Last summer, Marshalltown’s UnityPoint hospital shuttered its maternity ward. The year before that, Washington County Hospital in southeast Iowa did the same. These closures weren’t outliers.
According to the Iowa Department of Public Health, 28 Iowa hospitals stopped delivering babies between 2001 and 2018. Nearly half of those maternity wards (12) closed within a two-year span, from 2016 to 2018.
We’ve known about some of the contributing factors for a long time — our shrinking and aging rural populations don’t need as much maternity care, and Medicaid reimbursement rates are too low to keep maternity services viable at more remote, financially strained facilities. But within the past few years, there is another concern: sky-high awards and settlements in medical malpractice cases.
When I moved to Iowa 20 years ago, Iowa enjoyed the reputation of practical and reasonable juries and malpractice judgments — attractive for a physician looking for a place to practice.
When a patient was injured, a jury would determine how much money they should award to cover “economic damages,” including things like treatment costs and lost wages. If indicated, juries could also order doctors and hospitals to pay “punitive” damages. But sometimes when a patient is hurt, justice demands more. In those cases, juries would award more money to ensure the patient was fairly compensated for non-quantifiable things like pain and suffering. Those awards are called “non-economic damages.” For a long time, awards in all three categories in Iowa were generally reasonable.
Over the past few years however, the situation has rapidly changed. Trial lawyers, some from out of state, began demanding massive non-economic damages awards and settlements for plaintiffs — millions, or even tens of millions of dollars for a single malpractice case. In lawsuits decided between 2017 and 2019, Iowa juries awarded plaintiffs more than $63 million in non-economic damages alone. This amount was nearly three times the $21.4 million awarded in economic damages — the compensation awarded to plaintiffs for their out-of-pocket costs and lost wages.
My specialty of obstetrics and gynecology is one of the specialties most vulnerable to lawsuits. Everyone hopes for a healthy and happy outcome for both mom and baby. However many things influence the birth outcome, including mom’s underlying health and her own access to care during pregnancy. The labor and delivery process can be complicated and unpredictable. An underlying complication or any number of concerns in labor might result in a difficult birth or health issues for the newborn.
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Malpractice insurance for doctors has policy limits — usually around $1 million or $2 million. A judgment to pay $20 million in damages can spell financial disaster. A doctor’s office or clinic may close, and it is everyday Iowans who lose. The administrator of a struggling rural hospital, concerned about the risk of a multimillion-dollar lawsuit, makes the tough decision to close its maternity unit, and it is everyday Iowans who lose.
When a rural hospital stops offering maternity services, the negative effects cascade across Iowa’s entire health care system. More women deliver outside of the hospital. Expectant mothers in remote areas have to travel long distances, often driving an hour or more away, to receive basic prenatal care. If such a patient has a complicated pregnancy, she may need frequent visits as she nears term. Unfortunately, she might not be able to afford to take that much time off work, or to pay the extra gas money. She may not be able to follow her doctor’s advice, increasing the probability of a poor outcome — and potentially a lawsuit against her maternity doctor. This situation drives up health care costs for all Iowans as malpractice insurance premiums rise, while putting patients, doctors and hospitals at risk.
Iowa has long faced challenges in recruiting physicians, especially to rural areas. Many of Iowa’s rural counties are entering crisis mode regarding maternity care access. Left unchecked, massive malpractice verdicts and settlements will further hurt Iowa’s communities as they attempt to recruit maternity providers. Data from the Association of American Medical Colleges shows that Iowa already ranks last (behind all other states, Washington, D.C., and Puerto Rico) for the number of OB/GYNs per 10,000 women. Half of Iowa’s counties lack any maternity services.
Thankfully, there is a solution to this problem: The Iowa Legislature needs to set a firm dollar limit or “hard cap” on non-economic damages. Iowa is nearly surrounded by states that have done just that. Iowa cannot afford to have a target on its back for outrageous awards.
Although Iowa doesn’t have mountains or an ocean, it’s well known in the medical community that the legal climate plays a huge role for physicians when they’re deciding where to practice. The ability to recruit physicians to Iowa, and especially those who provide maternity services, will continue to decline unless the Legislature gets serious about reforming the legal landscape for medical malpractice lawsuits.
All Iowans deserve to have easy access to basic medical care. Please join me in contacting your legislators and asking them to protect Iowa’s patients by capping non-economic damages in medical malpractice cases.
Dr. Marygrace Elson is an obstetrician/gynecologist practicing in Iowa City and is president of the Iowa Medical Society.