At ACOG’s annual meeting, Dr. Elizabeth Platz presented a study which demonstrated that fear of lawsuit (and particularly in states that have high lawsuit pay-outs for malpractice during birth) increase the rate of C-sections. Specifically, “for every $10,000 increase in insurance premium there was a 15% increase in the rate of cesarean delivery.”
Whether you like it or not, here’s how insurance premiums work in America — insurance companies are for-profit companies, which means that they’re in the business to make money; this means that if they just break even, they’re not happy. So, they have to charge more than they pay out (not rocket science — this is the way it works in every business, from restaurants to grocery stores to car dealerships — if they don’t make money, they close). This means that if they insure a doctor who ends up costing them a million or two due to a dead or injured baby or mother, then they have to recoup that money somehow. Which means that they have to raise premiums on all doctors they cover. Or, raise premiums on the doctor who got the negative judgment. It’s just like car insurance — you have a car wreck (even if it’s not your fault) or a traffic ticket, or have some other indication that you may cost the insurance company money, or even worse, that you did cost them money, then they will raise your premiums. If you have too many tickets (or pay-outs or settlements), they may even drop coverage. As a driver, that means you aren’t legally allowed to drive, which is a difficult thing; as a doctor, that means you can’t work! Don’t you think that would make you ultra-cautious in attending births? (This doesn’t even take into consideration the human feelings one might have at attending a birth with a negative outcome, whether the attendant was at fault or not. But even if there were no lawsuit, I could see that such a birth could make you err on the side of caution the next time. Just as a mother who had a term stillbirth or intrapartum death might opt for a medically unnecessary C-section to avoid the risk of a repeat of her first birth, a doctor who attended such a woman might be more prone to choose an unnecessarean for the next woman.)
But this can be a thorny problem. I don’t think that doctors should be sued unnecessarily. But arbitrary lawsuit caps may be unjust for victims of malpractice. Most insurance companies will settle most lawsuits, preferring to take the known settlement than the risk of a jury handing down a possibly disastrous multi-million dollar verdict. The amount of money it takes to bring suits to court is also quite high. And although a jury may be legally and technically impartial, they may also be too ignorant (not using the term in a pejorative sense, but objectively) to hand down a just verdict. What if the doctor didn’t do anything wrong, but still got ruled against because of the sympathy factor of grieving parents? I suggest a special medical court that would try medical cases, with the pool of jurors or judges or justices being people with medical knowledge so that they can rightly decide fault. Unfortunately, this might unfairly favor medical personnel (the “old boys’ network” and feeling of shared experience), so it would have to be entered into cautiously, but I think it would work better than the current system. Perhaps some form of arbitration would work, rather than an actual trial.
Regardless, there is now evidence that what we’ve long suspected (though some refuse to admit) is true: defensive medicine is real, and it is driving up the rate of unnecessareans.
My thanks to “Sydney Midwife” for bringing the story to my attention.
Filed under: Uncategorized Tagged: | baby, birth, birth choices, C-section, caesarean, cesarean, cesarean section, childbirth, frivolous lawsuit, hospital, hospital birth, L&D, lawsuit, malpractice, obstetrician, pregnancy, pregnant, settlement, vaginal birth, VBAC