"Who Will Deliver Your Baby?"

How high medical liability insurance rates will affect the delivery of women’s
By Dr. Ronald Uva


As a practicing obstetrician-gynecologist I feel that I am uniquely qualified to write and speak on the subject concerning women’s healthcare as I have been delivering babies for more than 30 years (6,500-plus babies), have been born and educated in New York state, received an Oswego County scholarship for medical school and give back by rendering care to the very large underserved population of Oswego County.

I am section chair of district II of the American College of Obstetricians and Gynecologists and a member of its liability committee. In this capacity I have been to the state Capitol four times and to Washington three times, sacrificing time away from my office to plead the case for malpractice reform—at no avail.

To completely understand the crisis that confronts us one has to understand the passion that obstetricians have for their chosen specialty. After many years of formal training and residency, we are qualified to provide prenatal care to routine and complicated pregnancies and to deliver these pregnancies sometimes under the most difficult of circumstances. We rejoice when mother and baby are healthy and cry when they are not. We are well aware that at the moment of delivery we are responsible not only for the child’s future but that of his family as well. Nothing is more intimate or reflective of humanity that being part of the birth process. All women remember who delivered their first baby. Because of this, obstetrics was once one of the most popular specialties to enter. Sadly, it now ranked dead last.

This downward spiral began in the mid 1980s when malpractice insurance rates began to rise astronomically as more suits were filed and awards became stratospheric. It was evident that people were now suing for results, and not necessarily for malpractice. To be deemed “malpractice,� three components are necessary: negligence, an injury, and the negligence must be the proximate cause of the injury. However, maloccurences became fodder for trial attorneys. This trend also now extends to every facet of life: vaccine manufactures, amusement park operators, McDonald’s, etc.

That most legislators are lawyers is not coincidental to the problem. Lawyers still maintain that the rates have gone up because the insurance carriers have lost money in the stock market, etc. In New York, our carrier, Medical Liability Mutual Company, is owned by the physicians it insures and the bulk of its holdings are in fixed equities and not subject to the vagaries of the market. So, our rates have gone up: $40,000/physician in Upstate; $120,000/physician downstate. But wait: at the very same time our reimbursements have done down 30 percent with the federal government promising a 5.7 percent cut in Medicare rates in 2007.

Our practice has lost money for the past two years. It is evident that if you’re being paid less than what it costs to do business, the end will inevitably come. There are days when it costs more to perform surgery than I am being reimbursed.

There are two components to an “award� in a malpractice case: economic damages and pain and suffering. We are told that justice is supposed to be sure and even. This is not the case when it comes to malpractice cases. An experience plaintiff lawyer is more likely to win a large award than a fledgling lawyer and, in general, Upstate juries are less disposed to award large sums than in, say, the Bronx. Juries are lay people who try hard to grasp the subject but malpractice cases are full of scientific intricacies that take medical students years to understand. How can this be fair to either the aggrieved party or to the physician on trial, especially since many expert witnesses for the plaintiffs are professional testifiers?

Doctors are not perfect but they risk everything they own ever time they go to work. In an attempt at fairness that would not impinge upon the right to sue, a few suggestions have been made: 1) a plan similar to California that does not put a cap on economic damages but does on pain and suffering; 2) health courts; 3) a neurologically impaired bill that would make awards outside the judicial system to neurologically impaired children similar to what Workman’s Compensation does now. Or, any other plan that any legislator at either the state or federal level is willing to put forward.

In New York, the state Senate has approved changes but the Assembly, under Sheldon Silver, will not allow any bills to come out of committee. Is it fair that Silver is a malpractice attorney? Is this a conflict of interest? At the federal level, the House of Representatives has voted for change but the Senate, the world’s greatest deliberative body, won’t even vote on it—they kept it mired in filibuster. I went to Washington in my white coat to the gallery and personally watch Clinton and Schumer vote to continue the filibuster.
Something has got to give. With our costs of practicing going ever higher (utilities, salaries, equipment and malpractice) and our reimbursements less than what they were in the 1980s, hospitals and practices are stretched to buy the most modern equipment and recruitment of new obstetricians is almost out of the question.

After retiring from the obstetric part of my practice a year and a half ago to spend time with children, grandchildren and aging parents, I am back to obstetrics since a lack of physicians would have forced my two partners to work every other night. How bad is the recruitment: Medical students rank obstetrics last and last year of 125 graduating seniors from SUNY Syracuse, only six went into Ob-Gyn and of that four left the state. The pipeline is drying up. This is exacerbated by New York’s high taxes so a young resident would much rather go to California or Wisconsin than come here.

The crisis is rapidly becoming one of access to care. I don’t have to remind you that Oswego County is the snow capital of the USA. If not for the local obstetricians women would have to travel 40 miles to get to Syracuse in a potential blizzard. If it costs more to practice than what is realized, who will take care of the underserved? The American College of Ob-Gyn has mounted a publicity campaign entitled: “Who Will Deliver My Baby?� Who indeed. I fear that the deaf ears that government has turned to women’s health care is going to become a huge crisis. So far, no one other than physicians have offered any solution. Maybe it is time for the women in this state to beat down the doors in Albany and Washington and to demand action. Their lives and those of their daughters and granddaughters are at stake.
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