Hi All Is there something I am missing re admission CTG's and CTG's in general?
I see the whole issue of their use in reducing litigation as spurious. Is it true that only around 10% of hypoxic events can be attributed to labour and that the vast majority of damage cannot be linked to a certain time (ie the event could of taken place at 31 wks while Mum was washing up at home!!!!!!!!) Although my hat goes off to each and every one of you that work in these sick systems with a profession (Obstetrics) that epitomises misogyny midwives still have a responsibility to try and claw back normal birth and I would think challenging these ridiculous protocols as an important part. I agree working with women is very important and there is an element of letting women refuse etc, but as we all know many women place trust in health professionals (and are so fearful and have little relationship with carers in a highly fragmented system), so in the end will pretty much go with whatever! So many insidious practices can hide behind the shield of 'defensive medicine' and 'fear of litigation'. We need to help empower women and what we know about litigation is whenever a doctor is successfully sued, individual doctors, the AMA, and indemnity organisations start trotting out the old story of the �medical negligence crisis� and its link to �rising insurance premiums� (Banham & Dasey, 2003). However, contrary to popular opinion, the evidence does not support claims of a medical negligence crisis. The Health Care Complaints Commission (HCCC), set up to provide an accessible process for complaints about all facets of health care (not just medical practitioners), received a total of 2673 complaints for the year 2001-2002, 215 fewer than the year before. Of these complaints, 212 were assessed as suitable for investigation by the commission (Annual Report 2001-2002). While there is no central database containing information on the number of common law negligence cases, it can be extrapolated from the HCCC�s annual reports that the amount of cases that eventually come before a court would be low indeed (Review of Professional Indemnity Arrangements for Health Care Professionals, 1995). It can be assumed that a potential litigant would at first establish their case with the HCCC, and consequently these complaints are likely to be included in the HCCC�s statistics. In the Commonwealth Government�s Review of Professional Indemnity Arrangements for Health Care Professionals (1995) the issues of professional indemnity, negligence actions and adverse outcomes were described as surrounded by myths and assertions supported by little hard data. Much of the information relating to the �litigation crisis� was anecdotal: �evidence for a so-called claims crisis is scant�, said the Report, concluding that a crisis mentality has been fostered by some medical defence organisations to deflect attention from their own �irresponsible financial management�. Although an increase in the rate of incident reporting was noted, the Final Report held that this did not appear to be reflected in an increase in claims filed in courts. Hirsch (2003) also explains that the rise in medical insurance has more to do with the chronic mismanagement of the medical indemnity industry, and the global decline in investment markets, than to the handful of people who sue doctors and the even smaller proportion of those who do so successfully. The current �climate of litigation� and the link between this and rising insurance premiums is yet to be borne out by evidence. However, despite the evidence, when a medical negligence case is successful judgements are met with hysteria, scare mongering, and threats. In relation to the Melchoir judgment, the Queensland Court of Appeal agreed, as did the Supreme Court, and finally the High Court, that the doctor was negligent and yet doctors were still �stunned� by the decision (Graycar, 2003). One doctor wrote a letter stating, �The constant threat of litigation makes the provision of medicine a living hell� and questioned, �what sort society rewards such behaviour [of the person suing] while punishing those who devote their lives to helping the sick?�(Owen, 2003). Another doctor wrote in and stated, �as of today, I shall not perform tubal ligation (sterilisation)� (Symington, 2003). The AMA and indemnity insurance organisations also threatened that this case will further increase insurance premiums and cause doctor shortages (Banham & Dasey, 2003). How? I can�t help but wonder isn�t this the purpose of medical indemnity - to pay for medical negligence claims? It is hard to believe that the extremely small amount of successful plaintiffs that are compensated can cause the collapse of an entire industry. If this is the case, then it is obvious that the industry is not managed correctly, as the collapse of United Medical Protection organisation so painfully revealed. It is misleading to blame the rise in indemnity premiums, and vehemently criticise, the small amount of people that successfully sue their doctors. It deflects attention away from the more disturbing trend of mismanagement of the insurance industry. Furthermore, it benefits doctors to allude to the litigation crisis as the cause of increased premiums, doctor shortages, and so on, as this conceals doctors� more disingenuous protest of a potential drop in income with the more influential fantasy of the harassed doctor battling money grabbing litigants. Obstetricians in particular seem to have taken the �litigation crisis� to heart with many ceasing practice, leaving a gap in services for pregnant women, particularly in rural and regional areas. When asked to comment on the withdrawal of obstetric services the president of the National Association of Specialist Obstetricians and Gynaecologists, David Molloy, predictably stated, �the crucial issue for obstetricians was not money but fear of litigation�(Metherell, 2003a). However, the indemnity insurance issue is more likely to represent a drop in annual income due to the rising cost of premiums rather than a genuine increase in the risk of being sued. It seems rather devious to use fear of litigation as a reason to withdraw services when there is no supporting evidence. A survey of Australian specialist obstetricians (response rate 74%, n: 829/1116) demonstrated that during the period between 1978 and 2001 a total number of 401 claims commenced in the courts, of these 279 were settled before a verdict. Of the 401 claims only 26 were complete trials and after verdict 19 claims were settled in favour of the defendant (the obstetrician) and 4 in favour of the plaintiff (the remaining three claims are not explained) (MacLennan & Spenser, 2002). Disturbingly, the survey also reveals that 77% of the respondents indicated the present climate of litigation encouraged higher rates of caesarean section. As mentioned, much of the information relating to the �litigation crisis� is anecdotal and not supported by hard evidence and yet obstetricians are basing their clinical practice decisions on the supposed crisis! Furthermore, the HCCC�s Annual Report (2001-2002) reveals that only 20 of the total 2673 complaints made that year were pertaining to obstetricians, a decrease of 42% from the previous year. It was not recorded how many of these initial 20 complaints were deemed suitable for investigation, but it is likely it would be even less than 20. -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
