What are the most common scenarios leading to claims against hospital-based obstetrics and gynecology (OB/GYN) providers, such as failure to recognize declining fetal status in a timely manner, incomplete doctor-to-doctor and/or nurse-to-nurse handoffs, and delayed cesarean sections (C-sections)?
What strategies can be employed to mitigate risk?
How do general changes in the healthcare environment set the stage for increased or decreased risk going forward?
The Society of OB/GYN Hospitalists (SOGH) defines an OB/GYN hospitalist as “an obstetrician/gynecologist who has focused their professional practice on care of a hospitalized woman,” and this may include inpatient or Emergency Department gynecological care.1 By now, it is well accepted that an OB/GYN's risk of becoming involved in a malpractice suit is the highest of all medical specialties. As noted in a widely cited 2011 article in the New England Journal of Medicine, 74% of physicians practicing in the specialty were projected to face a claim of some type by age 45.2 In comparison, 11% to 12% of OB/GYN physicians incur a claim, with or without payment, each year, with median and mean payments being well into six figures nationally.2 Interestingly, a recent study of malpractice claims in Saudi Arabia between 2008 and 2013 found that 24.6% of them were OB/GYN related.3 It seems that the risk of OB/GYN-related malpractice is not confined to the United States. Of those cases in this study that are OB/GYN related, more than 80% of them were delivery room related.
Some of those types of claims, such as shoulder dystocia and fetal distress, are consistently associated with high-value claims occurring in the United States. In a 2012 study by the American Congress of Obstetrics and Gynecology (ACOG) for the time period of January 1, 2012 to December 31, 2014, survey respondents reported that neurologically impaired infant cases were more likely to be the primary allegation in obstetrics claims (constituting 27.4% of the total). Of these claims, 55.2% were delivered by C-section; 40.5% were delivered vaginally, and 2% were delivered via Vaginal Birth After Cesarean (VBAC).4 Not surprisingly, these kinds of claims, if liability is found, can result in significant indemnity payments to the infant and sometimes the mother (for negligent infliction of emotional distress) that reach the millions of dollars due to the child often suffering from lifetime impairment.
While the studies are informative, none of the general reflections of the risk that OB/GYN physicians face discuss particular risks faced by hospital-based OB/GYN physicians (i.e. hospitalists). However, because OB/GYN hospitalists face many of the same challenges that specialists on call may face, risk-mitigation strategies must include the same techniques employed by both general medicine hospitalists and OB/GYN hospitalists on call. Given these points, in analyzing how hospital-based OB/GYN physicians should attempt to mitigate their risk of becoming involved in a malpractice suit, a review of the basics of malpractice is necessary.