A malpractice cap can help maternity care access

By Marygrace Elson Iowa Source

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  • January 31, 2020

SOURCE: The Gazette

Last summer, Marshalltown’s UnityPoint hospital shuttered its maternity ward. The year before that, Washington County Hospital in southeast Iowa did the same. These closures weren’t outliers.

According to the Iowa Department of Public Health, 28 Iowa hospitals stopped delivering babies between 2001 and 2018. Nearly half of those maternity wards (12) closed within a two-year span, from 2016 to 2018.

We’ve known about some of the contributing factors for a long time — our shrinking and aging rural populations don’t need as much maternity care, and Medicaid reimbursement rates are too low to keep maternity services viable at more remote, financially strained facilities. But within the past few years, there is another concern: sky-high awards and settlements in medical malpractice cases.

When I moved to Iowa 20 years ago, Iowa enjoyed the reputation of practical and reasonable juries and malpractice judgments — attractive for a physician looking for a place to practice.

When a patient was injured, a jury would determine how much money they should award to cover “economic damages,” including things like treatment costs and lost wages. If indicated, juries could also order doctors and hospitals to pay “punitive” damages. But sometimes when a patient is hurt, justice demands more. In those cases, juries would award more money to ensure the patient was fairly compensated for non-quantifiable things like pain and suffering. Those awards are called “non-economic damages.” For a long time, awards in all three categories in Iowa were generally reasonable.

Over the past few years however, the situation has rapidly changed. Trial lawyers, some from out of state, began demanding massive non-economic damages awards and settlements for plaintiffs — millions, or even tens of millions of dollars for a single malpractice case. In lawsuits decided between 2017 and 2019, Iowa juries awarded plaintiffs more than $63 million in non-economic damages alone. This amount was nearly three times the $21.4 million awarded in economic damages — the compensation awarded to plaintiffs for their out-of-pocket costs and lost wages.

My specialty of obstetrics and gynecology is one of the specialties most vulnerable to lawsuits. Everyone hopes for a healthy and happy outcome for both mom and baby. However many things influence the birth outcome, including mom’s underlying health and her own access to care during pregnancy. The labor and delivery process can be complicated and unpredictable. An underlying complication or any number of concerns in labor might result in a difficult birth or health issues for the newborn.