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Florida Liability Lowdown Overview of the 2009 ACOG Survey on professional liability claims in both obstetrics and Professional Liability gynecology, although these claims have been limited to those opened or closed or both between January 1, The 2009 Survey on Professional Liability is the 2006 and December 31, 2008. tenth survey conducted by the American College of Obstetricians and Gynecologists since 1983 to assess The data reported in this Liability Lowdown pertains the effects of professional liability litigation and only to Florida unless otherwise noted. related liability insurance issues on the practice of obstetrics and gynecology. The entire population of PHYSICIANS' DEMOGRAPHICS ACOG Fellows and Junior Fellows in practice in the The majority of Florida survey respondents were male 50 states, the District of Columbia, and Puerto Rico (59.0%) which is higher than the national average were surveyed and, for the first time, the (52.6%). questionnaire was available exclusively online. Junior Fellows still in residency and fellowship The average age of Florida respondents was 49.8 years (subspecialty) training, Founding Fellows, Life compared to the national average of 49.2. Fellows, members of the Armed Forces District, and members living outside the 50 states, the District of PATIENT CARE Columbia, and Puerto Rico were excluded from the Florida respondents reported providing the following survey. type of patient care: The survey questionnaire was developed and tested Obstetric and gynecologic care 70.5% with select ACOG Fellows and staff members. The Gynecologic care only 24.8% questionnaire included segments on demographics, Obstetric care only 3.2% patient care, liability claims experience, and practice Previously offered obstetric care 96.6% changes associated with the cost of liability insurance and the fear of litigation. In total, 31,665 Fellows and On an annual average basis, Florida respondents Junior Fellows in practice were surveyed. The final reported performing the following types of procedures: 5,644 completed surveys were coded and analyzed using Statistical Package for Social Sciences (SPSS). Total deliveries 225 Data analysis yielded frequency distributions and Vaginal 138 percentages for each of the survey questions. The Cesarean 77 final data represents only those 5,644 ob-gyns who VBACs 10 responded to the survey. Hysterectomies 49 Other surgical procedures 110 Similar to the nine previous ACOG national surveys Surgical Assists 55 (1983, 1985, 1987, 1990, 1992, 1996, 1999, 2003, and 2006), this survey addresses the impact of professional liability on the practice of obstetrics and PROFESSIONAL LIABILITY INSURANCE gynecology. It provides continuing trend data about A lower percentage of Florida ob-gyns reported being ob-gyns’ professional liability experiences and covered by professional liability insurance than the changes in their practice patterns. For all purposes, national average (59.4% vs. 95.7% respectively). except analysis of claims, the survey interval is January 1, 2006 through December 31, 2008. Claims Claims-made coverage 62.7% themselves may have a duration which extends Occurrence coverage 29.5% beyond the survey interval. Similar to the previous Another type or self-insured 7.9% surveys, the 2009 survey includes data on DEPARTMENT OF THE AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS PROFESSIONAL LIABILITY/RISK MANAGEMENT 409 12TH STREET, SW, PO BOX 96920, WASHINGTON, DC 20090-6920 2 CHANGES IN PRACTICE AS A RESULT OF THE CLAIMS EXPERIENCE JANUARY 1, 2006 AFFORDABILITY AND/OR AVAILABILITY OF THROUGH DECEMBER 31, 2008 PROFESSIONAL LIABILITY INSURANCE Respondents of the 2009 survey were asked a series of The 2009 Survey on Professional Liability asked questions on claims that were opened and/or closed whether ob-gyns had made any practice changes since during the interval January 1, 2006 through December January 2006 because of the affordability and/or 31, 2008. Of the ob-gyns who responded from Florida, availability of professional liability insurance. 44.5% reported one or more such claims during that period. A higher percentage of Florida ob-gyns reported having made one or more following changes to their practice One claim 31.6% than the national average (77.7% vs. 59.2%). Two claims 11.5% Three claims 0.5% Obstetric Practice Changes Four or more claims 1.0% Stopped offering/performing VBACs 36.0% Decreased number of high-risk obstetric 34.5% Of those claims, 69.7% involved obstetric care, and patients 30.3% were related to gynecologic care. Increased number of cesarean deliveries 31.7% Decreased number of total deliveries 14.0% Obstetric Claims Stopped practicing obstetrics 9.0% Florida survey respondents reported on a total of 85 obstetric claims. The most frequent primary allegations included: Gynecologic Practice Changes Decreased gynecologic surgical procedures 21.9% Neurologically impaired infant 30.6% Stopped performing major gynecologic 8.3% Other infant injury – major 15.3% surgery Stillbirth/neonatal death 14.1% Stopped all surgery 0.4% Delay in or failure to diagnose 11.8% Retirement Other Obstetric Factors Retired from medical practice 3.0% Respondents were asked to identify other factors that applied to their claims. The most frequent that applied In addition to the changes shown above, 5.4% of ob- to obstetric claims included: gyns in Florida reported they had liquidated holdings, accessed savings, or secured a loan to fund liability Shoulder dystocia/brachial plexus injury 27.1% insurance premium increases. Electronic fetal monitoring 24.7% Actions on non-physician providers 12.9% PROFESSIONAL LIABILITY CLAIMS Lack of communication among providers 11.8% EXPERIENCE Preeclampsia 11.8% In 2009, 90.9% of Florida respondents indicated they had at least one professional liability claim filed against Gynecologic Claims them during their careers. Survey respondents reported on a total of 37 gynecologic claims. The most frequent primary The average number of claims filed against Florida allegations included: survey respondents during their careers was 2.62 compared to the national average of 2.69. Delay in or failure to diagnose 24.3% Patient injury – minor 21.6% One claim 17.8% Patient death 18.9% Two claims 28.3% Patient injury – major 13.5% Three claims 15.7% Four or more claims 29.1% In 2009, 33.5% of Florida ob-gyns reported that they had at least one professional liability claim filed against them as a result of care rendered during their residency. DEPARTMENT OF THE AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS PROFESSIONAL LIABILITY/RISK MANAGEMENT 409 12TH STREET, SW, PO BOX 96920, WASHINGTON, DC 20090-6920 3 Other Gynecologic Factors CHANGES IN PRACTICE AS A RESULT OF Florida respondents were asked to identify other factors THE RISK OR FEAR OF PROFESSIONAL that applied to their claims. The most frequent factors LIABILITY CLAIMS OR LITIGATION that applied to gynecologic claims included: Survey respondents reported making the following changes because of the risk or fear of medical Surgical complications 42.5% professional liability claims or litigation: Hysterectomy-related 24.3% Laparoscopic procedure 18.9% Obstetric Practice Changes Medication related complication 13.5% Stopped offering/performing VBACs 44.2% Decreased number of high risk obstetric 43.9% Claim Outcomes patients Florida respondents reported on the outcomes of all ob- Increased number of cesarean deliveries 37.1% gyn claims closed during the survey interval. These Decreased number of total deliveries 18.7% included: Stopped practicing obstetrics 9.4% Settled with payment on behalf of the ob-gyn 56.3% Dropped or settled without any payment on 29.5% Gynecologic Practice Changes behalf of the ob-gyn Decreased gyn surgical procedures 24.8% Closed by way of a jury or court verdict 9.9% Stopped performing major gyn surgery 9.4% Closed through arbitration or other 4.2% Stopped all surgery 1.1% alternative dispute resolution mechanism Retirement Characteristics of Co-Defendants Retired from medical practice 3.0% Florida ob-gyns reported on co-defendants, which included: CONCLUSION Hospital 50.0% • 80.0% of ob-gyns have made one or more changes Other ob-gyn associated with practice 26.2% to their practice as a result of the risk or fear of Nurse 17.2% professional liability claims or litigation. Other ob-gyn not associated with practice 12.3% • Over two thirds (77.7%) of ob-gyns have made Nurse midwife 9.0% one or more changes to their practice as a result of the affordability and/or availability of professional liability insurance. August 2009 DEPARTMENT OF THE AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS PROFESSIONAL LIABILITY/RISK MANAGEMENT 409 12TH STREET, SW, PO BOX 96920, WASHINGTON, DC 20090-6920
"Florida Liability Lowdown"