Professional liability payments in obstetrics and gynecology

AW Cohen, W Hill, JT Parer, P Ogburn, R Stiller, J Yankowitz, E Amon, JE Ferguson, Medicine Medical Legal Subcommittee — 2006

As a subspecialist in maternal–fetal medicine, I found Dr. Barbieri's paper on professional liability payments made on behalf of subspecialists1 very intriguing but in significant conflict with yet-to-be-published data presented in abstract form at the Society for Maternal–Fetal Medicine's Annual Meeting (Cohen A, Hill W, Parer J, Ogburn P, Stiller R, Yankowitz J, et al. Professional liability claims and maternal fetal medicine specialists: MFM compared to general obstetrician gynecologists [abstract]. Am J Obstet Gynecol 2005;193:S13.).

In his paper, Dr. Barbieri reviewed professional liability payment data from the Massachusetts Board of Registration in Medicine. Based only on claims-paid data, he found that during a 10-year period, only 3.7% of maternal–fetal medicine specialists had at least one claim paid. In fact, his report indicated that only one maternal–fetal medicine specialist of 27 were sued in 10 years. In looking at Table 2, it appears that this one specialist was sued twice and accounted for all of the paid claims in the state for maternal–fetal medicine specialists over a 10-year period. This is a striking finding and would seem to indicate that there is no professional liability crisis in Massachusetts for maternal–fetal medicine specialists.

In contrast, a recent national survey done by the Society for Maternal Fetal Medicine found that almost 80% of all maternal–fetal medicine specialists have been sued and they have on average 3.9 cases against them (50% greater than a general obstetrician–gynecologist). This survey also indicated that maternal–fetal medicine specialists have a higher percentage of cases resulting in a plaintiff's verdict (30%) than is found for generalists (19%)2 when the case is tried. The experience from Massachusetts does not seem to be consistent with the experience of maternal–fetal medicine specialists across the country.

Based on our maternal–fetal medicine survey data, 75% of maternal–fetal medicine physicians are hospital-based physicians and are employed by the hospital. We question if this fact has altered Dr. Barbieri's determination of the true magnitude of the medical–legal crisis for maternal–fetal medicine specialists. The defendant in some of these cases may be listed as the hospital and not the physician, and would therefore be excluded from the data recorded in the Massachusetts Board of Registration. In addition, an early settlement by the hospital in a medical–legal case may not appear in these data. Clearly, claims-paid data does not include legal actions that are either subsequently dismissed or where the verdict is found for the defense. Both of these situations still add to the physician's legal costs, personal stress, and greater tendency to change one's medical practice to avoid potential lawsuits in the future.

We champion Dr. Barbieri's efforts to provide further information on the malpractice crisis but are concerned that the methodology used in the study does not portray an accurate picture of the magnitude of the problem for maternal–fetal medicine specialists or other groups.