The country's approximately 2,500 certified nurse-midwives are finding insurance companies increasingly unwilling to renew their medical malpractice insurance. Their plight is part of a problem that affects the entire medical profession. Malpractice insurance premiums for gynecologists and obstetricians have risen as high as $80,000 a year in some areas, and as a result some expectant mothers are being turned away.
In 1984 the property and casualty insurance industry, which covers medical malpractice, suffered its worst financial year ever. Because of that, some companies have concluded that medical malpractice insurance is just too risky a venture these days. That has caused insurers to increase greatly the premiums they charge physicians and to refuse to renew policies for midwives at all. If the trend continues and obstetricians and midwives leave their professions, there could be a real question of whether qualified and trained personnel will be on hand.
The medical profession has made remarkable strides in its capacity to cure or give a fighting chance in cases where there once was no hope. Despite that advancement, or perhaps because of it, patients and their families have become increasingly litigious and juries increasingly generous.
One of every 20 doctors was named in a malpractice suit in 1975. In 1983, it was one of every six doctors. The average malpractice settlement has leaped from $5,000 in 1979 to $330,000 today. About 60 percent of the nation's obstetricians and gynecologists have been sued. It is a safe bet that not all of them deserved to be. The system needs to be changed.
More than 35 states are considering laws to decrease the number of lawsuits through some preliminary steps, to limit jury awards or to reduce lawyer fees. In New York, the state legislature approved a bill that calls for better monitoring to weed out incompetent doctors, cuts attorneys fees (frequently one-third or more of a settlement) and imposes fines up to $10,000 for filing "frivolous" malpractice lawsuits. Virginia has placed a $1 million ceiling on medical malpractice awards. Some have suggested that the responsibility of setting malpractice awards should be removed from juries.
The midwives, who have been paying $800 to $1,000 a year for malpractice insurance, say they are willing to pay two or three times that amount. People who earn in the $20,000 to $25,000 range, however, can hardly afford to pay more. If something is not done, competent doctors will continue to turn away pregnant women, while the low-cost alternative of midwives is slowly eliminated.