OB/GYNs Talk about Litigation and Risk Reduction

January 5, 2009

The December issue of the journal Obstetrics and Gynecology has an article, “Reducing Obstetric Litigation Through Alterations in Practice Patterns,” which summarizes material the authors presented at an annual meeting of the Society for Maternal–Fetal Medicine. In it, they look at 189 closed obstetric liability claims from 2000-2005, classifying whether each incident was associated with what they considered substandard care.

The authors attributed 23% of cases and 14% of costs to incidents that were deemed avoidable had an obstetrician been available continuously in-house (something that is not possible in all facilities). They attributed a chunk of the costs to failures to follow protocols, explaining:

“Forty-five percent of cases involving fetal monitoring in non-VBAC patients (27% of total costs) and 16% of maternal injury cases (3% of total costs) were deemed avoidable had the health care providers followed published, checklist-driven protocols for administration of oxytocin, misoprostol, and magnesium sulfate.”

The authors also address whether VBAC occurrences were appropriate (such as whether labor was spontaneous and non-augmented) and poor documentation and care in cases of shoulder dystocia.

Among their conclusions, the authors state, “First, even when judged by treating providers or defense consultants, most money currently paid in conjunction with obstetric malpractice cases is a result of actual substandard care resulting in preventable injury.” The authors also suggest a more conservative approach (with which many would disagree) to allowing VBAC, although they acknowledge that this would be for litigation reduction purposes and would reduce the number of women successfully having VBACs.

Authors from the same health care corporation wrote in the August issue of the American Journal of Obstetrics and Gynecology of the protocols within their large, multi-hospital system for misoprostol, magnesium sulfate, and management of shoulder dystocia. Although they did not assess their VBAC rates under the institutionally restrictive policy, they did find a somewhat reduced primary c-section rate in 2006, and guess that it “appears to be attributable to fewer cesareans for oxytocin-induced fetal heart rate abnormalities associated with the universal implementation in 2006 of a uniform, checklist-based system for oxytocin administration.”

Although these two papers are not as fully detailed as I would like, they’re an interesting read on which issues are being discussed by healthcare providers and institutions when it comes to birth choices and practices and litigation concerns.

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