Saturday, December 09, 2006

Big correction

In doing further research about midwifery and malpractice, I realize that I made a big mistake in yesterday's post. The mean malpractice payout for CNMs and L&D nurses in 2004 was indeed $532,000. However, the number of judgments against CNMs in 2004 was a CUMULATIVE assessment from 1990-2004. So the number of malpractice judgments per year is drastically smaller than what I wrote. The number of purely obstetric malpractice payouts by nurse midwives in 2004 was only 58, not 459. Interestingly, this represents almost 13% of all payouts by CNMs over the previous 15 years. According the the American College of Nurse Midwives, there are 6200 practicing midwives in the US. 58 payouts represents a rate of 9.3/1000 CNMs. This is a successful judgment rate of approximately 1/5 the rate of obstetricians. Although this rate makes much more sense, it is still significantly higher than I would have expected.

According to The National Practitioner Data Bank: information for and about midwifery. Jevitt C, Schuiling KD, Summers L. J Midwifery Womens Health. 2005 Nov-Dec;50(6):525-30, The NPDB received 484 reports about nurse-midwives from September 1, 1999, to March 31, 2005. Of the 484 reports, 375 have an obstetric malpractice code.

The top 10 reasons for claims against CNMs were:

Not otherwise classified 126 (26.8)
Improper management 103 (21.9)
Failure to treat fetal distress 40 (8.5)
Delay in performance 37 (7.9)
Improperly performed vaginal delivery 37 (7.9)
Failure to diagnose 25 (5.3)
Improper choice of delivery method 20 (4.3)
Delay in treatment of identified fetal distress 18 (3.8)
Failure to identify fetal distress 14 (3.0)
Delay in diagnosis 7 (1.5)

According to the article:
The dollar range of malpractice payments made on behalf of nurse-midwives is $1500 to $3,450,000,..

The year with the most nurse-midwifery obstetrics related reports during September 1, 1990 to March 31, 2005, is 2004 (n = 58 [12.3%]). However, it is important to understand that the median time from incident to payment for nurse-midwives in the NPDB is 4 years. Thus, although 2004 is currently the year with the most reports, other years may eventually surpass the number of reports for 2004.
So, although the CNM liability crisis may not be as severe as that for obstetricians, it is quite serious, and represents more judgments and larger payouts than I would have expected.

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