Coevolution of Medical Malpractice Claims and Mortality Due to Complications from Medical Care

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Numerous studies point to links between patient safety and malpractice claims. Two predictions are prominent: (1) better patient safety leads to fewer medical errors and fewer malpractice claims, and (2) over-aggressive malpractice compensation encourages defensive medicine, where physicians attempt to reduce malpractice risk by ordering unnecessary medical procedures (or foregoing certain types of care). This study expands on this literature by introducing a unique measure of patient safety: the number of deaths due to medical complications. To compare this measure with paid claims, the study uses nationwide multiple mortality data collected by the National Center for Health Statistics (under the Centers for Disease Control) with data about paid malpractice claims from the National Practitioner Data Bank. Using hybrid fixed/random effect negative binomial models, this study investigates associations between paid malpractice claims alleging death, and deaths reported to the NCHS as occurring because of complications or accidents related to medical care (iatrogenic causes of death). The study finds (1) a positive association between deaths due to medical complications and subsequent paid malpractice claims; (2) a small, but positive association between paid malpractice claims and subsequent deaths due to medical complications; and (3) an increase in deaths due to medical complications in states that have experienced drastically large increases in malpractice claims for several years. These results are consistent with both proposed associations: from patent safety to malpractice claims; and from malpractice claims to patient safety. This suggests a mutually reinforcing endogenous system between malpractice claims and patient safety.