First, do no harm, second, say sorry? Investigating the impact of a new tort reform.

This article investigates the impact of "apology laws"—legal statutes that protect physicians' statements of apology or fault from being used as evidence in malpractice litigation—on obstetricians' procedural choices and birth outcomes in the United States. Using a large dataset of birth and infant death records from 1995 to 2012, the study distinguishes between two types of apology laws: partial apology laws, which protect only expressions of sympathy or apology, and full apology laws, which also protect admissions of fault or liability. The findings indicate that partial apology laws are associated with a statistically significant increase in Cesarean section (C-section) rates, particularly among older physicians and non-risky pregnancies, suggesting an unintended rise in defensive medicine possibly due to increased perceived liability risk. Conversely, full apology laws show no consistent effect on C-section rates or defensive medicine practices. Additionally, partial apology laws correlate with a reduction in preventable pregnancy complications, implying some clinical benefit from the increased interventions, though no significant changes were found in infant mortality or low Apgar scores. The study also reveals racial and access-to-care disparities in the effects of apology laws, with Black mothers experiencing increased C-section rates under partial apology laws. Overall, the research suggests that partial apology laws, the more common form, may inadvertently increase liability risk and defensive medical practices rather than reduce them, while full apology laws may better align with the intended goal of reducing malpractice litigation pressures.