A. 344a Paulin / S. 5153a Grisanti

MEMORANDUM IN SUPPORT

A.344a (Paulin)                                  Health Committee 01/5/2011
                                                            Reported to Ways and Means 04/12/11

S.5153a (Grisanti)                              Health Committee 04/12/11

ACT to amend the public health law and the insurance law, in relation to premium reduction for obstetric practitioners who complete a risk management strategies obstetric course

The American Congress of Obstetricians and Gynecologists (ACOG) District II has for many years developed and implemented a statewide quality agenda that promotes evidence based improvements in obstetric and gynecologic patient safety driven by practice guidelines, best practiced, evidence-based medicine, and experience. ACOG has explored safety and quality opportunities as well as developed and implemented educational initiatives that improve outcomes and reduce liability premiums for ob-gyns in New York State. For example ACOG has recently completed work on the following:

- Implementation of evidence-based guidelines and clinical protocols that address:
    1. Induction and Augmentation of Labor
    2. Management of Maternal labor
    3. Management of Shoulder Dystocia
- Comprehensive peer review for all pregnancy-related deaths and other adverse outcomes
- Electronic Fetal Monitoring (EFM) training and Certification

Teamwork, Training and Standardized Communication strategies, achieved through on going education, rapid response to emergent situations, and simulation exercise.

An Obstetrical Patient Safety Workgroup was included in the 2011-12 Budget which would include the development of a statewide perinatal safety strategy. ACOG has recommended nationally and state recognized perinatal experts to participate in the workgroup with the Department of Health. This legislation comport with the new budget implementation regarding patient safety and financing strategies that promote high-quality health care that is responsive to the unique needs of all women.

Study after study has shown obstetrical malpractice costs are not closely tied to quality of care. Cerebral palsy, which both the National Institutes of Health and the Centers for Disease Control and Prevention have demonstrated is rarely related to events in labor, still results in the greatest liability cost. And jurors routinely award substantial payouts even when there is little actual evidence of substandard care.

The medical liability climate is currently threatening the ability of obstetrician-gynecologists (ob-gyns) to provide care to women.  The dramatic increases in medical liability premiums during the past six years coupled with the fear of litigation have caused many ob-gyns in New York State to make changes to their practices, including early retirement, dropping high-risk obstetric patients, dropping obstetric services altogether

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, increasing cesarean section rates, and decreasing the number of deliveries they perform.

Unfortunately, fear of lawsuits is a very real concern for ob-gyns practicing in New York State. Ob-gyns are particularly vulnerable to being targeted in medical malpractice cases compared to other physician specialties. Obstetrics and gynecology is considered among the specialties at highest risk for malpractice claims and most severely affected by rising insurance premiums.

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A medical liability premium reduction incentive for ob-gyns who complete patient safety courses, as developed by the state’s Obstetrical patient Safety Workgroup, will allow a cost benefit for the physician and a linkage to patient safety education. Safety and medical liability reform are the twin pillars of a safer maternity system, without both, malpractice cost and payouts will continue to soar.

This legislation is a step forward in high quality, safe, affordable, and accessible obstetrical care for all women in New York State.

For these reasons, ACOG SUPPORTS this bill and urges legislators to vote In FAVOR of this legislation.