Medical Malpractice Litigation and Inflammatory Bowel Disease

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Purpose: Gastroenterologists are concerned about potential litigation resulting from care of patients with inflammatory bowel disease (IBD). IBD patients are believed to be high-risk for malpractice litigation due to rapidly changing treatment paradigms, significant side effects of immunosuppressive therapy, frequent requirement for surgery, relatively young age and the overall complexity of their illness. There is limited information regarding medical malpractice litigation in IBD at the present time. We sought to characterize the patterns of medical malpractice litigation in IBD, and to determine changes in claims during the past decade which represents the era of increased immunosuppressive therapy. Methods: We queried a database of malpractice closed claims maintained by the Physician's Insurance Association of America (PIAA) between January 1, 1985 and December 31, 2008. The PIAA provides malpractice insurance for approximately 60% of private practice U.S. physicians. Results: Over the 24 year period there were a total of 559 claims brought against all physicians involving IBD patients. Surgeons were most commonly named with 185 closed cases (63 resulted in payments i.e., settled in or out of court). Internists were second, with 169 closed claims (52 resulted in payment). Gastroenterologists ranked third with 81 claims involving IBD patients, of which 19 were paid. Family Practitioners were fourth with 40 closed claims (14 resulted in payment). The rates of IBD litigation per specialty were as follows: 6.5 cases/1000 gastroenterologists; 3.2 cases/1000 general surgeons; 0.92 cases/ 1000 general internists. Further analysis of the medical defendants in IBD litigation revealed that 40% of gastroenterologists who were the target of a lawsuit had previous claim experience. The mean annual number of IBD related claims against gastroenterologists was 3.4 and the number decreased during the most recent decade compared with prior years. The most common reasons for litigation were: error in diagnosis (23%), improper performance (16%), failure to supervise a case (8%), and medication errors (7%). Conclusion: Medical malpractice litigation targeting gastroenterologists in the care of IBD patients occurs rarely and has decreased over the past decade. Gastroenterologists who are targeted in IBD litigation have a high rate of repeat claims. Concern regarding increased use of immunosuppression and biologic therapy in IBD does not correlate with litigation patterns.