Obstetricians face crisis

Skyrocketing malpractice insurance rates might force private obstetricians to stop delivering babies.

The new rate for malpractice insurance for delivering babies has increased to $167,550 per year, but only if it is paid upfront. If the insurance is paid in instalments, the 2009 rate is nearly $181,000. Just four years ago the OB malpractice was about one-fifth of that rate at $35,800.

Most private doctors do not earn enough from delivering babies to cover the new insurance rate per year, stated Obstetrician Dr. Barry Richter.

‘It is getting to the point where it is getting prohibitively expensive to practice,’ said Mr. Richter. ‘With the amount paid by insurance for labour and delivery, it will take at least 86 deliveries to cover the cost of liability insurance and that is not even taking into account the cost of overhead. Most doctors don’t even do this amount of deliveries a year.’

The driving factor behind the escalating rates are three cases involving negligence in childbirth by obstetricians with the potential for awarding millions in legal settlements, stated the chairman of the Health Practice Commission, Dr. Steve Tomlinson.

This issue was first raised nearly three years ago when UK-based Medical Protection Society, the primary insurer for physicians here, informed the doctors and the government that the insurance rates would be increased to pay for potential legal settlements. The rates could be kept down if the government intervened with tort reform that would limit their exposure to high legal awards.

While a special committee from the Health Practice Commission was set up to report to the Health Ministry with its recommendations, more than a year later, government officials have yet to take any tangible action to deal with the escalating rates, stated Mr. Tomlinson.

‘We worked feverishly to write a comprehensive report to talk about the issues and what other countries are doing to deal with the rates,’ said Mr. Tomlinson. ‘It is not just the Cayman Islands that is dealing with this issue; it is all the English-speaking countries around the world that are having to deal with OB rates going up.

‘Then we made a presentation to the Ministry officials last year. It was well received, but I haven’t heard back anything further.’

Health Ministry chief officer Diane Montoya did not respond to queries about OB malpractice rates by press time.

Over the last five years, the average number of babies delivered on island are about 650 annually. About half of that number are delivered by midwives at the Cayman Islands Hospital, with hospital obstetricians supervising them. In recent years, the other half are delivered by six private obstetricians. But the number of private obstetricians could be reduced in the next few months because some may not be able to pay the $167,000 malpractice insurance rate.

If the escalating rates push the number of obstetricians down to two or three doctors, then they will have to work longer hours to provide the around-the-clock care that deliveries can take, said obstetrician Dr. Greg Richmond-Peck.

While midwives provide excellent care, many mothers are more comfortable having an obstetrician for their delivery said Mr. Peck.

‘About 90 per cent of mothers I see prefer to have obstetrician deliver their baby,’ he said.

With fewer local obstetricians, this could lead to a waiting list and cause more mothers to go off island to have their babies.

‘In the end, the patient is going to lose out. The country is going to lose talented doctors and no new doctors are going to be encouraged to replace the ones that are retiring or going somewhere else,’ said Mr. Peck.

Dr. Howard Deosaran was also stunned by the new OB malpractice rates,

‘More women are career-oriented and many of them tend to postpone childbirth until their late 30s and early 40s,’ he said. ‘This automatically puts these mothers at higher risk for complications with their pregnancy such as hypertension and diabetes so it is critical to have a sufficient number of trained local obstetricians to deal with these pregnancies.’

If the number of obstetricians shrinks, this could motivate families to move to another country where there are more choices, or it could make the country less attractive to families considering moving the Cayman Islands, said Dr. Deosaran.

While doctors are required to have malpractice insurance to practice in the Cayman Islands, Florida doctors do not have to carry coverage. This puts Florida doctors at price advantage over Cayman obstetricians. And insurance companies may have to send more mothers to Miami to deliver if there is a shortage of obstetricians, he said.

The level of obstetrician care is high right now, but some of the doctors could leave because of the high malpractice rates, said Dr. Bob Glatz, a member of the OB malpractice committee.

‘There is no question that the country is going backwards,’ he said. ‘There are always going to be pregnant mothers on the island here. If we don’t have OBs capable of delivering babies with problems, we may have to ship them overseas. And we have already seen evidence of problems with that with one birth on Cayman Airways.’

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