Over half of obstetric claims due to substandard care

Altering routine practice patterns could alleviate more than half of hospital litigation costs related to obstetric malpractice, according to a report published in the December issue of Obstetrics and Gynecology.

Steven L. Clark, MD, of the Hospital Corporation of America in Nashville, TN., and colleagues reviewed 189 perinatal legal claims, totaling $168 million, to examine how the cost of obstetric malpractice suits might be reduced. Each claim was evaluated using three criteria: whether substandard care caused the adverse outcome; what practice changes could have avoided that adverse outcome; and whether inadequate documentation caused payment to be made despite missing objective evidence. All of the claims were closed and had occurred between 2000 and 2005.

The researchers report that 70% of the obstetric-related claims were associated with substandard care, accounting for 79% of the total $168 million. Several adverse outcomes-including non-vaginal birth after cesarean, VBAC-related fetal monitoring, maternal injury, and shoulder dystocia-would have been avoidable with the implementation of four practice patterns, including delivery in a facility with constant obstetric coverage, improved adherence to protocols for high-risk medication, a more conservative approach to VBAC, and use of a comprehensive standardized procedure for cases of shoulder dystocia, the report indicates.