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Did you know that obstetricians and gynecologists (OB/GYNs) experience a higher probability of a lawsuit when compared to other specialties? From allegations of delay in care, failure to diagnose, and surgical injuries, there are many circumstances in which a physician might be named as an individual party to a lawsuit. In fact, by age 65, 75 percent of physicians in low-risk specialties and 99 percent in high-risk specialties will have experienced a lawsuit. According to several recent studies, OB/GYNS are among the most likely to be sued among all physicians. To better understand the liability that private-practice OB/GYNs face and how they can ensure their practice is safe, we asked Ob Hospitalist Group’s Heather Moore, Director of Risk Management, Quality and Compliance, to answer a few questions.
Q: What are the circumstances in which a private-practice OB/GYN might be sued?
A: OB/GYNs practice in a fast paced, rapidly evolving, often complex labor and delivery setting. Like every other high-risk, high-reward profession, there’s always a possibility of failing to respond appropriately and effectively to that which is unanticipated and unexpected. That possibility exists for all physicians regardless of level of training and experience, but OB emergencies provide an emotionally charged environment in which delays can result in devastating outcomes for moms and babies.
In addition, there’s no such thing as a one-size-fits-all response to an emergency situation. Given all those factors, it’s critical that what we call “OB emergency departments” or OBEDs, are staffed with clinicians who can respond immediately to emergent situations in a team-based and patient-centric environment. While OBHG often assists community providers on routine procedures and deliveries, the availability for us to respond quickly and effectively to high-risk emergent cases of both private patients and unassigned patients is where we see the most outcome improvement for patients who present to the OBED.
Q: Doesn’t an OB hospitalist program protect a hospital from liability, more than a community OB and his/her practice?
A: It protects both, actually. In about 68 percent of lawsuits against OB/GYNs, more than one party is named in the lawsuit. While the event may happen in the labor and delivery unit or an emergency room, the private physician is almost always a party to the suit.
Statistics show that being on-site for immediate provision of care is critical. National obstetrical frequency of claims is estimated at about ten percent, and a 2015 Doctors Company study found 31 percent of these claims are associated with delays in care -- 22 percent related to delays in fetal distress and another nine percent with delays in delivery. While delays in care are often due to lack of staff availability and broken processes and can be complex in terms of their root cause, the perceived liability is almost always still focused on the primary provider. Nationally, our OB hospitalist programs are associated with significant (60 percent and more) decreases in adverse events resulting in medical malpractice claims.
More recently, a 2016 study identified a 15% reduction in perinatal serious safety events at hospitals where an OBHG program was implemented, and concluded that our OB hospitalist program was a key risk-mitigation initiative. So there’s clear benefit to hospitals as well.
Q: How can a clinician avoid a lawsuit before it is filed?
A: The practice of medicine is, by its very nature, subject to human fallibility and healthcare process errors, but the best way to avoid litigation is mounting a solid offense. Clinicians should make every effort to stay abreast of current education and best practices and have privileges at facilities that prioritize the same. There are also tangible things they can do, like document thoroughly and consult with a broad healthcare team for second opinions, which can buoy the chance that no litigation will occur.
It’s also very important that they do not embrace defensive medicine practice for fear of litigation. More than half of U.S. states now have “I’m sorry” laws that protect physicians who apologize after an adverse event from having those medical apologies being used as evidence in medical malpractice litigation. Medical apologies, along with early resolution programs, have been very successful in reducing claim activity. And if litigation does occur, physicians still tend to perform very well in lawsuits with over 70 percent of cases going to trial ending in defendant verdicts. Successful tort reform, along with “apology” protections, support providers in providing the best care possible without operating in a fear-based environment over the potential of litigation. We are firm believers that if you provide the best care possible to maximize the best outcome for our patients and work hard to ensure you maintain empathy and compassion for your patients, you will naturally mitigate a lot of potential risk.
Q: How can physician practices protect their teams?
A: Physicians should welcome quality assurance activities that identify quality improvement opportunities and be part of collaborative committees that look at clinical or process errors in a non-punitive manner. We need to continue to destigmatize discussing medical error so we can continually identify areas where physicians and healthcare organizations need to improve to provide better patient care. Taking a proactive and forward-thinking approach is the best way to mitigate future potential risk.
Physicians must work to institute a culture within their practices and hospitals that center on quality care and outcomes and fosters a team-based environment that focuses on patients first. When that culture is evident from the top down, other teams will adapt their practices to align with this cultural shift. OBHG’s risk management slogan is “healthy moms, healthy babies.” When the healthcare team works collaboratively to focus on the patient first above all else, the best risk and liability protection is already taking place.
This blog provides general information and discussion about healthcare-related subjects. The content and linked materials provided are not intended and should not be construed as medical advice. If the reader is an expectant mother with a medical concern, she should consult with an appropriately licensed physician or healthcare provider.
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