Blue Collar Muse

More and more hospitals and medical practices are reducing or eliminating any sort of care or treatment for pregnancy and childbirth. We have Democratic presidential candidate John Edwards and his fellow trial lawyers to thank for that.

Bad Idea Guy at ‘Target Rich Environment’ takes Edwards to the woodshed for his part in the process as Edwards made his millions specifically by suing OB/GYNs. BIG links to an ABC News affiliate covering an emerging story from Philadelphia.

The maternity care crisis could be getting worse in the Philadelphia area. … because yet another Philadelphia hospital - Chestnut Hill Hospital … is reviewing whether it can afford to keep its obstetrics program.

While the C-E-O says no decision on the future of the maternity unit has been made yet, the suggestion that it will close is causing worries in an area that many say is already facing a crisis, with fewer & fewer places left to deliver their babies.

14 hospitals have already closed, or are closing, their obstetrics units over the past decade.

That will leave Northeast Philadelphia, one of the most populous areas of the city, without any hospitals delivering babies.

Brooks Turkel, Chestnut Hill’s C-E-O (said), “Low reimbursement, high cost to deliver the services the women of this community deserve and then the layer of malpractice on top, makes it difficult. And just adding more patients often isn’t enough,” he said.

Turkel says it cost about 10 times more for the hospital to provide liability insurance for an obstetrician than a family practice doctor.

This illustrates an important truth. We can have many service providers and keep prices down. This means we give doctors more room to be fallible now and then. Or we can have expensive, limited access to medical professionals by holding doctors to unrealistic standards. Unfortunately, wish as we might, we cannot have it both ways.

John Edwards specialized in OB/GYN malpractice cases. Critics contend his courtroom victories were based on bad medical science and have come at a price. Edwards’ most celebrated case argued poor response to, or faulty interpretation of, fetal heart monitor information led to oxygen starvation during a delivery in North Carolina. The infant later developed Cerebral Palsy requiring extensive, lifetime care. Edwards convinced a jury the doctor was at fault and won a huge monetary award. But the doctor may not have been at fault.

Electronic fetal heart monitoring was introduced in the 1960’s … Advocates thought it would prevent most cerebral palsy by providing continuous immediate data on how babies were weathering labor and delivery.

But in the 1980’s, scientists began to challenge the premise that medical care during delivery had much to do with cerebral palsy. Studies concluded that 10 percent or fewer of cases could be traced to an oxygen shortage at birth. The vast majority of children who developed cerebral palsy were damaged long before labor, the studies found.

Then a series of randomized trials challenged the notion that faster delivery could prevent cerebral palsy. Reviewing data from nine countries, two researchers reported last year that the rate of the disorder had remained stable despite a fivefold increase in Caesarean deliveries.

Dr. Karin B. Nelson, a child neurologist with the National Institutes of Health, says the notion that paying greater heed to electronic monitoring will prevent brain injuries remains just that, a notion.

“Evidence of high medical quality contradicts the assumption that the use of electronic fetal monitoring during labor can prevent brain damage,” Dr. Nelson said.

The bill for the lawsuits is now due and payable in Philadelphia and elsewhere as medical malpractice insurance premiums force hospitals and doctors to discontinue service. While Edwards claims he is helping people, his cure may be worse than the condition he is fixing.

Costs faced by OB/GYNs are real. That is to say, real high! A friend, studying to be an OB/GYN, claims malpractice insurance could cost as much as $40,000 per year. Further, if she joins a practice and later leaves she must also leave cash behind to cover future premiums.  She and/or the practice could be sued years down the road by patients claiming something during delivery caused problems later. Her window of liability runs to about 18 years - per child delivered!

Trial lawyers like John Edwards work for a percentage of the award or settlement their client receives.  So, if a family gets $2 million dollars from a jury they don’t REALLY get the $2 million. They get $2 million minus attorney fees which can be a third or more of the award.

Citizens need services but cannot get them. Doctors decide between serving patients and risking bankruptcy. Attorneys salivate playing ‘What if?’. The cycle repeats while government refuses to bring common sense to the process. ‘We The People’ are not much better. Philadelphia citizens had this to say about how the problem should be solved.

JoAnne Fisher, executive director of the Maternity Care Coalition is very disturbed by present state regulations which require hospitals to seek official permission to add units and services, but not when it comes to closing them.

“There needs to be some measure of accountability,” Fisher argued.

Many officials who spoke with Action News say its time for Harrisburg to get involved and help bring malpractice insurance costs down, before the 8 Philadelphia hospitals still delivering babies shrinks even more.

It is unclear what Ms. Fisher means by ‘accountability’.  It is scary to contemplate that she would consider requiring hospitals to ignore financial considerations when making decisions.  It is also unclear what those speaking with Action News think Harrisburg can do to bring down the cost of malpractice insurance down.

In the real world, where words mean things and actions have consequences, accountability means those responsible for the problem answer for their actions. John Edwards and the families who profit with him from large settlements should be held accountable for their parts in reducing the amount of OB/GYN healthcare available. Perhaps they should be required to give back all or part of the money they made from the case.

Bringing costs down is relatively simple for those with the courage to act. Despite the tragedy of a child’s suffering or death, multi million dollar awards are excessive and do more harm than good. Awarding damages based on actual loss or cost and eliminating or capping ‘pain and suffering’ awards will help curb excess.

Limiting attorney fees to fixed amounts or a lower percentage would also help. Attorneys like John Edwards only take high dollar, high profile cases as these are the most personally beneficial. Lesser cases with lower awards get little or no representation as there’s no incentive for attorneys to take those cases. Smaller payments would restrict plaintiffs and attorneys to cases with real merit, not just real possibilities of hitting the jackpot.

Better yet, require attorneys suing doctors and hospitals for millions to pay the defendant’s legal fees if they lose. That solves the accountability problem and the reducing costs problem in one step. Of course, it would raise costs for attorneys to do business since they would have to insure against loss, too. Think of it as justice being done.

Thinking this justice is both blind and poetic …

Blue Collar Muse

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This entry was posted on Thursday, April 12th, 2007 at 9:28 pm and is filed under 2008 election season, Business, Conservative, Politics. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.