10 pitfalls that can lead to big OB malpractice cases

Many birth-related lawsuits can be traced back to fundamental flaws in how your OB department or practice is run, says Larry Veltman, MD, chairman of the department obstetrics and gynecology at Providence St. Vincent Medical Center in Portland, OR, and medical director of the healthcare professional liability division for the Farmers Insurance Group of Companies. Veltman offers this list of the most common failures that lead to OB malpractice lawsuits:

  1. Expecting a physician or nurse to be in three or four places at once.
  2. Overbooking and high patient volume.
  3. Multiple providers caring for one patient, especially if sign-outs are poor.
  4. Inadequate protocols for consultation, referral or transfer.
  5. Trying to hard to please the patient, bending the rules "just this once."
  6. Underestimating the risk of a particular situation and trying for the miracle vaginal birth.
  7. Off-site monitoring of intensive care situations.
  8. A hierarchy (doctor vs. nurse, or attending vs. resident) that creates safety issues of makes them difficult to overcome.
  9. Failure to recognize the effects of human factors on the ability to impair vigilance. Vigilance can be impaired by fatigue, illness, feeling rushed, stress, financial worries, anger, drugs, gambling, feelings of invulnerability, and complacency.
  10. Inadequate use of backup.