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Florida Liability Lowdown

VIEWS: 14 PAGES: 3

									 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

								
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