Since the initiation of comprehensive collaborative care and health care safety protocols in the last 10 plus years, there is evidence that medical liability payments may be diminishing in obstetrics and gynecology when patient safety measures are instituted. The author reviewed Oregon’s malpractice data from 1996 to 2010 and discusses the relationships between liability payments and utilization of safety protocols.
My clinical practice in obstetrics and gynecology began in 1973, but my secondary interest in peer review and administrative oversight evolved over many years, culminating with my selection as the medical director of the Oregon Medical Board in 1995. This interest in administrative oversight continued after my retirement when I was accepted as a public member of the Oregon State Bar Board of Governors in 2003 to a 4 year term.
During my career I observed, with interest and frustration, the evolution of what I saw as an increasing divide between efforts to improve patient safety and quality of care on the one hand and malpractice prevention, defensive medicine, and tort reform on the other. Although it is totally understandable for physicians to respond to the threat and costs of litigation, my concern has been that this somewhat divided approach to malpractice protection has at times been counterproductive, expensive, and detrimental to our relationship with our patients and may not be the most efficient or cost-effective way to reduce litigation. In the last 10 or more years, medicine has been involved in a movement emphasizing patient safety and professional collaboration that will hopefully have a significant impact on improved outcomes, reduction of adverse events, and a reduction in physician liability.
Oregon placed a cap on noneconomic liability damages in 1987. However, in 1999 the Oregon State Supreme Court found that the capping of noneconomic damages was unconstitutional, and in 2007 the Oregon Supreme Court also found that Oregon’s liability cap for public bodies including their employees violated the Oregon Constitution, which substantially changed the Oregon Health Science University’s liability exposure. No other legislative actions involving medical tort reform or alternative dispute resolution have been enacted in Oregon since the 1999 and 2007 Supreme Court actions outlined in the previous text.
The Oregon Medical Board receives all complaints and malpractice claims involving Oregon’s 12,000 active physician licensees. Insurance companies reported 4692 medical malpractice claim files were closed for the 15 year period 1996-2010. Oregon’s closed malpractice claims are outlined in Table 1 and the indemnity paid for the years 1996-2010 closed claims are listed in Table 2 . Table 3 lists the gynecological and obstetrical categories of claims paid more than $250,000. There was a rapid rise in both numbers of closed claims and indemnity paid from 1999-2001 through 2002-2004 followed by a steady decline, especially obstetrics-gynecology paid claims, over the following 6 years. Obstetric payments were the lowest in 2008-2010 since 1996-1998.
| Years | 1996-1998 | 1999-2001 | 2002-2004 | 2005-2007 | 2008-2010 a | 2008 a | 2009 a | 2010 a |
|---|---|---|---|---|---|---|---|---|
| Total closed claims | 1102 | 924 | 1085 | 926 | 658 | 236 | 252 | 170 |
| Total paid claims | 248 | 287 | 311 | 209 | 180 | 70 | 59 | 51 |
| Obstetric closed claims | 36 | 43 | 56 | 52 | 23 | 12 | 7 | 4 |
| Gynecological closed claims | 51 | 50 | 75 | 69 | 47 | 19 | 15 | 13 |
| Paid obstetric claims | 12 | 20 | 30 | 16 | 10 | 4 | 3 | 3 |
| Paid gynecological claims | 19 | 12 | 14 | 22 | 24 | 8 | 5 | 6 |
| Obstetric-gynecologic paid/total claims | 13% | 11% | 14% | 18% | 19% | 17% | 10% | 18% |
| Years | Total obstetrics | Total gynecology | Total claims, obstetrics gynecology | Total, $ |
|---|---|---|---|---|
| 1996-1998 | $2,867,400 | $4,711,899 | $78,336,822 | 10% |
| 1999-2001 | $30,322,774 | $3,764,578 | $142,403,558 | 24% |
| 2002-2004 | $54,373,710 | $3,861,912 | $128,224,690 | 45% |
| 2005-2007 | $22,031,000 | $6,745,943 | $80,640,225 | 24% |
| 2008-2010 a | $8,629,000 | $4,026,697 | $94,488,101 | 13% |
| 2008 a | $2,275,000 | $2,417,697 | $34,592,654 | 14% |
| 2009 a | $5,054,000 | $704,000 | $34,562,683 | 17% |
| 2010 a | $1,345,000 | $905,000 | $23,332,764 | 9% |
| Gynecology | ||||||
|---|---|---|---|---|---|---|
| Closed claims | Total awards | Operative injury negligence | Other complication | Failure to diagnose | Postoperative infection | Other |
| 24 | $19,451,578 | 10 | 2 | 7 | 5 | 0 |
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