An analysis of obstetric medical malpractice lawsuits filed in Harris County, Texas and an analysis of the use of Cesarean section and vaginal birth after Cesarean section before and after Texas' 2003 medical malpractice reforms
In 2003, Texas enacted significant reforms to medical malpractice statutes. One purported outcome is to reduce defensive medical practices. A preference for cesarean section delivery, when a vaginal birth after cesarean (VBAC) delivery is clinically possible, is often noted as a defensive medicine practice. Population rates of delivery methods can indicate defensive medicine. ^ This study assesses the impact of these 2003 Texas malpractice reforms by examining trends in delivery methodology before and after reform, along with examining medical malpractice lawsuit filings in Harris County, Texas. ^ Harris County, Texas medical malpractice lawsuits for one three-year period before the reforms, and two three-year periods following the reforms were reviewed. Percentage of malpractice suits as a portion of all civil suits, and obstetric suits as a portion of all malpractice suits, were noted. Numbers and types of plaintiffs, defendants, and the type of alleged harm, were noted; and case resolutions were tabulated. Harris County birth data were obtained for the total numbers of deliveries, cesarean sections and VBACs.^ Medical malpractice lawsuits filed after reform decreased from 1,215 malpractice lawsuits, and 124 obstetric suits (10.21%), to 716 malpractice lawsuits, and 47 obstetric suits (6.56%), and 644 malpractice lawsuits, and 53 obstetric suits (8.23%) in the two post-reform periods.^ Rates of plaintiffs and defendants per case did not change. Primary negligence claims included failure to diagnose/recognize and failure to manage labor/delivery. Injury claims included hypoxia, injury to mother, shoulder dystocia, injury to child; and death of mother/child. Procedural methods were not major factors in case resolution; but resolution by settlement increased after reform.^ Cesarean deliveries, as a portion of all deliveries, pre-reform period, was 24.2%; in the two successive post-reform time periods this portion was 31.1%; and 34.5%, respectively. The VBAC portion of deliveries decreased very slightly from1.6%, to 1.3%, and to 1.2%.^ After reform, malpractice filings decreased greatly, and cases settled at a higher rate. The use of cesarean section did not decrease as would be expected, but increased. The use of VBACs did not change.^ Influences upon physician litigation concerns and preferences for delivery method deserve further study.^
Lewandos, Noel Anne, "An analysis of obstetric medical malpractice lawsuits filed in Harris County, Texas and an analysis of the use of Cesarean section and vaginal birth after Cesarean section before and after Texas' 2003 medical malpractice reforms" (2015). Texas Medical Center Dissertations (via ProQuest). AAI3721383.