Rising Malpractice Concerns in Turkish Gynecology and Obstetrics

Malpractice lawsuits are increasingly common in Türkiye, with gynecology and obstetrics facing the highest number of claims. This trend is impacting physician morale, career choices, and patient care. This article examines the factors contributing to this rise, the concerns within the medical community, and potential solutions.

The Landscape of Malpractice Lawsuits

Approximately 33 percent of malpractice cases in Türkiye are filed against gynecologists and obstetricians, significantly higher than other surgical specialties like general surgery (11.9 percent), plastic surgery and aesthetics (11.8 percent), ophthalmology (9.2 percent), and orthopedics and traumatology (8.9 percent).[1] Common issues leading to lawsuits include complications related to Down syndrome diagnoses, birth injuries such as shoulder dystocia and cerebral palsy, nerve damage during procedures, tubal ligation complications, and failure to detect fetal limb deficiencies.

Unique Challenges in Obstetrics and Gynecology

The field of obstetrics and gynecology is unique in that physicians are responsible for the health of both the mother and the developing fetus. Complications can arise rapidly and unexpectedly, even during carefully monitored pregnancies. These unforeseen emergencies, such as placental abruption or fetal distress, can be difficult to explain to patients and often lead to legal scrutiny. As Prof. Dr. İsmail Mete İtil, President of the Turkish Gynecology and Obstetrics Association (TJOD), notes, the inherent unpredictability of childbirth contributes to the higher rate of lawsuits.

The Limits of Medical Certainty

Even as medical technology has advanced significantly, it cannot eliminate all risks associated with pregnancy and childbirth. Even with comprehensive screening tests like Non-Invasive Prenatal Testing (NIPT), combined tests, detailed ultrasounds, chorionic villus sampling (CVS), and amniocentesis, it’s impossible to guarantee a healthy baby. These tests provide probabilities, not definitive results, and may not detect all genetic mutations, metabolic diseases, or functional neurological problems.

Conditions like autism spectrum disorder and some forms of mental retardation may not be apparent at birth and can emerge years later. Medicine can reduce risk but cannot eliminate it entirely. Obstetrics remains a high-risk specialty.

Impact on Physicians and the Profession

Recent high-profile malpractice awards, such as a 77 million lira compensation case in Diyarbakır involving a baby born with Down syndrome, have created a “shock” within the medical community. [1] This has led to decreased morale, reluctance to capture responsibility, a more cautious approach to difficult cases, and a decline in enthusiasm for the profession. Some physicians are leaving their training programs mid-course, and obstetrics and gynecology is now among the least preferred specialties in the Medical Specialization Examinations (TUS).

The fear of litigation is also contributing to “defensive medicine,” where physicians may order unnecessary tests or avoid certain interventions to protect themselves legally. Judges are increasingly disregarding patient consent, even when obtained, and awarding substantial compensation amounts.

Recommendations for Improvement

The TJOD has proposed several solutions to address the crisis, including:

• Clear regulations from the Ministry of Health regarding consent forms, negligence, and malpractice, developed in consultation with medical associations.
• Detailed guidelines on informed consent, specific to each branch of medicine, published electronically.
• Limiting compensation amounts in malpractice cases to a reasonable level.
• Strengthening the Professional Responsibility Board and ensuring its decisions are binding on the courts.
• Protecting physicians from blame for unforeseen complications during childbirth.
• Establishing a fund for malpractice compensation, supported by contributions from public and private hospitals.
• Creating dedicated funds for families with children born with Down syndrome.
• Reviewing the private insurance system to provide clearer guidelines for physicians.
• Reducing the burden of unnecessary CIMER complaints through improved filtering processes.

The Path Forward

Addressing the rising concerns surrounding malpractice in Turkish gynecology and obstetrics requires a collaborative effort between the medical community, the judiciary, and the Ministry of Health. Clear regulations, fair compensation practices, and a supportive environment for physicians are essential to ensure the continued provision of high-quality maternal and fetal care.