Reducing obstetric litigation through alterations in practice patterns - experience with 189 closed claims

Abstract

PATTERNS EXPERIENCE WITH 189 CLOSED CLAIMS STEVEN CLARK, MICHAEL BELFORT, GARY DILDY, Hospital Corporation of America, Nashville, Tennessee OBJECTIVE: To determine to what extent obstetric malpractice claims might be reduced by adherence to a limited number of practice patterns. STUDY DESIGN: We examined all 189 closed perinatal claims between 20002005 in a large healthcare delivery system. Substandard care was defined as practice at odds with published ACOG guidelines, or judgment to this effect by a treating health care provider or defense consultant. RESULTS: 61% of obstetric cases (accounting for 79% of all costs) involved substandard care. 23% of cases involving non-VBAC fetal monitoring, (14% of total litigation costs) were avoidable had an obstetrician been continuously in-house. 45% of such cases (27% of total cost) and 16% of maternal injury cases (3% of total cost) were avoidable had the health care providers followed available, checklist-driven protocols for administration of oxytocin, misoprostol and MgSO4 An additional 17% of fetal monitoring cases (10% total costs) were avoidable with either of the above. 80% of cases involving VBAC (5% of total cost) were avoidable had this procedure been limited to spontaneous labors progressing without augmentation and absence of repetitive moderate/ severe variable decelerations. 54% of shoulder dystocia cases (4% of all costs) were avoidable had documentation been complete and consistent. CONCLUSION: Obstetric claims appear less likely to involve actual substandard care than general medical claims. Well over half of hospital litigation costs might be avoided if physician practice included: 1. Practice in a facility with 24 hour in house obstetric coverage, 2. Adherence to existing medication protocols. 3. A more conservative approach to VBAC. 4. Use of a comprehensive, standardized procedure note in cases of shoulder dystocia,. Malpractice insurance might be offered at a fraction of the current cost for most physicians who abide by these 4 practice patterns.