Medical malpractice lawsuits are most frequently filed against obstetricians and gynecologists in Türkiye, and the resulting high damage awards are impacting the specialty’s appeal among medical residents. The trend is raising concerns about access to women’s healthcare as some physicians-in-training are even leaving their programs.
Currently, Türkiye has approximately 6,000 obstetricians and gynecologists practicing, with nearly 4,000 more in residency programs. While national data on malpractice claims is unavailable, an analysis by the Hanyaloğlu and Acar Law Firm of 3,500 malpractice cases tracked between 2010 and 2024 supports observations within the medical community. The firm’s data shows that the five specialties facing the most lawsuits are all surgical.
Approximately 33% of these claims are filed against obstetricians and gynecologists, followed by general surgery (11.9%), plastic and aesthetic surgery (11.8%), ophthalmology (9.2%), and orthopedics and traumatology (8.9%). Common issues leading to litigation include Down syndrome diagnoses, shoulder dystocia during birth, neurological damage such as cerebral palsy, nerve injuries during delivery, tubal ligations, and failure to detect fetal limb deficiencies.
Is the Physician Responsible for Unforeseen Emergencies?
Professor Dr. İsmail Mete İtil, President of the Turkish Society of Gynecology and Obstetrics (TJOD), addressed the concerns. He believes that cases related to Down syndrome and chromosomal anomalies should be removed from the scope of potential lawsuits.
Obstetricians and gynecologists are uniquely positioned to consider the health of two individuals simultaneously – the mother and the developing baby. Physicians must work to ensure the well-being of both, but unexpected emergencies can arise rapidly during pregnancy and childbirth. These can include placental abruption, sudden infant respiratory distress, and shoulder dystocia. “Even when everything appears normal during pregnancy, these situations can occur,” İtil explained. “This unpredictability increases the number of lawsuits. It’s a team and system effort. The physician cannot be held responsible for everything, but they bear a significant burden.”
Medicine Can Reduce Risk, But Not Eliminate It
Families understandably desire healthy babies, and advancements in medical imaging and testing have improved diagnostic capabilities. However, can physicians guarantee a healthy baby? İtil responded with a firm “No,” and continued: “As technology advances, there’s a growing perception that ‘with so many tests, everything should be known beforehand.’ However, medicine reduces risk, but it cannot eliminate it. Obstetrics is a high-risk specialty.”
“Despite advancements in medicine, DNA-based screening tests, and sophisticated ultrasounds, guaranteeing a healthy baby is impossible. Even with the best monitoring, some genetic mutations, microscopic anomalies undetectable by tests, late-onset metabolic disorders, and unforeseen birth complications can occur.”
We Cannot Eliminate Every Possibility of Nature
The screening tests that often lead to legal claims provide probabilities, not definitive results, İtil noted. “NIPT (non-invasive prenatal testing), combined testing, and detailed ultrasounds reduce risk but do not eliminate it. Even diagnostic tests (CVS – chorionic villus sampling, amniocentesis) do not cover every disease.”
“Medicine has limitations. No matter how advanced imaging technology becomes, many functional neurological issues remain invisible during the prenatal period. Autism spectrum disorder, certain metabolic diseases, and mild intellectual disabilities may appear years later in babies who initially appear ‘healthy.’”
“Even in closely monitored pregnancies, most major structural anomalies can be detected, and a significant portion of chromosomal anomalies can be screened for. Maternal risks can be largely controlled. But there is no risk-free pregnancy. An obstetrician cannot eliminate every possibility of nature.”
Investigations and CİMER Complaints Are Exhausting
A recent high-profile case sparked outrage among physicians. In a case involving a family in Diyarbakır who sued a physician over the birth of their child with Down syndrome, the court awarded approximately 77 million lira (roughly $2.5 million USD) in damages, including execution costs. Similar cases with substantial damage awards have been seen before.
İtil described the impact of these rulings on the field: “These high damage awards have had a strong shock effect on the medical community. Some of our colleagues are leaving residency. Obstetrics and gynecology are now appearing lower on the list of preferences in the Medical Speciality Exam (TUS). There is a decline in morale, a reluctance to take responsibility, a cautious approach to tricky cases, and a decrease in motivation to work.”
“It’s not just about the number of lawsuits filed. When you add in the hundreds of investigations opened and the constant need to respond to CİMER complaints – many of which are unfounded – the situation is not encouraging.”
“The exodus from the field began with the full-time law and healthcare transformation applications, and has increased in recent years with the successive regulations restricting independent practice. There is currently discussion of even more restrictive laws. Preventing the exodus from the public sector should not involve restricting independent practice.”
Judges Don’t Even Accept Consent
Another significant consequence of malpractice lawsuits is the strengthening of “defensive medicine” – the practice of ordering unnecessary tests, overemphasizing complication risks, and avoiding certain procedures. İtil explained: “This can lead to changes in both patient care processes and physicians’ clinical decision-making mechanisms. It can manifest as increased risk aversion, referrals, and an increase in surgical interventions. For example, consent is not required for everything outside of surgical procedures. But in recent cases, we are seeing that even when a physician obtains consent, the judge does not accept it, claiming it was not adequately explained, and awarding millions of lira in damages. Physicians are confused about when and under what conditions to obtain consent. It is impossible for this not to lead to defensive medicine.”
TJOD Recommendations
İtil outlined the association’s proposed solutions:
- The Ministry of Health should establish clear regulations regarding informed consent forms, negligence, and malpractice, and should seek input from associations. These regulations should be reflected in judicial decisions.
- The requirements for informed consent should be detailed and clarified on a specialty-by-specialty basis, and regulations should be published. This should also be provided electronically.
- The fear of malpractice lawsuits should be completely removed from physicians’ shoulders. The limits of compensation should be established in coordination with the judiciary.
- The Professional Responsibility Board is an important step, but it should be developed to include private practice and its decisions should be binding on the courts.
Don’t Blame the Physician for Unpredictable Complications
- Physicians should not be blamed for unforeseen complications that arise during childbirth. This should be reflected in legal frameworks.
- A fund should be established with contributions from both public and private hospitals to cover physician malpractice payments.
- Special funds should be created for families with children with Down syndrome.
- The private insurance system should be reviewed, with rules established by the Ministry of Health. Physicians should know when and what to do.
- Physician-friendly improvements must be made. There are many unnecessary CİMER complaints, which should be filtered before investigations or responses are requested.
