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Medical Malpractice Crisis More Information A pregnant Rebeca Fuentes, 30, readies herself for an examination as her doctor, Bob Comeau, checks her chart. Comeau is one of several obstetrician/gynecologists who have terminated their privileges at some area hospitals in an effort to lower their risk of medical malpractice lawsuits. Photo by Amy Beth Bennett.

Wednesday, April 24, 2002
Copyright © Las Vegas Review-Journal

MEDICAL MALPRACTICE CRISIS: OB/GYNs shedding ER duties

Doctors say they can't take chance of treating patients at high risk

Some Southern Nevada obstetricians are relinquishing their privileges at select hospitals to reduce the number of mandatory emergency shifts they must work taking care of high-risk patients.

Women who receive no prenatal care and arrive in emergency rooms ready to deliver are considered high-risk patients, and the obstetricians say they can no longer afford to risk their careers caring for them.

According to the Clark County OB/GYN Society, at least 10 area obstetricians are giving up their privileges at several area hospitals, the latest casualty in what has come to be known as Southern Nevada's medical malpractice crisis.

Skyrocketing medical malpractice rates and the unavailability of insurance threaten the future of trauma care, pediatric heart surgery, obstetrics, radiology and other medical specialities in Las Vegas.

"I love what I do, but I have to cut my risk, and if I work in fewer emergency rooms I have less risk," said Dr. Bob Comeau, an obstetrician who recently requested a leave of absence from Sunrise Hospital and Medical Center.

After leaving Sunrise, Comeau expects to have fewer on-call shifts and fewer emergency room patients to take care of.

"It's too much of a medical liability to take calls in emergency rooms," he said. "People come in with no prenatal care ready to deliver, and anything can happen. These are the most high-risk patients, and all it takes is one bad outcome to end your career medically. I have a very good record so far, but that can be ruined even if you don't do something wrong."

Sunrise Hospital President Allan Stipe said he's concerned that physicians are resigning from the facility, but that there are still plenty of obstetricians to cover emergency room shifts.

"We're still in good shape; we've got the coverage," Stipe said. "Sixty-seven OB/GYNs participate in ER call."

Although the doctors have given up their privileges with a variety of hospitals, most of the 10 have chosen to stop delivering at Sunrise.

They say the hospital gets more high-risk patients than other facilities because of its location, thereby increasing their risk for lawsuits.

"You just don't get the same high-risk patients at hospitals on the other side of town," Comeau said. "You are almost guaranteed several patients a night with complications. At other hospitals, sometimes you're not called in at all."

About 100 Las Vegas doctors already have either left Nevada to practice elsewhere, have announced they will be closing or have retired early because they can't find medical malpractice insurance or can't afford doubling, tripling or even quadrupling rates, said Larry Matheis, executive director of the Nevada State Medical Association.

Nine of the 140 obstetricians and gynecologists in Clark County already have shut down their practices and 30 more are preparing to leave, according to a survey commissioned by the Clark County OB/GYN Society.

The doctors that are trying to stay in town say they are doing everything they can to cut risks and cut costs. Some obstetricians have stopped delivering babies altogether while others are limiting the number of hospitals they serve.

Other specialty physicians besides obstetricians also are declining to cover emergency room on-call shifts.

Many area plastic surgeons and orthopedic surgeons no longer want to perform emergency hand surgeries because they often are risky procedures, said Dr. Jeff Davidson, emergency room director at Valley Hospital Medical Center.

These surgeons cover on-call shifts voluntarily, unlike the mandatory shifts for obstetricians.

"Just a few years ago we had hand surgeons on call at every ER in this city," he said. "Now only two emergency departments have them. We don't have one anymore."

In order to have privileges at area hospitals, most obstetricians must rotate covering the emergency room.

The doctors are called in when women without regular obstetricians show up in emergency rooms with pregnancy complications, postpartum problems or when they are ready to deliver.

A woman with a regular doctor will have her own physician called in to care for her.

"The women without prenatal care can suffer from a wide range of things: high blood pressure, uncontrolled diabetes, bleeding disorders that can lead to stroke or seizures, things that are health risks to both mom and baby," said Dr. Rafael Juarez, who recently relinquished his privileges at several area hospitals.

Obstetricians are more at risk for lawsuits than many other doctors because they are liable for a child until the child turns 18.

The doctors also are more likely to be sued by an emergency room patient with no prenatal care because there's an increased risk of complications and because there's no doctor-patient relationship, said Dr. Shelby Wilbourn, who recently requested a leave of absence from Sunrise.

"If somebody comes in at 9 months with no prenatal care, I'm still supposed to pull out a grade A baby and hand it over to that mommy who never bothered to get prenatal care," he said.

If obstetricians are unavailable to cover emergency room shifts, than emergency room doctors will be forced to care for patients they might not have the expertise or qualifications to handle, said Dr. Dale Carrison, director of the emergency room at University Medical Center.

Emergency room doctors can handle uncomplicated deliveries, but most cannot perform emergency cesarean sections, deliver breached babies or handle other complications.

"If that delivery is imminent, than I'm going to do everything I can to deliver the infant safely, but it's not our expertise," Carrison said. "If I can't find a specialist I need in the state, then I'll have to send them out of state and hope that the patient doesn't die in the meantime."