Presidential address: Medical-legal issues in obstetrics and gynecology

Patients, physicians, insurance companies, and legislators are expressing mounting concern in the area of malpractice insurance costs and its effect on the availability of health care. In 1986, the highest award in the history of medical-legal claims, $1,200,000, was paid. By 2001, the average award had increased to $3,500,000. In the late 1970s the California's Medical Injury Compensation Reform Act (MICRA) was passed. This article discusses the elements of this important legislation and its effects on the cost of medical malpractice in California, the anatomy and pathophysiology of a medical-legal claim, and the characteristics of excellent expert witnesses and suggests some important elements of a redesigned system of medical-jurisprudence.