Hysterectomy: a medical-legal perspective, 1975 to 1985

Article Abstract:

The increase in malpractice suits has forced obstetricians and gynecologists to pay large insurance premiums. In fact, physicians were forced to start their own insurance companies when insurance companies stopped issuing malpractice liability insurance policies. The tense medical-legal climate has changed the way obstetricians and gynecologists practice medicine. Many obstetrician-gynecologists (OB-GYNs) are retiring early, abandoning delivering babies entirely, or reducing the number of high-risk obstetrical cases they accept. Although most of the attention has been focused on lawsuits directed towards obstetrical cases, the potential for lawsuits in gynecology is also great. Hysterectomy is one of the most common operations performed in the United States. The number of hysterectomy-related malpractice claims was evaluated using reports of a physician-owned insurance company (Norcal Mutual Insurance Company). All closed-claim files (excluding hysterectomies that were performed because of obstetrical- or abortion-related claims) were examined for appropriateness of care. Of the 87 cases available for review, the most frequent allegation or injury was to the urinary tract (37 cases) followed by unnecessary hysterectomy (15 cases). There were a total of five deaths, four of which were preventable. Most operations were performed by board certified OB-GYNs. The remaining cases were performed by a general surgeon (five cases) or a family physician (three cases). Most cases were settled by an out-of-court settlement or jury award (87 cases, 39 percent). There were 34 cases in which payment was made; 20 out of 28 cases (71 percent) not meeting standard of care criteria were awarded payment. The younger the patient, the larger the award was. As the severity of the injury increased, so did the payment. The five cases involving death received an average payment of $127,000. Seven out of 15 patients having unnecessary hysterectomies received payment. The insurance company found that it was much more expensive to try a case in court (average of $37,000) than it was to settle (average of $16,100). Filing of a lawsuit did not necessarily signify substandard care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Laws, regulations and rules, Reports, Personal injuries, Hysterectomy, Gynecologists, Forensic obstetrics

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The economic cost of the medical-legal tort system

Article Abstract:

The medical-legal tort system that awards malpractice claims may be very inefficient and prevent plaintiffs from receiving much of the monetary award. Researchers calculated the actual amount spent on the medical-legal system in the largest medical center in the U.S. and related it to the total income and expenses. Medical-legal system costs were over 6% of the center's total annual income. Only 12% of the original amount claimed by plaintiffs was awarded to them. The other 88% went to attorney fees and administrative costs. High malpractice costs have led doctors to practice defensive medicine.

Economic aspects, Finance, Medical centers, Detroit Medical Center (Detroit, Michigan)

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