OB-GYNs Support President's Call for Medical Liability Reform

WASHINGTON -- The American College of Obstetricians and Gynecologists (ACOG) today applauded President George W. Bush for addressing the nation's medical liability insurance crisis at a roundtable discussion in Scranton, Penn. ACOG has long supported national solutions to the acute problems in the nation's medical liability system, problems that threaten the availability of physicians to deliver babies and health care to women.

"We commend President Bush for coming to Scranton to highlight the lack of affordable liability insurance for physicians," said ACOG president Charles B. Hammond, MD, of Durham, N.C. "Pennsylvania was one of the first states to experience the rising liability insurance crisis. The problem has rapidly spread to other states," he noted.

"Across the country, liability insurance for many ob-gyns is unaffordable or unavailable," said Hammond. "Without insurance, OB-GYNs are forced to stop delivering babies, stop surgical services, or close their doors. Pregnant women and newborns are hurt the most: in places like Las Vegas, women who are 6 months pregnant are scrambling to find their third ob-gyn in as many months, as more and more doctors lose coverage," he said.

ACOG officials are warning that the liability crisis will impact more than the need for prenatal care. "All women needing check-ups and primary health care can be affected," explained Hammond. "Fewer OB-GYNs means longer travel times to find a doctor, perhaps out of state; longer waiting periods for appointments, yet shorter quality time with one's doctor; less access to screening and special procedures; and a shrinking pool of ob-gyns to choose from, as we begin to lose residency training programs in women's health care."

Pennsylvania, West Virginia and Florida are three of the states hardest hit by the liability insurance problem that has escalated since 2000. All three were named by ACOG in May 2002 as among the top nine "Red Alert states" experiencing the worst of the liability insurance crisis in obstetrics-gynecology. Other states included Mississippi, Nevada, New Jersey, New York, Texas, and Washington.

ACOG data from a survey of its members in the Red Alert states shows that in Pennsylvania, 18.6 percent of respondents said they have dropped obstetrics due to the liability insurance situation, and over 13 percent have decreased the number of high-risk obstetrics cases they take. Thirteen percent have decreased gynecologic surgery and 10.61 percent have stopped major gynecologic surgery.

Rates of the major liability insurance carriers in Pennsylvania increased by 50 percent to more than 100 percent between 1997 and 2001, and rates for the carriers now remaining in the state increased by another 18 percent to 21 percent between 2001 and 2002. The state is the second highest in the country for total payouts for medical liability. During the fiscal year 2000, combined judgments and settlements in Pennsylvania amounted to $352 million or nearly 10 percent of the national total. In 2002 alone, two hospitals in Philadelphia -- Methodist Hospital and Mercy Hospital -- announced they were no longer providing labor and delivery services, with rising liability costs being a major factor in the decision.

"Some initial steps have been taken in Pennsylvania to improve the situation, but these barely scratch the surface of our far-reaching problems," said the chair of ACOG's Pennsylvania section, William R. Crombleholme, MD, of Pittsburgh. "We need bipartisan, national leadership to effect long-term solutions."

Florida has some of the highest annual liability premiums in the country (reaching $210,567 in south Florida in 2002). One in six Florida doctors will be sued, compared to one in 12 doctors nationwide. Denise Baker, MD, of Bradenton, Fla., wants to share her story with President Bush in Scranton. After delivering hundreds of babies in her career, Baker was forced to give up obstetrics when she could not find insurance after her carrier pulled out of Florida. "It broke my heart to leave obstetrics, because I became a doctor to deliver babies," she says. "Now I can no longer be there with and for my pregnant patients."

In West Virginia, nearly one in five OB-GYNs surveyed said they have stopped obstetrics due to the liability insurance situation. More than 20 percent have decreased high-risk obstetric services, 16.81% have decreased gynecologic surgery procedures and nearly 8 percent have stopped major gynecologic surgery. There are only three insurance carriers in the state, including the state-run West Virginia Board of Risk and Insurance Management, currently writing medical liability policies. Premiums are among the highest in the country, ranging from $90,700 to $99,800 per year.

James Brown, MD, of Martinsburg, W.V., is another OB-GYN hard hit by the liability crisis. Brown is the only private practice ob-gyn in a three-county area in the West Virginia panhandle, which has been designated by the federal government as medically underserved. For several years, Brown has been unable to successfully recruit OB-GYNs to come to the Martinsburg area, which he directly attributes to the medical liability insurance rates in his state. "If the situation does not change," reported Brown, "once I retire, women in my area will not have access to a West Virginia ob-gyn in private practice."

"Increased premiums are forcing obstetricians to leave states like Pennsylvania, West Virginia and Florida," said Hammond. "The constant threat of litigation is making it very difficult to attract new physicians to our specialty."

OB-GYNs have more claims filed against them than any other specialty. "Even the best ob-gyns will be sued at least once and typically will experience 2.5 medical liability claims throughout their career," noted Hammond. "Although half of all claims will be dropped or settled without payment, and OB-GYNs win more than two thirds of the cases that do go to court, nuisance lawsuits drive up the cost of healthcare for all women and keep the best physicians out of the labor and delivery room," he said.

ACOG supports Congressional passage of federal tort reform identical to HR 4600, the bipartisan HEALTH Act of 2002, and supports federal funding of pilot projects for many of the reforms outlined in a recent Institute of Medicine report, including no-fault systems and patient safety measures.

"Meaningful reform is absolutely essential to our ability to care for America's mothers and babies," stressed Hammond. "Medical liability reform must be high on the national agenda. We look forward to working with the Administration, Congress and state legislatures to pursue solutions," he said.

The American College of Obstetricians and Gynecologists is the national medical organization representing over 40,000 physicians who provide healthcare for women.

Source: American College of Obstetricians and Gynecologists