. Accurately analyze the information provided by monitors and adjust the anesthetic care plan accordingly

In cases like this one, the births could have been successful had these drivers of risk been effectively managed. There may have been no story of trauma; though it’s still not a certainty. What is certain is that managing those factors would have contributed to lower, or no claims, had the hospital and staff been able to demonstrate that effective protocols were followed to the best of their ability.

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