Medical Professional Liability and the Delivery of Obstetrical Care -- Copyright -- LIST OF CONTRIBUTORS -- CONTENTS -- PREFACE -- KEYNOTE ADDRESS -- THE MEDICAL BACKGROUND -- The Impact of Technology Assessment and Medical Malpractice on the Diffusion of Medical Technologies: The Case of... -- HISTORY OF FETAL MONITORING -- EFFICACY AND SAFETY OF ELECTRONIC FETAL MONITORING -- DIFFUSION OF TECHNOLOGY -- Policies Toward Medical Technology -- Policies Toward Development of Electronic Fetal Monitoring -- Policies Toward Evaluation of Electronic Fetal Monitoring -- Policies Toward Payment for Electronic Fetal Monitoring -- Policies Toward Use of Electronic Fetal Monitoring -- IMPACT OF TECHNOLOGY ASSESSMENT -- INFLUENCE OF MEDICAL MALPRACTICE ON THE USE OF ELECTRONIC FETAL MONITORING -- References -- Is the Rising Rate of Cesarean Sections a Result of More Defensive Medicine? -- HISTORICAL PERSPECTIVE -- EPIDEMIOLOGY OF CESAREAN SECTIONS -- Demographic Factors -- Maternal Age -- Prenatal Care -- Maternal Demographics -- Hospital Teaching Status -- Private or Clinic Care -- Hospital Ownership -- Insurance Coverage -- Comparison of National Cesarean Section Rates -- ELECTRONIC FETAL MONITORING -- DYSTOCIA -- BREECH PRESENTATION -- REPEAT CESAREAN SECTIONS -- RISKS ASSOCIATED WITH CESAREAN SECTION -- HAS THE INCREASED RATE OF CESAREAN SECTIONS LOWERED PERINATAL MORTALITY? -- COST OF CESAREAN SECTIONS -- HEALTH POLICY -- SUMMARY -- References -- Medical Professional Liability in Screening for Genetic Disorders and Birth Defects -- SCREENING PAST: PHENYLKETONURIA -- SCREENING PRESENT: MSAFP TESTING FOR NEURAL TUBE DEFECTS -- SCREENING FUTURE: DNA-BASED TESTING -- CONCLUSIONS -- References -- EFFECTS ON ACCESS TO AND DELIVERY OF OBSTETRICAL CARE -- Obstetrical Care for Low-Income Women: The Effects of Medical Malpractice on Community Health Centers.

MEDICAL MALPRACTICE AND LOW-INCOME WOMEN -- PURPOSE OF STUDY -- METHODOLOGY -- RESULTS -- Service Capacity -- Provider Recruitment and Retention -- Contractual Arrangements -- Effect on Access to Maternity Care -- Malpractice and Standards of Care -- Increased Risk for Family Doctors -- Accumulated Exposure -- Per Se Risk -- CONCLUSIONS -- RECOMMENDATIONS -- References and Notes -- Medical Professional Liability and Access to Obstetrical Care: Is There a Crisis? -- METHODOLOGY -- PROFESSIONAL LIABILITY CONCERNS AND CHANGING OBSTETRICAL PRACTICE -- What Changes Are Occurring in Obstetrical Practice? -- Are These Changes Occurring Because of Professional Liability Concerns? -- Summary -- THE IMPACT OF PHYSICIAN PRACTICE CHANGES ON ACCESS TO CARE -- Access for Medicaid Recipients and Low-Income Women -- Access to Care in Rural Areas -- Summary -- MEDICAID RECIPIENTS AND PROFESSIONAL LIABILITY -- Cost of Insurance Coverage -- Fear of Litigation -- CONCLUSIONS -- References and Notes -- Medical Professional Liability and the Relations Between Doctors and Their Patients -- CAUSES OF THE PROBLEM -- Malpractice -- The Tort System -- Social Attitudes -- Commercialization of Medicine -- EFFECTS OF THE MALPRACTICE CRISIS ON DOCTOR-PATIENT RELATIONS -- Changes in Attitudes -- Changes in Practice Organization -- Changes in Physician Behavior -- SUMMARY -- Professional Liability Insurance and Nurse-Midwifery Practice -- PROFESSIONAL LIABILITY INSURANCE FOR NURSE-MIDWIVES -- Effects on Structure of Practice -- Effects of Insurance Surcharges -- Changes in Practice -- CONCLUSION -- References and Notes -- THE LEGAL ISSUES -- Market and Regulatory Approaches to Medical Malpractice: The Virginia Obstetrical No-Fault Statute -- THE LOGIC OF MARKETS: WHY CONTRACT? -- The Limitations on Contract -- Imperfect Information -- Binding the Child -- Access for the Poor.

THE VIRGINIA NO-FAULT STATUTE -- The Political Setting -- The Statutory Design -- Coverage -- Funding -- CONCLUSION -- References and Notes -- A Fault-Based Administrative Alternative for Resolving Medical Malpractice Claims: The AMA-Specialty Society Medical... -- THE NEED FOR DRAMATIC CHANGE -- PROPOSAL FOR A FAULT-BASED ADMINISTRATIVE SYSTEM -- Medical Practices Review Board -- The Claims Resolution Process -- Prehearing -- Hearing -- Board Review -- Judicial Review -- Reforms of the Legal Rules Governing Medical Liability Determinations -- Standard of Care -- Causation -- Informed Consent -- Damages -- Physician Monitoring and Quality Assurance -- IMPLICATIONS OF THE PROPOSAL FOR LIABILITY AND ACCESS PROBLEMS -- Implications for Resolving Liability Disputes -- Implications of Proposed Changes in Legal Standards -- Changes Resulting from Improved Physician Monitoring and Credentialing -- Possible Modification of the Proposal for Specific Types of Claims -- References and Notes -- The Shadow of the Law: Jury Decisions in Obstetrics and Gynecology Cases -- JURY VERDICTS AND THE DISPUTE RESOLUTION PYRAMID -- JURY VERDICTS AND THE SHADOW THEY CAST -- JURY VERDICTS IN OBSTETRICS AND GYNECOLOGY -- General Contours of the Shadow -- Distribution of Verdicts Among Sites -- Plaintiff Success Rates -- Types of Obstetrics and Gynecology Cases -- Severity of Injury -- Cause of Injury -- Class of Injury -- Awards -- A More Detailed View of the Shadow -- Pregnancy -- Labor and Delivery -- Abortion -- Hysterectomy -- Tubal Ligation -- Cancer -- Interpreting the Shape of the Shadow -- CONCLUSIONS -- References -- The Virginia Birth-Related Injury Compensation Act: Limited No-Fault Statutes as Solutions to the "Medical Malpractice... -- SIGNIFICANT FEATURES OF TRADITIONAL TORT AND ALTERNATIVE COMPENSATION SYSTEMS -- General Descriptions of the Systems.

Traditional Tort Liability System -- Comprehensive No-Fault Alternative -- Limited No-Fault Statutes -- How Is Each System Implemented? What Is the Source of Each System's Legal Authority? -- The Traditional Tort System -- The DCE System -- The Virginia No-Fault Statute -- What Triggers Liability? What Events Are Compensable? -- The Traditional Tort System -- The DCE System -- The Virginia No-Fault Statute -- Who Pays? Who Gets Paid? -- The Traditional Tort System -- The DCE System -- The Virginia No-Fault Statute -- How Is the System Funded? -- The Traditional Tort System -- The DCE System -- The Virginia No-Fault Statute -- How Are the Benefits Measured? -- The Traditional Tort System -- The DCE System -- The Virginia No-Fault Statute -- By What Processes of Decision Are Claims Handled? -- The Traditional Tort System -- The DCE System -- The Virginia No-Fault Statute -- How Exclusive Is the Remedy Provided? What Is the Interface with Other Compensation Systems? -- The Traditional Tort System -- The DCE System -- The Virginia No-Fault Statute -- COMPARING AND CRITIQUING THE GOALS AND OBJECTIVES OF THE THREE LIABILITY-COMPENSATION SYSTEMS -- The Traditional Tort System -- The DCE System -- The Virginia No-Fault Statute -- CONCLUSION -- References and Notes -- Legislative Proposals on Medical Professional Liability Regarding the Delivery of Maternal and Child Health Care -- THE PROBLEM -- STATE REFORMS -- Collateral Source Rule -- Joint and Several Liability -- Limitations on Attorneys' Fees -- Limits on Damages -- ALTERNATIVES TO TORT REFORM PROPOSALS -- Federal Proposals -- Provider Proposals -- SUMMARY -- References and Notes -- INDEX.