**11. References**


9. Medicine advances most effectively by narrowing its scope. Psychology advances by broadening its scope and generalizing to theory. Both together are necessary in the treatment of the child with cancer. As we continue to develop the research and intervention efforts with the children with oncological and hematological illnesses, we have seen our biopsychosocial efforts become a model for the increasing integration of the psychosocial in the treatment of children with a variety of chronic illnesses (Roberts, 2003). We should continue to disseminate our research and intervention findings among pediatric practitioners who are dealing with similar issues in different settings

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**Part 5** 

**Professional Liability** 

distinguishing non-harmful from harmful therapies. Pediatric Blood and Cancer 42, 106-108.


**Part 5** 

**Professional Liability** 

266 Complementary Pediatrics

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**15** 

 *USA* 

**Risk Management in Obstetrics** 

Eric Culp, Gretchen Garbe and John Morrison

Jonathan Muraskas, Lindsay Ellsworth,

 *University of Mississippi Medical Center,* 

*Loyola University Medical Center,* 

 **and Neonatal-Perinatal Medicine** 

The professional liability crisis remains a common problem for obstetricians. Approximately 90% of American College of Obstetricians and Gynecologists fellows have been sued at least once and 25% have been sued four or more times. Approximately 15% of obstetricians have ceased obstetric practice because of exorbitant premiums and the prevalence of nonmeritorious claims in this field of practice. The average age at which an obstetrician/gynecologist stops providing obstetrical care is currently 48 years of age; the

This current liability crisis is very relevant to all practitioners who care for newborns. Neonatologists, pediatricians, hospitalists, and nurse practitioners all provide critical care to sick newborns in different venues. These newborns are younger, more fragile, often extremely small and the risk of life long chronic disease, pain and disability are significant for these patients. Parents often experience emotional and economic distress when their newborn is in the NICU. These factors have contributed to an increased number of

Juries tend to have a natural sympathy for disabled children even when allegations are nonmeritorious. In addition, many states exempt minors from the statute of limitations for medical liability which can lead to a physician defending claims 10-20 years after the alleged incident. Capping noneconomic damages in children is difficult. The increase in litigation cases is mirrored by an increase in the awards received by the plaintiff. Today the average jury award for poor obstetric and neonatal outcome exceeds \$3,000,000. Obstetricians pay some of the highest insurance premiums, up to \$300,000 per year in some states. Efforts at tort reform, award caps and the policing of junk science have not been uniformly successful. The purpose of this Chapter is to identify the etiology, pathology and prevention of common allegations of professional liability for the obstetrician and practitioner of neonatalperinatal medicine. The author has reviewed 100 closed cases of alleged professional liability against obstetricians for causation of poor neonatal outcome and 100 closed cases of alleged professional liability involving practitioners of neonatal perinatal medicine as an expert. These cases were reviewed over a 25 year period (1985-2010). Approximately 75% of

age at which most physicians approach the peak of judgment and experience.

allegations against practitioners of neonatal/perinatal medicine.

**1. Introduction** 
