McCool William F, Guidera Mamie, Griffinger Ellie, Sacan Dulcy
J Midwifery Womens Health. 2015 Jul-Aug;60(4):437-44. doi: 10.1111/jmwh.12310.
The risk of litigation remains of concern to midwives, their practice partners, employers, and malpractice insurance providers. Closed claims analysis is a method of examining risk patterns and behaviors in lawsuits, including those involving health care practices. The purpose of this investigation was to evaluate claims brought against midwives, with the intent of developing strategies to decrease the incidence of litigation.
Data were collected in joint meetings with members of the American College of Nurse-Midwives (ACNM); the American Association of Birth Centers; the American International Group (AIG), a major malpractice insurer for certified nurse-midwives/certified midwives (CNMs/CMs); and Contemporary Insurance Services, an independent insurance agency that has worked with AIG to facilitate the writing of malpractice insurance policies for CNMs/CMs. The purpose of the meetings was to review 162 litigation cases that involved midwives insured by AIG and had been closed between the years 2002 and 2011. Follow-up analyses of data and reporting of results were performed by the authors, who are members of the Professional Liability Section of the ACNM Division of Standards and Practice.
Findings reflected 7 major categories of liability risk ranging from the most prevalent (ie, fetal/newborn complications or death) to the least prevalent (ie, attending a vaginal birth after cesarean). Data also were examined regarding the highest amounts incurred in court decisions or pretrial settlements because they were related to types of adverse outcomes that occurred.
Recommendations for improving clinical practice and avoiding litigation based on findings from the closed claims analysis include, but are not limited to, the need for thorough and accurate documentation in practice, appropriate and timely consultation and collaboration, and the presence of practitioners whose clinical skills match the level of care assessed to be necessary for each woman for whom care is offered.
助产士、其执业伙伴、雇主及医疗事故保险提供商仍对诉讼风险忧心忡忡。封闭索赔分析是一种审视诉讼中的风险模式及行为的方法，包括涉及医疗保健执业的诉讼。本调查旨在评估针对助产士的索赔，以期制定降低诉讼发生率的策略。
数据收集于与美国助产士学院（ACNM）成员、美国生育中心协会、美国国际集团（AIG，认证助产士/注册助产士（CNMs/CMs）的主要医疗事故保险公司）以及当代保险服务公司（一家独立保险机构，曾与AIG合作，为CNMs/CMs撰写医疗事故保险政策）的联席会议。会议目的是审查162起涉及由AIG承保且在2002年至2011年间结案的助产士的诉讼案件。作者（ACNM标准与实践部职业责任组的成员）对数据进行了后续分析并报告了结果。
调查结果反映了7大类责任风险，从最常见的（即胎儿/新生儿并发症或死亡）到最不常见的（即剖宫产术后接生阴道分娩）。还审查了与法院判决或审前和解中产生的最高金额相关的数据，因为它们与所发生的不良后果类型有关。
基于封闭索赔分析结果提出的改善临床实践和避免诉讼的建议包括但不限于：在实践中需要进行全面准确的记录、进行适当及时的咨询与协作，以及配备临床技能与为每位接受护理的女性评估所需护理水平相匹配的从业者。
