Pricey business delivering babies may result in fewer OB/GYN doctors in the future

By Megan Maughan Roe

December 13, 2004 | Barry Noorda loves delivering babies.

However, soon he may have to change his occupation.

"It’s your very life and the life of your family that you’re putting at risk,

" Noorda said. "Why would you do that to yourself?

Seven years ago, Noorda had to pay $20,000 per year for his medical malpractice insurance as an obstetrician/gynecologist. Today, he has to pay $70,000.

"Let’s say next year (the insurance companies) decide it’s $160,000. Then I’m gonna quit," Noorda said.

"All the insurance that patients paid would also have to double. That’s not going to happen. They could take you right out of business.

According to the Doctors for Medical Liability Reform (DMLR) web page, of 106 Utah members of the American College of Obstetricians and Gynecologists surveyed, 15 have already stopped practicing obstetrics, and another 23 plan to do so within five years, citing liability and insurance costs as the mains
reasons.

In a Capitol Hill press conference in February, Sen. Orrin Hatch said, "Over the past two years, only three University of Utah medical students out of more than 200 chose obstetrics for their residency programs. And in 2002, not one student entered obstetrics. Not one student.

Hatch said graduates are not choosing the OB/GYN profession because they know they will have to pay "outrageously high" professional liability insurance premiums. They also know that they will probably be sued at least once, Hatch said.

Noorda said the average amount nationally that OB/GYN’s pay in medical malpractice insurance each year is $50,000 to $60,000. He said Utah OB/GYN’s have to pay an average of $80,000 per year.

The American College of Obstetricians and Gynecologists’ web page tagged Utah as being a "Red Alert" state where "crisis is brewing." States such as Nevada and Florida are also "Red Alert" states but are already in crisis. Noorda said he knows a doctor in Las Vegas who had to quit when his insurance
premiums reached $234,000.

There are a couple of predominant reasons why insurance premiums have become so high and keep rising, Noorda said. The amount of lawsuits continues to rise, and the amount of money claimed per lawsuit has increased. He said the litigants sue for "ridiculously high amounts."

"It’s hard to place a value on human life or damages, but a jury sees someone there with whatever horrible thing happened. Their natural instinct is, 'Oh my goodness, we need to give them as much as possible,’" Noorda said. "They decide this poor person needs $15 or $20 million."

Since 1995, the frequency of claims against Utah physicians has increased by almost 25% and the average amount of money paid for those claims has increased 100%, according to the DLMR web page.

According to the Salt Lake Tribune, a Tooele county jury awarded $1.25 million to Athan Montgomery, a boy whose brain was damaged during a negligent delivery by physician Gregory Drezga. Utah has a cap of $250,000 on "non-economic damages" so the award was cut down to that amount, but the jury also awarded more than $1 million for Athan’s medical bills and care, according to the Tribune.

Noorda said the lawsuits are not only making his malpractice insurance premiums go up, they are making hospitals charge more for health care because hospitals also have to pay insurance. Moreover, people are paying more for health insurance.

"Everyone thinks that that money magically comes from the doctor or the insurance company," Noorda said. "Well, it comes from all of us. We all end up paying those type of liability claims.

So why is an OB/GYN’s malpractice insurance higher than, say, a brain or heart surgeon’s?

"Appropriately we all put incredible value on our children, But the natural expectation is, 'this kid’s gonna be perfect,’" Noorda said. "The first thing they say when a baby comes out is 'count it’s fingers and toes."

Noorda said OB/GYN’s are often blamed for health problems that might be related to a birth accident or trauma. The doctor is normally considered responsible for these problems that may have occurred at birth, until the baby turns 18 years of age.

Noorda said OB/GYN’s are also constantly performing deliveries "all of the time" on babies who are expected to be perfect, while brain or heart surgeons only do a few surgeries a week on someone who already has a problem.

Emily Blakesly holds her 2 1⁄2 -month-old baby close to her chest. As tiny Mary Ann softly whimpers, Blakesly explains the complications that arose while she was having her baby. While in labor, her OB/GYN told her that Mary Ann might be suffocating because the umbilical cord was wrapped around her neck. Blakesly’s doctor knew this meant he must deliver the baby quickly. Blakesly
said she pushed, but the baby’s shoulders would not come out.

Nearly half a decade ago, Blakesly’s grandmother had the same problem giving birth to her uncle. When he was finally delivered, his collarbone was broken.

To avoid the same fate for Mary Ann, the doctor made some quick decisions. He had the nurse push on Blakesly’s pelvis, while he twisted Mary Ann and pulled her out.

Mary Ann has had no abnormalities due to the difficult birth. Blakesly said she trusted her doctor and felt if her baby had been injured or killed during birth, she would not have blamed him. However, if a doctor she wasn’t familiar with had made a mistake while delivering her baby, she would be mad.

"I would definitely be angry," Blakesly said, "but unless I thought there was negligence on the part of the doctor, I wouldn’t sue."

Noorda said there are many pressures on OB/GYN’s from different angles. He is monitored closely on the amount of caesarean sections he performs. He said the most common reason why an obstetrician is sued, is for not having done a caesarean section early enough or not having done it at all. He said most
people want to have their baby naturally so he has to decide whether to do what they want or do what is needed.

One birth abnormality is cerebral palsy. Noorda said it can be related to birth complications, but most cases of the disorder have nothing to do with obstetrical care. People blame the doctor because of the association the disorder has with birth, Noorda said. Since doctors are sued more often and for more money because of birth defects like cerebral palsy, their malpractice insurance premiums are skyrocketing.

So what affect do these high insurance premiums for OB/GYN’s have on Utah?

"I know my home state. Utahns are not going to stop having babies," Hatch said. "But if we don’t do something now to stop this trend, the number of pregnant women in Utah and similar states who have no one to deliver and provide medical care for their babies is going to increase dramatically.

Noorda said the state legislature is considering adopting a plan to let lay midwives deliver babies.

Webster’s Medical Dictionary defined a lay midwife as a midwife who has entered the profession as an apprentice to a practicing midwife rather than attending a formal school program

"A lay midwife is someone who says 'you know what, I want to deliver babies, I think I know what’s going on and I’m going to start doing that at home,"

Noorda said. "What’s their malpractice insurance? Well guess what, it’s zero."

A birth performed at home is four times more likely to result in death, Noorda said. He said a home delivery with a lay midwife is a "very risky thing."

Noorda said one way to bring premiums down is for doctors to be more careful.

"I think doctors need to be more strict about monitoring themselves," Noorda said. "The trial lawyers’ argument is, 'Nobody checks and balances you, and if we didn’t sue you, you would just go around doing horrible things.'

Noorda said he’s never met a doctor who intentionally did something wrong in practice. He said the lawsuits against doctors normally allege they purposefully cause complications. Intermountain Health Care and the OB/GYN Committee Board are strict about analyzing doctors’ track records. They asked an OB/GYN to leave the community a few years ago because of his mistakes, Noorda said.

As much as Noorda loves delivering babies because it’s such a positive thing, he hates when it turns negative.

"I hate bad outcomes," Noorda said. "I’d love to tell you it’s always perfect, but it’s not. It’s hard to watch. I like birth, I don’t like death."

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