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Farm, Nutrition, and Bioenergy Act of 2007

Floor Speech

Location: Washington, DC

FARM, NUTRITION, AND BIOENERGY ACT OF 2007 -- (Senate - December 12, 2007)


Mr. COBURN. Mr. President, I wanted to speak for a few minutes on the Gregg amendment simply because I have unique personal experience with it. I am now somewhere close or over having delivered 4,000 children. The last one was an 8 pound, 9 ounce healthy baby, no problems that we know of. I also just signed a check to pay for my malpractice insurance, which next year will come to about $3,000 per baby I deliver--$3,000 per baby, per case. Now, that is excessive because I don't deliver that many babies anymore. But on average, it is $300 to $400 to $500 for every baby that is delivered in this country in terms of malpractice insurance.

Why is it important to fix this problem, not just for OB/GYNs but for all doctors? Well, there are a couple of reasons. The cost of defensive medicine today on the basis of the litigious aspect of medical malpractice causes us to spend $600 per person per year on tests nobody needs, except the doctor needs to be able to say he went the extra mile in case they get sued. That comes to about $150 billion a year of tests that were ordered. That doesn't include the cost of the malpractice insurance, which the year before last in Oklahoma rose 98 percent--a 1-year rise. There are significant problems with the tort system in Oklahoma that show the excessive costs. But more importantly, what about the women and children? The heck with the money. What about the women and children? What happens?

Well, we know we are not filling the spots for the OB/GYN residencies in this country anymore because you can't afford to pay the loans and get a job and earn enough and then pay for your malpractice to be able to pay off your loan and make a living. So people are opting not to go into obstetrics and gynecology. Why do they do that and what is the result of that? The result is we have fewer trained specialists to actually offer care. Who suffers the most--women in the large cities or women in the smaller rural cities? The reason this is offered on this bill is because it has tremendous direct application to the women who live in rural America. Access is denied. We are now talking an hour, 2-hour, 3-hour drives for OB care in Oklahoma because we don't have the available people who will do this service.

There are two other points I want to make as we consider this, thinking only about the women and children. One is that because of the tort system we have, if you are a woman who has a C-section--not because you can't physically deliver a baby, but because you had a sign that your baby may be in trouble--the next time you come to have a baby, there is an almost 80-percent chance that you could deliver that baby naturally, without having to undergo surgery. But because of the litigious environment, we now have hospitals all across the country that forbid vaginal delivery after cesarean section--not because it is that unsafe but because the risks associated with the procedure in terms of the legal consequences make it financially not a risk that hospitals want to take, let alone whether the doctor is capable of doing it and managing that patient at all.

So what does that mean? It means we expose women to a major surgical procedure, not because they need it but because the trial bar has forced them to do it. We are now making decisions not based on medical indications; we are making decisions based on legal implications. That is the wrong way to practice medicine.

Finally, the third point I will make is as we see this shortage of available obstetrical care in the rural areas, we say: We are going to give you care, but then we give you somebody who is great in terms of caring for you, and has some knowledge, and has some capability, but isn't a fully trained physician. We give you a nurse-midwife. But if you get in trouble, you are still going to have to have somebody come in. Well, what do we know about that? What we know is that time makes a significant amount of difference when we have a baby in trouble. So what we are going to do is we are going to continue to increase the costs of complicated deliveries, with children who get injured, when the whole goal of the tort bar in the first place was trying to prevent that, because we don't intercept and we don't interrupt a process that could have made a major difference in that child's life.

In my hospital, you can't deliver a baby unless you have the ability to do an operative procedure to handle every complication of obstetrics. But that is not true around the country anymore because we have decided we are going to do it in a less cost-efficient way.

Mr. President, I ask unanimous consent for 3 additional minutes.

The PRESIDING OFFICER. Is there objection?

Mr. HARKIN. On both sides.

Mr. COBURN. I am happy with that.

The PRESIDING OFFICER. Without objection, it is so ordered.

Mr. COBURN. So our point is this: This isn't a perfect bill to be talking about this issue, but it truly has impact to our agricultural communities. They are the ones who live in the rural areas. What we have done is we have moved away from the ball where we now practice legal medicine, rather than medicine. We are offering a care that is not as good as what it could have been. We are putting women through procedures that they don't have to go through with a tremendous increase in cost, all because we can't say there ought to be some type of limitation so we can rebuild the medical structure.

If we really believe in women and children, we will grant the same equality in the rural areas that we grant around the rest of this country by making sure they have competent, well-qualified, certified obstetricians and gynecologists to take care of them at this great time of their life.

I yield the floor.


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