A Breach of Promise: Tort Regimes and the Impact of Medical Malpractice on American Obstetrics

• In Event: 4263 - The Role of Culture and Organizations in Reproductive Experiences

Abstract

In this paper, I outline a theory of obstetric tort regimes as one pillar of reproductive regimes. Many observers both inside and outside the maternity care field view obstetric practices like routine use of continuous electronic fetal monitoring and high rates of cesarean deliveries as indicators of defensive medicine. I use data from interviews with obstetricians, hospital administrators, and malpractice attorneys to outline the impact of tort regimes on American maternity care. Obstetricians view malpractice risk and the high cost of liability insurance as a threat to their profession, although the rate of malpractice lawsuits has declined over time. Then I use data from the National Practitioner Databank (NPDB) to analyze longitudinal multilevel models of the effects of tort reform laws on obstetric malpractice lawsuits from 1995-2015. I find that the rate of malpractice lawsuits has declined more in non-tort reform states than in states that protect providers from liability. Average payments in obstetric malpractice suits are also higher in states with tort reforms than in states that offer more protection to victims of malpractice. The findings present a puzzle because they suggest that defense against tort liability is not a primary cause of obstetric practices that are widely viewed as hallmarks of defensive medicine. (This is adapted from a chapter of my forthcoming book, Reproductive Regimes: Birth, Malpractice, and the Maternity Care Business in the United States.)

Author

• Louise Marie Roth, University of Arizona