Premiums doubled since last year: nurse-midwives feel sting of rising premiums, lawsuits; Professional collaboration increases ob.gyns.' litigation exposure, vulnerability.(News)

Certified nurse-midwives are starting to feel the impact of the medical liability crisis, joining ob.gyns. who suffer from rising malpractice premiums and high-priced lawsuits.

When it comes to medical liability, there are few differences between the two professions, Dr. Richard Waldman, an ob.gyn. in Syracuse, N.Y., said. "What hurts them hurts us. I work collaboratively with two licensed professional midwives, and if they get sued, I get sued. If their premiums go up, so will ours."

Historically, certified nurse-midwives--or certified midwives, as some are known in New York and New Jersey--have had a low incidence of lawsuits. In surveys from the American College of Obstetricians and Gynecologists (ACOG), 2.4% of claims reported by ob.gyns, in 1992 named a nurse-midwife as a codefendant in lawsuits. In 1999, the percentage was 2.2%.

Other physicians involved in labor and delivery, such as family physicians and anesthesiologists, are more likely to be named in lawsuits than are CNMs, said Marion McCartney, director of professional services for the American College of Nurse-Midwives (ACNM).

Trial lawyers, however, are learning that nurse-midwives are governed by protocols or collaborative agreements, meaning that they could be easily implicated in lawsuits, Dr. Waldman said. "Midwives can independently manage only normal patients, but the definition of 'normal' can be deliberately misinterpreted in the courtroom." Specifically, an attorney could argue that a nurse-midwife was practicing beyond her education, he said.

If nurse-midwives are getting sued, "it doesn't mean they're being sued with any strategy; it just means they're brought in as a third party in the case," said C. Mitchell Goldman, a Philadelphia attorney who specializes in malpractice law. "It's another way for attorneys to get to the physician."

Rising premiums are another sign that things are getting worse and that large malpractice payout cases are starting to affect all health care providers.