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Sep112009

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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Reader Comments (13)

Numero Uno- OBs have not been "forced" to implement defensive medicine. It's a conscious choice which OBs have colluded into standard practice.

Dos- If ACOG issued new guidelines embracing best practice evidence based care policies, the insurance companies would- sure as- cover OBs. The fact that companies are continuing to provide coverage for harmful practices in the face of multiple studies demonstrating the negative outcomes just because of ACOG guidelines is the proof in the pudding.

Tres- Families should be entitled to sue for damages, including psychological damages, related to any malpractice. The only reason the standard of care has not already implemented mother and baby friendly policies is because there have not been enough lawsuits concerning lesser and temporary disabilities caused by "offensive" medicine. Sheez, most women are so busy with life that their traumas get swept under the rug. In the Listening to Mothers Survey, I believe that the number of women who had grounds to file a complaint hovered near 50%, and yet the actual number of complaints filed was minimal. So, sorry, a no-fault system is just a get-out-of-lawsuits-for-a-minimal-fee-card that will create zero incentive for a substantial standard of practice change, while simultaneously reinforcing the "not my responsibility" attitude.

Quatro- OBs would like to believe that women should be OK with offensive medicine, and that those that are not have psychological problems. In a recently re-posted article written by a retired OB, women who don't like being cut open for no reason are not suffering a "real" injury, just a narcissistic injury, in which the woman's sense of self importance is what has really been hurt: cesareans are surgeries, never mind the effect of increased morbidity and mortality. What this says to me is that the idea of women refusing offensive interventions is so injurious to even X-OBs, that they want to neatly label these women with a degree of craziness so as to massage their egos and guilt.

But hey, you can't fix something that you don't know is broken, right?

September 11, 2009 | Unregistered CommenterAnon

Sounds to me like the fools....er, folks, over at ACOG need a good therapist who can teach them that they are the ones solely responsible for their actions and nobody can be "made" to do/think/feel anything, unless of course there is a weapon held to the head. Which is ironic, because *technically* THEY are the ones with the weapons---ya know, those sharp shiny objects that they use on at least 30% of their patients.

Head, meet keyboard. Keyboard, meet head.

September 11, 2009 | Unregistered CommenterMonkey Mama

Wow, I completely agree with all of that, Anon. Point uno should be emphasized, especially. I'd be very interested in the re-published article you speak of in numero quatro, if you could point me in that direction.

Thanks for this extremely interesting info, Jill.

September 11, 2009 | Unregistered CommenterDou-la-la

Make mine another agreement with Anon's post. Jill, while I admire your sentiment when you said:

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?
let's be honest all this is going to be is a call for medical malpractice reform. Their reference to all of this depriving women of "experienced OB/GYNs" makes it clear exactly where the priorities lie. This is classic ACOG, continue to protect your own turf at all costs while reducing the actual choice that women have available to them (and reducing the OB/Gyn's responsibility for their bad practices which ever the more increasingly turn out not to be evidenced based).

Somedays I find it so eerie the way history seems to loop upon itself - where the conflicts between midwives and doctors never really changes from what took place back in the late 1800s and early 1900s.

September 11, 2009 | Unregistered CommenterPampered Mom

Let me get this straight. Defensive medicine hurts women. Women (and babies) who are hurt, sue the doctors who hurt them. Whose fault is this really?

September 12, 2009 | Unregistered CommenterCara

Dou-la-la, I have to send you to the Skeptical OB (skepticalob.blogspot.com) for her post "Cesarean section as a narcissistic injury" . I missed the post the first time around, and I wasn't happy to read it yesterday. I think women have enough trouble processing their births without attempts to shame away their indignation. I also think that if there is a group which is actually suffering narcissistic injury, it's the participants in defensive maternity practices,and their trade union, who want to dictate to women instead of providing proper care, and who are choosing to take their egos out on their clients and midwives.

Do doulas have problems with providers acting in an offensive or intimidating manner while they are advocating for their clients?

September 12, 2009 | Unregistered CommenterAnon

Cara,

Not a huge logical leap there, is it? I am pretty sure I'm impressed with their honest admission of the harm they are causing women. I *think* it's a big step in the right direction and hopefully will shed light on why many women who would otherwise never question giving birth in a hospital change their minds. The problem for anti-home birth advocates is that women find out that midwifery care is not just an escape from defensive medicine-- it usually meet theirs needs better than the medical model from what I've observed.

It's sort of funny to watch ACOG, et. al., sink their heels in the ground in resistence. Out-of-hospital birth will become even more mainstream, so why not put our collective efforts into the regulation and licensure of midwives in all 50 states?

September 12, 2009 | Registered CommenterJill

Pampered Mom... yes, that was a leading rhetorical question that you quoted. The real point of the press release was to find a way to protect the poor, poor doctors from their fears of being sued.

From the press release: "Women’s health care suffers as ob-gyns further decrease obstetric services, reduce gynecologic procedures, and are forced to practice defensive medicine."

If the quote had been cut off at "procedures," it would have a different a very different flavor. The first two imply that women's health care suffers due to LACK of OB-GYN services. Defensive (or as Anon called it, "Offensive Medicine") medicine is intentionally ordering unnecessary tests and performing unnecessary procedures that benefit the doctor or the hospital's self-interest but NOT the patient. Some women are fine with the unnecessary "treatment," especially when it's sold as taking extra safety measures. And some of us are just not.

September 12, 2009 | Registered CommenterJill

Anon,

Aww, crap, I shoulda known it was "Dr. Amy". SIGHHH. I guess I'll read it anyway, though visiting that site always puts a gloomy cartoon cloud over my head for the rest of the day.

Thanks though, really!

September 12, 2009 | Unregistered CommenterDou-la-la

Dou-la-la- Yeah I know. It's chilling to think that she was actually teaching obstetrics.

Jill- I like calling a spade a spade. In life there's that overwhelming attitude that the best defense is a good offense. By utilizing tactics like hiding risks, promoting social interventions, presenting misinformation as fact, bullying and coercion, physical force, and court orders, practitioners are playing offensively. Defensive medicine is a misnomer because that would limit their actions to dealing with only the families who actually chose to sue, instead of actively injuring as many as possible in an almost superstitious attempt at warding off civil court.

Instead, families are being faced with the equivalent of being on the opposing team. And the goals are different. For the home team, it is not a healthy baby and mom. The goal is having too few injuries to merit a civil suit, daylight working hours, maximized billable procedures and minimal expenditures. For the away team, families want the safest birth possible, for their autonomy to be respected, and to receive current and precise information pertaining to material risks.

Practitioners just can't,won't, and don't provide the real data on material risks because too many families would refuse treatment, thwarting their offense. (With some exceptions of course.)

If families goals changed, and we were most concerned with practitioners being "sued out" than safety, there'd be no problem.

If practitioners goals changed, and they were most concerned with the healthiest most non-invasive outcome for clients, there'd be no problem.

Unfortunately, as long as practitioners continue to view the health of their clients as secondary to their own agendas, the general public will continue to be at risk. Tort reform will not reduce the lures of interventions for convenience, profit, teaching, and research, and will just provide a safety net for (major) adverse outcomes.

September 12, 2009 | Unregistered CommenterAnon
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