Obstetrical Malpractice Cases
CRICO Top Responsible Services
180 160 140
number of cases
$120,000,000
Claim Count
Total Incurred
$100,000,000 $80,000,000
100 80 60 40 20 0
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$60,000,000 $40,000,000 $20,000,000 $0
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N = 1,279 PL cases asserted 1/1/02-6/30/07. Total Incurred = aggregate of expenses, reserves, and payments on open and closed cases. Surgery Subspecialty = Bariatric Surgery, Colorectal Surgery, Cardiac Surgery, Otorhinolaryngology (with Plastic), Hand Surgery, Ophthalmology, Otolaryngology (No plastic), Plastic (NOC), Pediatric Surgery, Oncology (Surgical), Thoracic Surgery, Urology Surgery, Vascular Surgery, Transplant, Podiatry. Medicine Subspecialty = Cardiology, Dermatology, Endocrinology, Gastroenterology, Genetics, Geriatrics, Hematology, Hospitalist, Immunology and Allergy, Infectious Disease, Oncology (Medical), Nephrology, Neurology, Physical Medicine/Rehabilitation, Pulmonary Disease, Rheumatology.
total incurred
120
Comparing Top Responsible Services
20% 18% 16% 14%
% of cases
12% 10% 8% 6% 4% 2% 0%
Ge ne ra Me d Su rg OB /G Nu r Or th Ra dio Em erg Ge ne y Ps yc ge ry
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N(CRICO)=1,279 PL cases asserted 1/1/02-6/30/07. N(CBS Peers)=1,505 PL cases asserted 1/1/02-6/30/07. CBS Peers are Cassatt, Medstar, Princeton and Stanford.
Comparing Case Severity
100% High Medium Low
80%
60%
40%
20%
0% CRICO Peers
N (CRICO)=91 PL cases asserted 1/1/02-6/30/07 with a responsible service of Obstetrics or Midwifery. N (CBS Peers)=162 PL cases asserted 1/1/02-6/30/07 with a responsible service of Obstetrics or Midwifery. CBS Peers are Cassatt, Medstar, Princeton and Stanford.
CRICO Obstetrics-related Cases
By Assert Year
20
20
By Loss Year
High Medium Low
15
High Medium Low
Statute of Limitations
15
10
10
5
5
0
0
2002
2003
2004
2005
2006
2007
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
N=91 PL cases asserted 1/1/02-6/30/07 with a responsible service of Obstetrics or Midwifery. Severity Scale: High= Death, Permanent Grave, Permanent Major or Permanent Significant Medium= Permanent Minor, Temporary Major or Temporary Minor Low= Temporary Insignificant, Emotional Only or Legal Issue Only
CRICO Defendants Named
Other 0.4%
Organization 24.9%
MD Staff 41.0%
RN 13.3% MD Fellow 0.4% MD Resident 11.6% NP 0.4% Midwife 8.0%
N=249 defendants named in 91 PL cases asserted 1/1/02-6/30/07 with a responsible service of Obstetrics or Midwifery.
CRICO Top Risk Management Issues
Issue Selection/management of therapy—labor and delivery Communication among providers—patient condition Misinterpretation of diagnostic studies Selection/management of therapy—pregnancy Failure/delay ordering diagnostic test % of cases* 62% 23% 20% 16% 12%
Failure/delay obtaining consult/referral
Communication—language barrier
11%
11%
*A case may have multiple issues identified.
N (CRICO)=91 PL cases asserted 1/1/02-6/30/07 with a responsible service of Obstetrics or Midwifery.
CRICO Top Final Diagnoses
# Cases IUFD/Stillbirth Neonatal death Brachial plexus injury 15 11 8
Intrauterine hypoxia/birth asphyxia
Neonatal subdural bleed Cerebral palsy
7
5 5
Retained foreign body
Newborn seizures Failure to diagnose fetal genetic syndrome Neonatal intraventricular bleed
4
4 4 3
N=91 PL cases asserted 1/1/02-6/30/07 with a responsible service of Obstetrics or Midwifery.
Comparing Case Rate
14 12
Cases per 10,000 Births
Peers
10 8 6 4 2 0
2002 2003 2004
Assert Year
CRICO
2005
2006*
N (CRICO)=91 PL cases asserted 1/1/02-6/30/07 with a responsible service of Obstetrics or Midwifery. N (CBS Peers)=162 PL cases asserted 1/1/02-6/30/07 with a responsible service of Obstetrics or Midwifery. CBS Peers are Cassatt, Medstar, Princeton and Stanford. * The 2005 births were used for 2006 due to incomplete birth data.
CRICO Disposition of Closed Cases
Defense Verdict 29% Dropped/Denied/ Dismissed 38%
Plaintiff Verdict 4% Settled 29%
N=91 PL cases closed 1/1/02-6/30/07 with a responsible service of Obstetrics or Midwifery.
% of Cases Closed with Indemnity Payment
100%
80%
% of cases
60%
Peers
40%
20%
CRICO
2002 2003 2004 2005 2006 2007
0%
close year
N (CRICO)=91 PL cases closed 1/1/02-6/30/07 with a responsible service of Obstetrics or Midwifery. N (CBS Peers)=185 PL cases closed 1/1/02-6/30/07 with a responsible service of Obstetrics or Midwifery. CBS Peers are Cassatt, Medstar, Princeton and Stanford.
CRICO Average Indemnity Payments
$2,000,000 $1,800,000 $1,600,000 $1,400,000 $1,200,000 $1,000,000 $800,000 $600,000 $400,000 $200,000 $0
2002
2003
2004
2005
2006
2007
close year
N(CRICO)=30 PL cases closed with payment 1/1/02-6/30/07 with a responsible service of Obstetrics or Midwifery.
CRICO Summary
CRICO # Physicians with a specialty of Ob/Gyn (297) in 2006 and # Midwives (64) insured in 2006 Cases asserted 2002–Q2 2007 (responsible service of OB or Midwifery) # cases asserted Average indemnity incurred Cases closed 2002–Q2 2007 (responsible service of OB or Midwifery) # cases closed % cases closed with payment 91 33% 91 $1,270,672 361
Average indemnity payment
# cases closed with payment >$1 million
$1,243,767
14