Reducing Obstetric Litigation Through Alterations in Practice Patterns

malpractice claims might be reduced by adherence to a limited number of specific practice patterns. METHODS: We examined all 189 closed perinatal claims between 2000 and 2005 from a single, large, professional liability insurer. Each case was subjected to three separate analyses: 1) whether the adverse outcome was caused by substandard care, 2) what changes in practice likely would have avoided the adverse out-come, regardless of standard-of-care considerations, and 3) to what extent did substandard documentation lead to payment in cases in which there was no objective evidence of substandard care. RESULTS: Seventy percent of claims involving obstetric practice (accounting for 79 % of all costs) involved substandard care. Payments in 85 % of cases involving non–vaginal birth after cesarean (VBAC) fetal monitor-ing, 16 % of maternal injury cases, 80 % of cases involv-ing VBAC, and 54 % of shoulder dystocia cases were avoidable had four specific practice and documenta-tion patterns been followed. CONCLUSION: Most money currently paid in conjunc-tion with obstetric malpractice cases is a result of actual substandard care resulting in preventable injury. Well more than half of hospital litigation costs might be avoided if physician practice included: 1) delivery in a facility with 24-hour in-house obstetric coverage; 2) adherence to published high-risk medication protocols; 3) a more conservative approach to VBAC; and 4) use of a comprehensive, standardized procedure note in cases of shoulder dystocia