Maryland Babies
anonsouthernbell
member
Berkowitz, a certified nurse midwife, got into the business of babies because she loved taking care of people and playing an important role in her patients? lives. But now, whenever she goes to Mercy Medical Center for a delivery, it?s a crush of extra doctors, extra paperwork and extra anxiety.
?When you think about every day, you could potentially lose everything because of a birth,? Berkowitz said. ?We spend a lot of time with our patients, but if just one thing goes wrong, one thing on your watch ... ?
Childbirth is a tense experience. But at hospitals and private obstetrician practices in the Baltimore area, tension is peaking. A string of high verdicts in obstetrics malpractice cases has caused a rise in malpractice insurance costs, heightened the fear of getting sued, and ushered in palpable changes to how delivery units and their doctors work.
Hospitals are spending millions to try to account for every potential ?what if,? private doctors are moving out of the city, and administrators are questioning how much longer these units will be financially viable.
In a sort of medical Cold War, every hospital seems to fear one of its peers will suddenly buckle under the financial pressure, pull the trigger and shut down obstetrics, leaving them with hundreds more babies to deliver.
Their fear isn?t unfounded. The University of Maryland Medical System is closing Maryland General Hospital?s obstetrics and gynecology department at the end of June as part of a restructuring that will merge those services with the University of Maryland Medical Center. The system said the decision was based on a decline in deliveries against high overhead costs.
With about 570 deliveries in fiscal 2012, Maryland General was the city?s least used maternity ward. But that?s 570 babies who will have to be delivered at some other hospital that may not want the business.
The combination of high risk, high cost and a potential tightening of the OB supply could be devastating for the city, hospital administrators say.
?This will destroy institutions,? said Dr. Robert Atlas, chairman of obstetrics and gynecology at Mercy Medical Center, Baltimore?s busiest delivery unit in 2012. ?Institutions will have to decide, will we go out of business trying to keep this going or will we have to close our door.?
For every doctor and every hospital, malpractice insurance is a major expense, and being sued a common concern. The issue is particularly potent in obstetrics, a specialty with a high potential for error ? no birth ever goes exactly by the book, doctors say ? and a large opportunity for litigation. Sympathy can sway a jury doctors say. And in Maryland, parents have until their child is 21 years old to decide to take legal action.
The result has been a national shift. Fewer new doctors are choosing obstetrics, more OB-GYNs are dropping the OB, and those who decide to stay in the baby business are making marked changes to their practices. In a national survey of obstetricians and gynecologists, about 51 percent said they had changed their practice in response to insurance affordability and 58 percent said fear of liability had caused practice changes. Cutting back the number of high-risk patients, performing more cesarean section births and stopping deliveries altogether were among the common changes, according to the 2012 survey by the American Congress of Obstetricians and Gynecologists.
In Baltimore, doctors and lawyers say both the causes and effects of that national trend are playing out in a drastic way.
In June 2012 a family whose son was born with severe brain damage won a record-setting verdict of $55 million against Johns Hopkins Hospital. In July 2012, a Glen Burnie couple won $21 million from MedStar Harbor Hospital in a birth injury lawsuit.
Hefty verdicts and a sense that the litigious atmosphere in the city will favor plaintiffs affects insurance rates and doctors? willingness to deliver here.
?Everyone wants a big payout,? said Dr. Jean Hundley, who is part of the private practice Womankind OB/GYN Associates in Columbia. ?Even if you did nothing wrong, it?s very hard to defend yourself in the city.?
The politics of insuranceIn some ways, malpractice insurance works like car insurance. If you live in an urban area, you will likely pay more for car insurance than your cousin in the country because you are statistically more likely to get in an accident. Similarly, doctors in Baltimore right now are more likely to wind up in a malpractice lawsuit that results in the insurance company paying out a lot of dough.
A lawsuit is what forced Dr. Carol Ritter, a private gynecologist in Towson, to stop delivering babies. After a series of lawsuits were filed against her in 2002, Ritter?s malpractice insurance costs went from $50,000 to $120,000, a price she could not afford.
The lawsuits ultimately did not stand up in court, but that didn?t matter.
?With malpractice insurance, you?re guilty until proven innocent,? Ritter said.
Ritter said she would like to return to obstetrics and practice in Baltimore. But not in this climate, she said.
Even doctors like Dr. Samuel Akman, who are willing to pay $100,000 for malpractice insurance, are staying away from Baltimore.
Akman and his six-person practice Ob/Gyn Specialists of Maryland LLC dumped their privileges at city hospitals 10 years ago, when a patient they treated in Baltimore County sued them in city court. That was possible because of their city privileges. Now the group practices only in the county, where they feel they stand a better chance defending their work in court.
More recently, Hundley and her partner also abandoned practice in the city. Hundley had practiced jointly at Mercy Medical Center and Howard County General Hospital for about a decade, but a few years ago business picked up and the doctors decided they needed to work exclusively with one hospital. They chose Howard. Hundley said their malpractice insurance rates dropped 10 percent.
Attorney Gary Wais, who represented the Waverly family against Hopkins, said he has not noticed a trend in families going after their doctors or juries favoring plaintiffs. Wais tells juries he does not want their sympathy, he said.
?It?s the doctors not practicing in standards of care ? they?re the ones getting sued,? Wais said. ?Anyone who is competent and does a good job has nothing to worry about.?
Regardless, hospitals say the verdicts have made an impact.
?It has really stressed our system,? said Dr. Andrew Satin, chairman of obstetrics and gynecology at Johns Hopkins Bayview Medical Center. ?Whenever the local environment is stressed by liability issues the poorer and sicker have fewer and fewer places to go for care.?
Bayview could end up with more high-risk pregnancies, which is extra risky at a time when fear of lawsuits is already high.
Million-dollar babies
The cost of maintaining OB when liability concerns are high is not just about insurance rates.
Mercy Medical Center is spending millions of dollars on extra precautions.
Obstetricians now work around the clock. Those who deliver babies are being called off all other duties in an attempt to avoid any delays or scheduling conflicts.
Mercy has also hired extra nurses and technicians for its 32-bed maternity unit and is calling for extra scans and tests for patients ? just to be sure.
It is expensive, reduces productivity and does not bode well for staff morale, but department chief Atlas does not know an alternative to protecting his department. Atlas did not know exactly how much this approach has cost the hospital, but said it is in the millions.
That?s big dollars at a time when hospitals say they are already struggling financially and are facing a whole host of financial unknowns, like federal health reform and a new system for hospital payment.
And there doesn?t seem to be a light at the end of the tunnel.
?I think most people who live in the city just won?t deliver their babies in the city,? said Ritter, the Towson doctor.
Philly offers Baltimore a look at what might happen to OB units
If Baltimore obstetricians want a worst-case scenario, they need only look to Philadelphia.
There, the number of hospitals with delivery units has dwindled from 19 to six over the past 15 years. The shift has led to collaboration among the hospitals still delivering to find a way to improve a notoriously unprofitable service line, the Philadelphia Business Journal, a sister paper, reported in November.
Women who can afford to are increasingly seeking care in the suburbs, leaving poorer and less healthy patients to turn to the struggling city maternity wards.
Mercy Medical Center?s Dr. Robert Atlas used to work in Philadelphia and said he left the city because of the trend he recognized among hospitals there.
Atlas even weighed in with the Philadelphia paper about how business was going in Baltimore. He touted Mercy?s new maternity ward, which opened in June 2012.
Now Atlas finds himself worried that trouble is following him.
?Absolutely I suspect that if things continue the way it is, it will be exactly what happened in Philadelphia,? Atlas said.
Read more at philadelphiabusinessjournal.com.
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State of Birth in Baltimore (fixed)
anonsouthernbell
member
The miracle of life has lost some of its sparkle for Bayla Berkowitz.
Childbirth is a tense experience. But at hospitals and private obstetrician practices in the Baltimore area, tension is peaking. A string of high verdicts in obstetrics malpractice cases has caused a rise in malpractice insurance costs, heightened the fear of getting sued, and ushered in palpable changes to how delivery units and their doctors work.
Hospitals are spending millions to try to account for every potential ?what if,? private doctors are moving out of the city, and administrators are questioning how much longer these units will be financially viable.
In a sort of medical Cold War, every hospital seems to fear one of its peers will suddenly buckle under the financial pressure, pull the trigger and shut down obstetrics, leaving them with hundreds more babies to deliver.
Their fear isn?t unfounded. The University of Maryland Medical System is closing Maryland General Hospital?s obstetrics and gynecology department at the end of June as part of a restructuring that will merge those services with the University of Maryland Medical Center. The system said the decision was based on a decline in deliveries against high overhead costs.
With about 570 deliveries in fiscal 2012, Maryland General was the city?s least used maternity ward. But that?s 570 babies who will have to be delivered at some other hospital that may not want the business.
The combination of high risk, high cost and a potential tightening of the OB supply could be devastating for the city, hospital administrators say.
?This will destroy institutions,? said Dr. Robert Atlas, chairman of obstetrics and gynecology at Mercy Medical Center, Baltimore?s busiest delivery unit in 2012. ?Institutions will have to decide, will we go out of business trying to keep this going or will we have to close our door.?
For every doctor and every hospital, malpractice insurance is a major expense, and being sued a common concern. The issue is particularly potent in obstetrics, a specialty with a high potential for error ? no birth ever goes exactly by the book, doctors say ? and a large opportunity for litigation. Sympathy can sway a jury doctors say. And in Maryland, parents have until their child is 21 years old to decide to take legal action.
The result has been a national shift. Fewer new doctors are choosing obstetrics, more OB-GYNs are dropping the OB, and those who decide to stay in the baby business are making marked changes to their practices. In a national survey of obstetricians and gynecologists, about 51 percent said they had changed their practice in response to insurance affordability and 58 percent said fear of liability had caused practice changes. Cutting back the number of high-risk patients, performing more cesarean section births and stopping deliveries altogether were among the common changes, according to the 2012 survey by the American Congress of Obstetricians and Gynecologists.
In Baltimore, doctors and lawyers say both the causes and effects of that national trend are playing out in a drastic way.
In June 2012 a family whose son was born with severe brain damage won a record-setting verdict of $55 million against Johns Hopkins Hospital. In July 2012, a Glen Burnie couple won $21 million from MedStar Harbor Hospital in a birth injury lawsuit.
Hefty verdicts and a sense that the litigious atmosphere in the city will favor plaintiffs affects insurance rates and doctors? willingness to deliver here.
?Everyone wants a big payout,? said Dr. Jean Hundley, who is part of the private practice Womankind OB/GYN Associates in Columbia. ?Even if you did nothing wrong, it?s very hard to defend yourself in the city.?
The politics of insuranceIn some ways, malpractice insurance works like car insurance. If you live in an urban area, you will likely pay more for car insurance than your cousin in the country because you are statistically more likely to get in an accident. Similarly, doctors in Baltimore right now are more likely to wind up in a malpractice lawsuit that results in the insurance company paying out a lot of dough.
A lawsuit is what forced Dr. Carol Ritter, a private gynecologist in Towson, to stop delivering babies. After a series of lawsuits were filed against her in 2002, Ritter?s malpractice insurance costs went from $50,000 to $120,000, a price she could not afford.
The lawsuits ultimately did not stand up in court, but that didn?t matter.
?With malpractice insurance, you?re guilty until proven innocent,? Ritter said.
Ritter said she would like to return to obstetrics and practice in Baltimore. But not in this climate, she said.
Even doctors like Dr. Samuel Akman, who are willing to pay $100,000 for malpractice insurance, are staying away from Baltimore.
Akman and his six-person practice Ob/Gyn Specialists of Maryland LLC dumped their privileges at city hospitals 10 years ago, when a patient they treated in Baltimore County sued them in city court. That was possible because of their city privileges. Now the group practices only in the county, where they feel they stand a better chance defending their work in court.
More recently, Hundley and her partner also abandoned practice in the city. Hundley had practiced jointly at Mercy Medical Center and Howard County General Hospital for about a decade, but a few years ago business picked up and the doctors decided they needed to work exclusively with one hospital. They chose Howard. Hundley said their malpractice insurance rates dropped 10 percent.
Attorney Gary Wais, who represented the Waverly family against Hopkins, said he has not noticed a trend in families going after their doctors or juries favoring plaintiffs. Wais tells juries he does not want their sympathy, he said.
?It?s the doctors not practicing in standards of care ? they?re the ones getting sued,? Wais said. ?Anyone who is competent and does a good job has nothing to worry about.?
Regardless, hospitals say the verdicts have made an impact.
?It has really stressed our system,? said Dr. Andrew Satin, chairman of obstetrics and gynecology at Johns Hopkins Bayview Medical Center. ?Whenever the local environment is stressed by liability issues the poorer and sicker have fewer and fewer places to go for care.?
Bayview could end up with more high-risk pregnancies, which is extra risky at a time when fear of lawsuits is already high.
Million-dollar babies
The cost of maintaining OB when liability concerns are high is not just about insurance rates.
Mercy Medical Center is spending millions of dollars on extra precautions.
Obstetricians now work around the clock. Those who deliver babies are being called off all other duties in an attempt to avoid any delays or scheduling conflicts.
Mercy has also hired extra nurses and technicians for its 32-bed maternity unit and is calling for extra scans and tests for patients ? just to be sure.
It is expensive, reduces productivity and does not bode well for staff morale, but department chief Atlas does not know an alternative to protecting his department. Atlas did not know exactly how much this approach has cost the hospital, but said it is in the millions.
That?s big dollars at a time when hospitals say they are already struggling financially and are facing a whole host of financial unknowns, like federal health reform and a new system for hospital payment.
And there doesn?t seem to be a light at the end of the tunnel.
?I think most people who live in the city just won?t deliver their babies in the city,? said Ritter, the Towson doctor.
Philly offers Baltimore a look at what might happen to OB units
If Baltimore obstetricians want a worst-case scenario, they need only look to Philadelphia.
There, the number of hospitals with delivery units has dwindled from 19 to six over the past 15 years. The shift has led to collaboration among the hospitals still delivering to find a way to improve a notoriously unprofitable service line, the Philadelphia Business Journal, a sister paper, reported in November.
Women who can afford to are increasingly seeking care in the suburbs, leaving poorer and less healthy patients to turn to the struggling city maternity wards.
Mercy Medical Center?s Dr. Robert Atlas used to work in Philadelphia and said he left the city because of the trend he recognized among hospitals there.
Atlas even weighed in with the Philadelphia paper about how business was going in Baltimore. He touted Mercy?s new maternity ward, which opened in June 2012.
Now Atlas finds himself worried that trouble is following him.
?Absolutely I suspect that if things continue the way it is, it will be exactly what happened in Philadelphia,? Atlas said.
Read more at philadelphiabusinessjournal.com.
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Re: State of Birth in Baltimore (fixed)
Thanks!
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