Maternity wards at risk [Commentary]

This summer, Gov. Martin O'Malley and public health leaders justly celebrated the fact that infant mortality in our state has been driven to a new record low. By increasing access to care and outreach for new mothers and their babies — particularly in low-income communities — Maryland's infant mortality rate fell by 21 percent between 2008 and 2012. This is a tremendous achievement.

But this hard won progress — as well as access for all expectant mothers — is at risk as we confront a looming obstetrics crisis: multi-million dollar medical malpractice judgments that are driving even higher the already high cost of medical liability.


The situation has already proved devastating in Pennsylvania.

Over the last decade, 13 of Philadelphia's 19 maternity wards have closed. In total, 21 maternity centers have closed in the Philadelphia region. Rising malpractice costs were a key driver in this exodus, according to an investigative series co-sponsored by the well-respected Commonwealth Fund.


In Maryland, three recent jury awards averaging $20 million each are beginning to put our hospitals on the same perilous path. These monetary awards, which are more than five times previous levels, have created an entirely new risk environment across Maryland that could ultimately reduce access to quality care. A recent survey by the Maryland Hospital Association found that 93 percent of the state's hospitals are concerned that the current liability situation could result in "a significant reduction in obstetrics services in Maryland." A quarter of hospitals in the state already have reduced their obstetrics services or are contemplating doing so.

The jurisdictions targeted by these lawsuits — Baltimore City and Prince George's County — are home to many of Maryland's most vulnerable families. For example, of the nearly 14,000 babies born in Baltimore each year, two-thirds are born to mothers covered by Medicaid. Many are high-risk pregnancies that require frequent prenatal visits provided by a limited number of doctors in community health clinics.

We understand that these are difficult policy issues to consider. But as lawmakers concerned about the health of Maryland's mothers and babies, we believe that we must do something to ensure that we maintain access for women, especially the poor.

Today's health care reform environment is an opportunity to explore responsible and even-handed medical liability reforms which will support improved patient care and community health while helping to control rising costs.

In promoting health reform during a 2009 speech to Congress, President Barack Obama said, "I've talked with enough doctors to know that defensive medicine may be contributing to unnecessary costs. … [We should] move forward on a range of ideas on how to put patient safety first and let doctors focus on practicing medicine."

We agree with President Obama, and as state policy makers we should follow his lead and seek out innovative national best practices. That's why we have proposed legislation this year that is similar to what has already been successful in states such as New York, Florida and Virginia, to address Maryland's looming maternity access crisis before more women's health care providers are forced to reduce services.

Our proposal would create a statewide "no fault" Maryland Birth Injury Fund — paid for by hospitals, OB/GYN doctors and insurance companies — that would help injured children and their families while protecting access to quality maternity health care.

If enacted, more babies who suffer birth injuries will get the lifetime care they need because acceptance into the program is based on the injury, not the outcome of a lawsuit. And every birth injury will be reviewed by state medical officials to ensure that if a doctor was negligent, he or she will be held accountable under Maryland law.


A recent poll by OpinionWorks of Annapolis found that voters support a birth injury fund by a 3-to-1 margin. Additionally, the poll found that two-thirds of voters believe it is fair that families give up their right to sue a doctor and a hospital in exchange for being guaranteed an award from the fund.

As Governor O'Malley said in August, "Since 2008, we've saved the lives of 368 babies by driving down the infant mortality rate by 21 percent. ... Only by making better choices can we achieve better results and save lives."

We must make the choice to preserve access to maternity care for mothers in Baltimore and throughout the state. This is not an abstraction — we have seen too clearly what has happened to women around Philadelphia when this problem was left unaddressed for too long.

Sen. Catherine E. Pugh is a Democrat who represents Baltimore's 40th District. Del. Dan K. Morhaim is a Democrat and practicing physician who represents Baltimore County's 11th District. Their email addresses are and

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