Progress at the Intersection of Patient Safety and Medical Liability: Insights from the AHRQ Patient Safety and Medical Liability Demonstration Program

Midwives and Liability: Results of the 2018 National Midwives and Liability Survey

INTRODUCTION

This is the third national survey about the incidence of midwifery involvement in malpractice litigation, case outcome, methods of coping, and the influence of fear of liability or actual litigation on midwifery practice and professional liability insurance. Incidence of disciplinary action was also included.

METHODS

A link to a web-based survey was sent to all American College of Nurse-Midwives members with an active email address in January 2018. Students and associate members were excluded from analysis. Logistic regression was used to identify predictors of involvement in lawsuit.

RESULTS

Of 6199 email links sent, 880 midwives responded (14%). One-third of participants (n = 280, 32%) have been named in at least one lawsuit after a median of 7 years in practice. Claims most often involved intrapartum hospital-based care and resulted from fetal heart rate interpretation. The most common outcome of a case was settlement prior to court or arbitration (n = 117, 42%). Significant predictors of litigation included older age of the midwife and region of practice (increased in Northeastern states, decreased in Midwestern states). Midwives' most common source of emotional support was their attorney. Only 6% (n = 53) of participants experienced disciplinary action against their state license. Half of the actions by a state governing board were unrelated to a lawsuit.

DISCUSSION

Midwives may experience litigation the longer they are in practice, but there has not been a significant change in the incidence since the previous survey in 2009. More resources and education are needed for midwives to provide adequate peer support to colleagues following adverse events or when named in a lawsuit. Continued education is also needed for midwives regarding types of professional liability insurance, affordability, and how policy terms and limits influence clinical practice.

Review of disclosure and apology literature: Gaps and needs

A review of the literature related to the disclosure movement was conducted to find gaps and needs while identifying areas where needs are being met. There are several articles that address claims and other economic factors. Moreover, there are many papers that define barriers to disclosure with suggested workarounds. There is also a wealth of training content that teaches how to say "sorry." However, gaps and needs were identified. The "gap list" was developed with a focus on concepts that are novel or not mentioned in the literature as well as issues in the disclosure movement that would benefit from greater attention: (1) lack of research and disclosure training content for health care professionals beyond acute care; (2) messaging and disclosure programs, including the meaning of "apology"; (3) insufficient integration between disclosure programs and second victim support programs; (4) confidentiality clauses; (5) the National Practitioner Data Bank and state licensure boards being viewed as an impediment to disclosure; (6) understanding awareness of the disclosure movement by consumers, personal injury bar, and payors; (7) measuring what medical and nursing schools are teaching about disclosure; and (8) encouraging states to pass apology laws that support the development of disclosure programs.