Medical Professional Liability and the Delivery of Obstetrical Care Volume I (1989) / Chapter Skim
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1 Summary of Conclusions and Recommendations
1 Summary of Conclusions and Recommendations
Pages 1-13
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Much less attention has been devoted to analyzing the effects of medical professional liability issues on the delivery of health care and the practice of medicine. MEDICAL PROFESSIONAL LIABILITY CONTROVERSY There is no consensus about the cause of the medical professional liability controversy in the health care delivery system, except that most observers agree it is unlikely that any single factor is responsible.
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The committee devoted much of its resources to investigating and documenting the problems posed by professional liability in obstetrics, both in the delivery of and access to care and in the way in which obstetrics is practiced. iThe term "claim" is used throughout this report to refer generally to complaints lodged with medical malpractice insurers alleging violations of the standard of care.
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Acknowledging that the problems posed by medical professional liability are part of a broader controversy, the committee nevertheless concluded that medical professional liability exhibits special features that will most likely require unique solutions. Accordingly, the committee evaluated data relating only to the medical professional liability problem and evaluated proposed legal solutions only as they addressed medical professional liability issues.
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ETHICAL CONSIDERATIONS Ethical issues loom large in any serious policy debate of the medical professional liability problem in obstetrics, yet they are among the most difficult issues to resolve in a morally pluralistic society. As a result, there is a tendency to concentrate on procedural, pragmatic, and consensus-forming positions rather than on more substantive ethical issues, about which disagreement is likely to occur.
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It does believe, however, that any permanent solution to the obstetrical medical professional liability problems outlined in this report will require that health professionals, policymakers, and legislators consider carefully what the ethical obligations of obstetrical providers are in such matters ensuring equity in access of care. STUDY FOCUS AND FINDINGS The committee grouped its inquiry into six areas: (1)
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From an examination of 21 state studies and 5 national studies addressing professional liability issues and their effects on family physicians, the committee concluded that the proportion of family physicians giving up obstetrical practice is even higher than the proportion of obstetricians. The delivery of obstetrical services in rural areas is seriously threatened by this development.
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Further, every relevant study identified by the committee found that physicians are increasingly reporting a reduction in their Medicaid caseloads, at least in part because of professional liability concerns. Because Community Health Centers and Migrant Health Centers are a vital source of obstetrical care for low-income women, the committee decided early in its deliberations to commission a survey of the effects of medical professional liability issues on the delivery of care in these centers.
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They report that the current legal climate makes it difficult to provide residents with appropriate responsibility and that the cost of medical malpractice insurance for obstetricians is impeding the ability of academic medical centers to hire obstetrical faculty. Obstetrical Malpractice Insurance Because of the controversy surrounding the role of the insurance industry, the committee commissioned an outside study of the structure of the obstetrical malpractice insurance market, the availability and affordability of insurance, and the actual effect of the insurance industry on the obstetrical malpractice problem and its solution.
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The Tort System and Its Alternatives In the course of its inquiry into the legal system the committee examined the role of the tort system in the medical professional liability problem, evaluated the data relating to the efficacy of tort reforms, and studied various proposed alternatives to the tort system. Although these are important issues in the medical malpractice debate, because of limited time and resources the committee did not examine the effectiveness of state licensing boards and peer review activities or the complex
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Moreover, the committee found that the threat of liability is having far-reaching and severe effects on access to and availability of obstetrical care, that the threat of liability is causing a variety of medically inadvisable procedures to be overused, and that both health care providers and patients have lost confidence in this method of resolving claims related to injuries occurring in the course of medical treatment. Studies to date suggest that, although the tort reforms implemented since the mid-1970s have slowed the increase in claims frequency and magnitude in some states, they have not had a dramatic effect on the costs, either direct or indirect, of the tort litigation system for resolving obstetrical malpractice claims.
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The committee recommends that states evaluate these three proposals for implementation on a limited basis: the no-fault designated compensable events scheme (including the variants enacted in Virginia and Florida providing no-fault compensation for certain neurologically impaired infants) , the AMA-Specialty Society's fault-based administrative system, and legislation authorizing the use of private contracts to stipulate arrangements for resolving medical professional liability disputes between providers and patients.
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Although the committee believes that efforts to develop alternatives to the tort system hold the most promise, it also urges states to address immediately the disruptions and deterioration in maternity services for the poor that have been worsened by professional liability concerns. The committee recommends that the states and the federal government consider several short-term solutions simultaneously with their efforts to resolve the medical professional liability crisis generally.
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SUMMARY OF CONCLUSIONS AND RECOMMENDATIONS 13 to reduce the professional liability risk of providers of obstetrical services to poor women. The committee recommends that, until the obstetrical professional liability issue is fully resolved, states should implement programs that would either indemnify or subsidize the medical professional liability premiums of obstetrical providers who participate in Medicaid or otherwise provide care to low-income women.
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