Cesareans Up In Liability Crisis States


CHICAGO — Cesarean section rates were significantly higher in states with an impending or current medical liability crisis in 2004, a year after 76% of U.S. obstetricians had experienced a litigious event.

This finding from a cross-sectional observational study “may reflect a pattern of 'defensive' medicine in response to liability concerns,” Dr. Elizabeth A. Platz said at the annual meeting of the American College of Obstetricians and Gynecologists.

She and her colleagues investigated whether a correlation existed between C-section rates in individual states in 2004 and the medical liability climates in those same states at that time.

The year 2004 was chosen, because that was the year ACOG issued a state-by-state alert on the status of medical liability coverage availability and costs, said Dr. Platz of the Medical University of South Carolina, Charleston.

The previous year, 76% of all U.S. obstetricians had experienced a litigious event, and the median award for “negligence in birth care” was $2.3 million.

Ob.gyns. were reported to be retiring early, moving to less litigious states, dropping obstetrics, or as the study hypothesized, “turning to C-section deliveries at any sign” of trouble, Dr. Platz said.

Individual states were categorized in that report as “in crisis” (14 states), having a “crisis brewing” (8 states), or “not in crisis” (28 states).

For purposes of statistical adjustment, state demographic and population data were collected from the U.S. Census Bureau and the National Center for Health Statistics.

The mean state C-section rate for the nation in 2004 was 28.1%, ranging from 20.4% to 34.9%, Dr. Platz reported.

In states on ACOG's in-crisis list, the C-section rate was 29.9%, followed by 28.1% in states with a crisis brewing, versus 27.2% in states not considered crisis malpractice states, with significantly higher rates found in the crisis states even after confounding variables, such as other known risks for C-section delivery, were controlled for.

This may lend credence to the theory that pressured physicians practice defensive medicine, said Dr. Platz. She added that the findings highlighted an association, not a causal relationship, which would require more study.

Dr. Platz and her coinvestigators reported no financial conflicts of interest relative to their study.

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