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Most OB malpractice claims involve cascading events, not isolated errors

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Analysis of more than 800 obstetric malpractice cases reveals common errors and a pattern of ‘rapidly devolving’ crises




Errors in clinical judgment were cited in 77% of more than 800 clinically coded obstetric malpractice cases analyzed by CRICO Strategies, a division of CRICO. CRICO is the patient safety and medical malpractice insurance company owned by the Harvard medical community since 1976. The findings of the analysis were published in a 2010 report entitled Malpractice Risks in Obstetrics.1 The cases on which the report is based were asserted from 2005 to 2009.

According to the report, other prevalent areas of causation were:

  • miscommunication (36% of cases)
  • technical error (26%)
  • inadequate documentation (26%)
  • administrative failures (23%)
  • ineffective supervision (15%).

The report also reveals the top three most common OB risks or allegations:

  • delay in treatment of fetal distress
  • improper performance of vaginal delivery
  • improper management of pregnancy.

In the CRICO analysis, OB malpractice issues were rarely the result of a single act or omission by a single clinician. Rather, cases typically involved a series of missteps and mishandled decisions by a team of physicians and nurses who converged too late to resolve a rapidly devolving crisis.

“Obstetrics has some unique vulnerabilities, most often involving situations in which a sequence of errors or oversights cascade into a crisis that can put mother and baby in jeopardy,” said Robert Hanscom, senior vice president of CRICO Strategies. “Because there is rarely that standout ‘single event,’ it is absolutely paramount that OB practices understand how these missteps unfold, and then focus on education and training initiatives designed specifically to help clinicians avert those mistakes.”

Although the rate of OB claims is relatively infrequent—less than one case for every 1,000 births—the average malpractice payment is approximately $947,000. That figure is more than twice that of other clinical areas, and second only to surgery in total indemnity payments.

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