Nuclear Verdicts in Obstetrics Show the Risk of Malpractice Claims — What Are the Root Causes?

The landscape of obstetric care is evolving rapidly, but not always in ways that benefit healthcare providers. One of the most pressing issues today is the rise of “nuclear verdicts” in obstetrics — staggering malpractice awards that exceed $10 million. For example:

• In 2023, A Pennsylvania jury awarded $183 million to the family of a boy born with severe brain injuries due to a delayed C-section at the Hospital of the University of Pennsylvania. This case marked the largest award to a single plaintiff in Pennsylvania’s history.
• In 2022, a Georgia verdict awarded $30 million in a case where the baby’s heart rate went unmonitored for a critical period during labor. The baby suffered catastrophic hypoxic brain injury and multiple neurological issues due to amniotic fluid embolism.
• Also in 2022, an Iowa case resulted in a $97.4 million verdict, the largest in Iowa’s history. The baby’s fetal heart rate indicated the need for an emergency C-section. The doctor attempted a vaginal delivery using forceps and a vacuum extractor, leading to the child suffering severe brain damage and other lifelong disabilities.

As we examine this alarming trend, it’s crucial to understand the root causes behind these high-risk claims and what we must do to mitigate them.

The rise of nuclear verdicts in obstetrics

Obstetrics has always been a high-risk area for medical malpractice. With the complex nature of childbirth, the stakes are incredibly high. Historically, obstetricians, gynecologists, and general surgeons have been at the greatest risk of malpractice suits, with more than three-fourths of OB-GYNs facing a lawsuit at some point in their careers.

In recent years, we’ve seen a dramatic increase in nuclear verdicts — cases where juries award exceptionally large sums to plaintiffs. Nuclear verdicts are becoming more common, growing more than 27% in 2023. In 2023 alone, there were 57 nuclear verdicts, a significant jump from previous years. This trend is not just alarming; it’s a call to action for healthcare providers and institutions to reassess their practices.

Understanding the root causes

The factors driving these nuclear verdicts are multifaceted, rooted in both clinical and social factors. Here are the key contributors:

Lasting impact of the pandemic — The COVID-19 pandemic left a lingering impact on patient perceptions and jury behavior. Many patients emerged from the pandemic feeling frustrated and, some would say, betrayed by the healthcare system. Malpractice claims are on the rise, and jurors are more inclined to punish healthcare providers with large awards, viewing them as part of a flawed system.

Deviations from standard of care — Malpractice claims often arise from variations in care — instances where healthcare providers deviate from established standards or guidelines. In obstetrics, this might involve improper management of labor, delayed or incorrect diagnoses, or failure to perform necessary clinical assessments. These deviations can create grounds for litigation.

Breakdowns in communication — Effective communication is the backbone of patient safety. Yet nearly 70% of adverse events in obstetrics can be traced back to miscommunication among the care team. Whether it’s a failure to relay critical information during a shift change or misunderstandings during labor and delivery, these lapses can have catastrophic consequences.

Socioeconomic factors — We also can’t ignore the broader socioeconomic context. Economic disparities, the rising cost of healthcare, and societal frustrations are all playing into the hands of plaintiffs’ attorneys, who are becoming increasingly adept at leveraging these issues into wins for their clients.

Evolving expertise of prosecution attorneys — Many well-prepared and trained attorneys represent the prosecution of these claims. They know what is expected of obstetricians, the standards of care, and what comprises a best-practice model for optimal OB care. In addition, they are knowledgeable about patient safety and improvement initiatives such as high reliability and a just culture. If these elements do not exist on the defense side, be assured that the prosecution will address these types of proactive risk mitigation initiatives to reduce patient harm.

Measures to minimize malpractice risk

Given these root causes, how can healthcare organizations proactively position themselves as well as possible? The following actionable steps can help reduce the risk of facing a malpractice claim or, even worse, a costly verdict.

Adopt high-reliability practices

Building a culture of high reliability is crucial. This involves committing to continuous improvement, fostering open communication, and ensuring that every team member — from the top down — is aligned on patient safety protocols.

Standardize care protocols

Implementing evidence-based practice protocols across all levels of care can help reduce variations in care. Hospitals that require their obstetric teams to complete regular training and education on the latest guidelines have seen significant reductions in adverse events and malpractice claims.

Invest in teamwork and communication training

Ensuring that all members of the care team are skilled in effective communication is essential. This includes not only clinical communication skills but also the ability to engage with patients and their families clearly and empathetically.

Increase transparency and accountability

Sharing data on adverse events and claims within the organization can lead to greater awareness and proactive problem-solving. When everyone on the team understands the stakes, they’re more likely to engage in practices that prevent errors.

Leverage technology for education

Online learning workforce enablement platforms like those offered by Relias deliver critical knowledge and judgment. Leaders can test competency across the entire care team, including those in rural or underserved areas. These platforms ensure that all providers can access the same high-quality, evidence-based education.

Models to follow

We can learn from initiatives such as the Joint Commission’s Journey to Zero Harm. Programs like those implemented at University Hospitals at Case Medical Center and Texas Children’s Hospital emphasize standardization of care and enhanced communication across the entire care team. This includes physicians, midwives, nurses, and medical residents.

Participation in recurring education on evidence-based guidelines, active and ongoing simulation, and team training strengthen a potential legal defense by showing that an organization is proactive in providing high-quality care.

Addressing the risks is even more critical in rural areas where patient populations face additional challenges related to the social determinants of health. Providers and nurses who serve these populations have lower volumes and must stay on top of evidence-based protocols and standards. Continuous education and training are essential for maintaining high standards and reducing the risk of adverse events.

Why healthcare organizations must be proactive

The rise of nuclear verdicts in obstetrics is a stark reminder of the risks inherent in this field. However, by understanding the root causes and implementing proactive measures, healthcare providers can better protect themselves and, more importantly, their patients. It’s about fostering a culture of safety where every team member is committed to the highest standards of care.

We can use these insights to not only reduce malpractice claims but also to improve the quality of care for every birthing person and child.