Thursday, April 29, 2010

The Lowdown on Lawsuits: An Interview with Premier Speaker Mamie Guidera

Last month, a National Institutes of Health (NIH)-convened panel urged greater access to vaginal birth after cesarean (VBAC) for low-risk women. However, many clinicians have noted since that access to VBAC is not likely to expand until the “elephant in the room” is addressed—fear of malpractice lawsuits. ACNM Communications Manager Yolanda Landon had a chance to chat with Annual Meeting Premier Speaker Mamie Guidera, CNM, MSN, about this growing reality that affects midwives and access to midwifery care. Read on for an inside look at what to expect during Mamie’s co-presentation at the ACNM 55th Annual Meeting. And don’t forget—Early Bird Registration ends today!

Yolanda: Through the media, we keep hearing about an increase in lawsuits against both midwives and physicians. What do you think accounts for this increased attention?

Mamie: Suits are more public now. We need tort reform! The costs have gotten out of control….If you look at ACOG’s ongoing litigation surveys and studies, you’ll notice that nearly 90% of physicians have been sued at least once in their lifetimes. Bill McCool and I did our first midwives and litigation survey in 2005, and we recently wrapped up another one. Among midwives who responded to our surveys, the percentages are close to 30%.These numbers have increased only slightly over the past few years; however, lawsuits affect practice in a major way because of malpractice insurance costs.

Really, there are four factors that can predict the likelihood of a lawsuit: the number of years in practice (the more years of practice increases the likelihood of litigation), the number of births done, your age, and the region of the US where the midwifery practice is located. For example, I’m at high risk because of my years of practice…it’s all about exposure. It’s not about skill, it’s about numbers.

Yolanda: A midwife is there to help women and families. So, s/he might get discouraged after the threat of a suit. Any advice for midwives to stay in the profession and not give up?

Mamie: First, there is a professional liability resource packet posted on the ACNM website. Part 4 is called “What to Do If You Are Named in a Lawsuit,” and provides practical advice. One of the most important things midwives should do is process. By that, I mean they should share their feelings with a professional counselor or religious/spiritual leader or [share the] details of the event with a formal morbidity and mortality committee where they work. These three places are “non discoverable.”

Most literature suggests getting back on the horse, stay in practice, and keep moving forward. And this [being named in a lawsuit/litigation] is part of our practice. This is just part of what happens. It’s as basic as carrying a Blackberry/pager device or assisting with a birth in the middle of the night.

Lastly, remember that a lawsuit is not usually because you did something bad. It tends to be about money. We live in a country where the system doesn’t take care of disabled children well. People need money [to take care of their families].

Yolanda: What will attendees learn during your session?

Mamie: They will learn the results from the midwives and litigation survey, which was distributed to all ACNM members in 2009. We asked members how litigation has affected their practice and what helped them cope. Attendees will also learn some lessons from closed claims analysis, which means we will review cases that are closed and try to learn lessons from them.

Yolanda: What are the take-away messages from the presentation? Please provide 1 or 2 pieces of advice that our attendees should always remember.

Mamie: Understand litigation and embrace the issue! Know why midwives get sued, and what kind of malpractice insurance you need and have. Get involved in your professional organization or your hometown to support tort reform…and if you get named in a suit, know you are not alone.

Guidera will co-present the Joint Risk Management Session Monday, June 14, at 5 pm with William McCool, CNM, PhD, FACNM, Tina Johnson, CNM, MS, and Israel Teitelbaum of Contemporary Insurance Services. Look for the expanded version of this interview in On Location, the newsletter that will be distributed to attendees at the ACNM 55th Annual Meeting & Exposition in Washington, DC.

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