California College of Midwives
July 30th 1998
Bruce Hasenkamp, President, DOL
Medical Board of California 1436 Howe Ave
RE: Update on Professional Liability Insurance for Licensed Midwives
& its relationship to Physician Supervision
Dear Mr. Hasenkamp,
I am pleased to be able to inform the members of the Board that as of July 24th 1998, the national insurance carrier Sand-Morahan, a subsidiary of Evanston of Illinois, has entered into a contract for a master policy with the American College of Domiciliary Midwives providing professional liability insurance to licensed midwives in the state of California. It is a claims-made policy in the amount of $300,00 / $300,000 that covers professionally certified midwives of all educational backgrounds. Specifically, it covers professional midwifery services in all birth setting -- the client’s home, free-standing birth centers and midwives who have hospital privileges. However, it excludes coverage the use of pharmaceutical agents to augment or induce labor in a domiciliary setting. It also contains a mandatory arbitration clause. In the future the ACDM may impose the standards of practice and protocols for consultation and transfer of care that have been adopted in Canada by the College of Midwives of British Columbia. A complete copy of this material is available to the Medical Board or staff members if anyone is interested. The Statement on Home Birth and supportive citations adopted by College of Midwives of BC are attached for your information.
When we began the process of arranging for professional liability, we expected to negotiate the standard medical malpractice coverage of 1 million/ $3 million. However, Sand Morahan was not able to offer that level of coverage based on two facts. The first factor is that licensed midwives have not yet established a performance record within the malpractice insurance industry. The second is that incomes for midwives are only about 20% of those of earned obstetricians -- neither the level of premiums charged or the deductible are able to equal that paid by the obstetrical community. While the absence of a performance record will change in the course of a few years, it is not practical to expect that the earning power of midwives will ever match that of physicians. For that reason, one of the major impediments to securing physician supervision -- that of parity of liability coverage -- will remain permanently out of our reach under the current law.
Now that we have secured malpractice coverage many licensed midwives, including myself, have had additional conversations with obstetricians requesting physician supervision. All physicians contacted have stated that regardless of the liability insurance available, they are unwilling to enter into a supervisory relationship with domiciliary midwives as it imposes an unnatural and unnecessary burden of vicarious liability and either they or their insurance carrier are unable to participate under these circumstances.
Sincerely, Faith Gibson, LM, CPM
cc: MBC- DOL Board MembersEnclosures - Letter Dr. Creevy on physician supervision, Homebirth Statement CM-BC, Article form the May 1998 Journal of Epidemiology on efficacy of midwifery care as compared to physician services