Washington, DC -- The fear of being sued is the driving force behind many obstetricians-gynecologists' decision to stop delivering babies, according to the latest medical liability survey conducted by The American College of Obstetricians and Gynecologists (ACOG). The national survey of ACOG ob-gyn members confirms that the medical liability insurance crisis has worsened in recent years, with one in seven ACOG Fellows reporting that they had stopped practicing obstetrics because of the high risk of liability claims. Ob-gyns have an average of 2.6 claims filed against them during their career.

"This crisis is getting more serious by the day. It's not only threatening today's ob-gyns, but also the future of our specialty," says ACOG President Vivian M. Dickerson, MD. The number of US medical students entering the specialty of ob-gyn has declined for the third year in a row. In 2004, only 65% of the ob-gyn residency slots were filled by US medical school seniors, compared with 86% a decade earlier. "Women's health is in jeopardy as new doctors turn away from our specialty," she adds.

Highlights from ACOG's Medical Liability Survey*:

Impact of Claims

• One in seven ACOG Fellows has stopped practicing obstetrics because of the risk of liability claims.
• Changes made by ACOG Fellows because of the risk of liability claims or of being sued:
  • Decreased the amount of high-risk obstetric care - 22%
  • Stopped offering/performing VBACs - 14.8%
  • Decreased the number of deliveries - 9.2%
  • No longer practicing obstetrics - 14%
  • Decreased gynecologic surgical procedures performed - 12.3%
  • No longer doing major gynecologic surgery - 5.6%
• Changes made by ACOG Fellows because of liability insurance costs and availability:
  • Decreased the amount of high-risk obstetric care - 25.2%
  • Decreased the number of deliveries - 12.2%
  • No longer practicing obstetrics - 9.2%
  • Decreased gynecologic surgical procedures performed - 14.8%
  • No longer doing major gynecologic surgery - 5.4%

• In 2003, one in two Fellows had been involved in a claim in the last four years.
• Over 76% of ACOG Fellows reported they had been sued at least once; 57% had two or more claims filed against them, and 41.5% had three or more claims.
• Ob-gyns have an average of 2.6 claims filed against them during their career.
• About three in ten (29.6%) of ob-gyns have been sued for care provided during their residency.

• Obstetric claims accounted for 61% of claims against ob-gyns; 38% were gynecologic claims.
• From 1999-2002, the top four primary obstetric allegations were: neurologically impaired infant (34%); stillbirth/neonatal death (15%); other infant injury - major (7%); and delay in or failure to diagnose (7%).
• From 1999-2002, the top four primary gynecologic allegations were: delay in or failure to diagnose (29%); patient injury - major (25%); patient injury - minor (15%); and other/non-specified (12%).

• Almost half (49.5%) of claims against ob-gyns are dropped by plaintiffs' attorneys, dismissed or settled without payment.
• Of cases that do proceed to court, ob-gyns win eight out of ten times (81.3%).
• From 1999-2002, on average the length of time from occurrence to closing of the claim was four years; 13% of claims took seven or more years to resolve.
• Closed claim resolution experience:
  • No payout - 49.5%
    • Dropped by plaintiff - 33.6%
    • Dismissed by court - 13%
    • Settled without payment - 2.9%
  • Settled with payment - 36.0%
  • Arbitration or other alternative dispute resolution mechanism - 2.7%
  • Jury/court verdict - 8.6%

Medical liability reform is ACOG's top priority. When ob-gyns can't find or afford medical liability insurance, they are forced to stop delivering babies, curtail surgical services, or close their doors. Across America, pregnant women cannot get the prenatal and delivery care they need but ACOG warns that the liability crisis hurts all women. With physician shortages, there are also fewer ob-gyns available to provide gynecologic surgery and preventive care, such as screening and special procedures. Women lose care that helps protect fertility, end pelvic pain, or treat cancer early. Women travel longer distances to find a doctor, have longer waiting periods for appointments, and have shorter visits once they get there.

"This crisis in health care is critical for both physicians and the women they treat. This is a national problem, and we need a national solution," states Dr. Dickerson.

*Every two to four years since 1986 ACOG has commissioned a national survey on the medical liability experiences of its members. This survey, designed and conducted with Princeton Survey Research Associates, covered the period 1999-2003. The response rate was 45.5%.

**ACOG Criteria for Identifying Red Alert States
ACOG considered a number of factors in determining the hardest hit states in the escalating medical liability insurance crisis for ob-gyns. The relative weight of each factor could vary by state. Factors included: the lack of available professional liability coverage for ob-gyns in the state; the number of carriers currently writing policies in the state, as well as the number leaving the medical liability insurance market; the cost, and rate of increase, of annual premiums based on reports from industry monitors; a combination of geographical, economic, and other conditions exacerbating an already existing shortage of ob-gyns and other physicians (for example, Mississippi and West Virginia, having a number of medically underserved areas ); the state's tort reform history, and whether tort reforms have been passed by the state legislature - or are likely to be in the future - and subsequently upheld by the state high court.

# # #