Slicing the data a different way, problems related to the 10 most commonly cited ObGyn procedures cost PIAA companies more than $120 million dollars in 2010—and that figure is only for the top 10.1 The top three procedures, in terms of number of claims closed in 2010, were operative procedures on the uterus, manually assisted delivery, and cesarean delivery (TABLE 2).
TABLE 2
Manually assisted delivery does not include vacuum extraction or forceps delivery, notes Dr. Stanchfield. “Manually assisted delivery is basically standing there like a quarterback and catching the baby.”
Top 10 “medical misadventures”
And another slice of data reveals the 10 most prevalent medical misadventures in the ObGyn specialty in 2010 (TABLE 3):
- improper performance of a procedure
- no medical misadventure (i.e., no misadventure was identifiable)
- errors in diagnosis
- failure to supervise or monitor a case
- delay in performance of a procedure
- failure to recognize a complication
- surgical foreign body left in a patient after a procedure
- necessary treatment or management was “not performed”
- failure to instruct or communicate with a patient
- medication errors.
The total indemnity paid for these so-called misadventures was more than $136 million.1
TABLE 3
Putting the dollars in perspective
PIAA also collects data on the number of claims reported, and indemnity dollars paid, for other specialties.
“Of the 28 specialty groups included in the database, ObGyn ranks second”—behind internal medicine—“in the number of claims closed between 1985 and 2010,” a PIAA report notes. The ObGyn specialty also ranks second—behind dentists—in the percentage (35%) of those claims that were paid (for dentists, the figure was 46%). Obstetrics and gynecology was also responsible for the single largest indemnity payment—$13,000,000.1
Medical liability: A national disaster?
According to figures from the PIAA Data Sharing Project, an ongoing claim study that includes 22 PIAA member companies, $19.7 billion in losses (total indemnity plus expenses) were reported during the period from 1985 through 2008. Those losses represented approximately 25% of the physicians who were practicing during that time.
“So if you multiply that $19.7 billion figure by four”—to extrapolate it to the full spectrum of physicians practicing between 1985 and 2008—“you’ve got almost $80 billion coming out of the pockets of the doctors in this country,” says Dr. Stanchfield. If you compare that $80 billion figure to the World Trade Center disaster, which involved approximately $42 billion in losses, the need for federal tort reform is highlighted, he says. In 24 years, the physicians “in this country have paid for almost two World Trade Center disasters. That’s an incredible dollar cost.”
From Dr. Stanchfield’s perspective as a risk manager, the best thing physicians can do to protect themselves is to practice medicine wisely.
“One of our speakers used to say, ‘Look, just practice good, middle-of-the-road medicine. Don’t get yourself out on the fringes where you’re doing something questionable. Just practice rock-solid, conservative, safe medicine.’”
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