Medical professional liability and the delivery of obstetrical care. Vol. 1 / Victoria P. Rostow and Roger J. Bulger, editors ; Committee to Study Medical Professional Liability and the Delivery of Obstetrical Care, Division of Health Promotion and Disease Prevention, Institute of Medicine.

Format:

Book

Author/Creator:

Institute of Medicine (U.S.). Committee to Study Medical Professional Liability and the Delivery of Obstetrical Care.

Contributor:

Rostow, Victoria P.

Bulger, Roger J., 1933-

Series:

Medical professional liability and the delivery of obstetrical care

Language:

English

Subjects (All):

Obstetricians--Malpractice--United States.

Obstetricians.

Physicians' malpractice insurance--United States.

Physicians' malpractice insurance.

Physical Description:

1 online resource (255 p.)

Edition:

1st ed.

Place of Publication:

Washington, D.C. : National Academy Press, 1989.

Language Note:

English

Summary:

This is the first part of an in-depth study focusing on medical liability and its effect on access to and delivery of obstetrical care. The book addresses such questions as: Do liability concerns impede the use of new technologies? Have liability issues affected the physician-patient relationship? Are community health and maternity centers being harmed? What specific remedies are being considered and what are their prospects for success?

Contents:

Medical Professional Liability and the Delivery of Obstetrical Care

Copyright

Chairman's Preface

Contents

1 Summary of Conclusions and Recommendations

MEDICAL PROFESSIONAL LIABILITY CONTROVERSY

PROBLEM MOST ACUTE IN OBSTETRICS

LIABILITY'S BROADER SCOPE

ETHICAL CONSIDERATIONS

STUDY FOCUS AND FINDINGS

Maternity Care in the United States

Availability of Obstetrical Providers

Obstetrical Care for Poor Women and Women Served by Medicaid

Practice of Obstetrics

Obstetrical Malpractice Insurance

The Tort System and Its Alternatives

THE COMMITTEE'S RECOMMENDATIONS

Long-Term Recommendations

Short-Term Solutions

2 Maternity Care in the United States

OBSTETRICAL PRACTITIONERS

Obstetrician-Gynecologists

Family and General Practitioners

Certified Nurse-Midwives

Other Practitioners

FACILITIES OFFERING PRENATAL CARE

Hospitals

Local and State Health Departments

Community and Migrant Health Centers

LABOR AND DELIVERY SERVICES

FINANCING OF MATERNITY CARE

NEED FOR OBSTETRICAL CARE

Evidence of Existing Shortages of Obstetrical Services

Insufficient Prenatal Care

Arrested Decline in Infant Mortality

Inability to Pay for Care

Physician Shortage in Rural Areas

Projected Increase in Need for Obstetrical Services

REFERENCES

3 The Effects of Medical Professional Liability on the Availability of Obstetrical Providers

OBSTETRICIAN-GYNECOLOGISTS

Careers in Obstetrics

Concerns About Professional Liability

Response to Concerns About Liability

Elimination of Obstetrical Practice

Reduced Volume of Obstetrical Care

Reduced Care of High-Risk Women

Trends

FAMILY PHYSICIANS

Malpractice Insurance Costs

Other Economic Factors

Response to Insurance and Liability Concerns.

Elimination of Obstetrical Practice

Adverse Effects on Rural Areas

NURSE-MIDWIVES

Availability and Costs of Professional Liability Insurance

Response to Insurance Problems

Changes in Practice Setting

Changes in Techniques of Practice

4 The Impact of Medical Professional Liability on the Provision of Obstetrical Care to Poor Women and Women Served…

PROFESSIONAL LIABILITY AND OBSTETRICAL CARE UNDER MEDICAID

BACKGROUND: THE ROLE OF MEDICAID IN THE DELIVERY OF OBSTETRICAL CARE

Physician Participation in Medicaid

Reduced Obstetrical Care for the Poor

High Insurance Premiums, Low Reimbursement Rates

Fear of Suit

Professional Liability Concerns and the Reduction of Care

PROFESSIONAL LIABILITY AND OBSTETRICAL CARE IN COMMUNITY AND MIGRANT HEALTH CENTERS

Problems Recruiting Providers

Problems with Access

Reduced Quality of Care and Increased Risk of Suit

Prohibitive Insurance Costs

CONCLUSION

5 The Effects of Medical Professional Liability on the Practice of Obstetrics

CHANGES IN PRACTICE PATTERNS OF INDIVIDUAL PHYSICIANS

THE RISING CESAREAN SECTION RATE

Electronic Fetal Monitoring

History

Regulatory Failure

Results of Randomized Clinical Trials

Effect of EFM on the Frequency of Cerebral Palsy

Electronic Fetal Monitoring, Cerebral Palsy, and Medical Malpractice

Conclusion

PRACTICE PATTERNS IN DEPARTMENTS OF OBSTETRICS

Reported Changes in Practice

Implications for Training

Effects on Careers in Obstetrics

Effects on Access to Care

IMPACT OF MEDICAL PROFESSIONAL LIABILITY ON THE PHYSICIAN-PATIENT RELATIONSHIP

The Importance of Trust

Consequences of the Breakdown in Trust

6 Obstetrical Malpractice Insurance

THE STRUCTURE OF THE MARKET

Limits of Coverage.

Availability of Medical Malpractice Insurance

Physicians

Nurse-Midwives

THE AFFORDABILITY OF PREMIUMS

Premiums as a Percentage of Gross Income

Premiums as a Percentage of Professional Expenses

Premiums as a Percentage of Net Income

Rising Professional Liability Premiums Linked to Increases in Fees

PROFITABILITY OF MEDICAL MALPRACTICE INSURANCE

Insurer Risk Management Activity

Data Gathering and Analysis

Clinical Standard Setting and Protocol Development

Educational Efforts

Discounted Premiums as Risk Management Incentives

PROPOSALS TO ALTER THE MEDICAL MALPRACTICE INSURANCE SYSTEM

Spreading the Costs of Coverage Over a Wider Base

Limiting the Number of Claims

Limiting the Amount of Awards

Experience Rating of Physicians for Medical Malpractice

7 The Legal System: The Committee's Findings and Proposals for Change

THE TORT SYSTEM

Tort Reforms: The Committee's Findings

TORT REFORM: THE COMMITTEE'S RECOMMENDATIONS

ALTERNATIVES TO THE TORT SYSTEM

No-Fault Compensation for Certain Events

Virginia's Compensation System for Birth-Related Injuries: A Case Study of DCE

The AMA-Specialty Society Medical Liability Project

Claims Resolution Function

Credentialing and Disciplinary Functions

Codification of the Legal Elements of Medical Liability

Private Contracts

Economic Damage Guarantee (Moore-Gephardt Proposal)

Social Insurance

OTHER NEEDED REFORMS

Expansion of the National Health Service Corps

Extension of the Federal Tort Claims Act Coverage

Liability Coverage for Physicians Providing Public Health Services

8 Principal Findings and Recommendations

PRINCIPAL FINDINGS

Medical Malpractice Insurance Trends and Their Implications

Effects of Professional Liability Concerns on Access to Care.

Effects of Professional Liability Concerns on the Practice of Obstetrics

Effects of Professional Liability Concerns on the Physician-Patient Relationship

RECOMMENDATIONS

Glossary

Bibliography

CASES, REGULATIONS, AND STATUTES

Appendixes

Appendix A Summary of Methodology Used in Studies of Changes in Obstetrical Practice

Survey Population

Samples

Response Rates

Phraseology

Appendix B Summary of Study Results Regarding Changes in Obstetrical Practice

Appendix C Summary of Study Results Regarding Professional Liability, Family Practitioners, and Rural Areas

Appendix D State and National Liability Surveys Summarized

State Studies

National Studies

Appendix E Survey of Selected Risk Management Activities

Appendix F Risk Management Activities and Experience Rating Policies of Selected Malpractice Insurers

Appendix G Possible Modifications to the Virginia Neurological Birth-Related Injury Compensation Act

Members of the Committee

Index.

Notes:

Bibliographic Level Mode of Issuance: Monograph

Includes bibliographical references and index.

ISBN:

9786610214693

9780309185950

0309185955

9781280214691

1280214694

9780309543002

0309543002

9780585177519

0585177511

OCLC:

726823034