Average Indemnity Payment Research Articles

Examining Nursing Medical Malpractice Cases Related to Medications.

The aim of this study was to analyze medication-related nursing medical malpractice cases to gain insights regarding how malpractice risk can be reduced. The criminal prosecution and verdict of nurse RaDonda Vaught focused attention on the potential medicolegal risk for nurses related to medications. Medication-related medical malpractice cases involving nurses were obtained from a national database. Various attributes of these cases were examined, including contributing factors, injury severity, and case outcomes. Authors identified 231 nursing medication-related medical malpractice cases closed from 2017 to 2021. The most frequent adverse events involved medication administration. Not following policies or protocols was the most common contributing factor. Opioids and epinephrine were the medications most frequently involved in the cases. Indemnity payments were made in 56.3% of the cases, with an average indemnity payment of $366 002. Nursing medication-related medical malpractice cases are relatively uncommon, which may reassure nurses regarding medicolegal risk. Medications and contributing factors involved in the cases suggest patient safety interventions including education related to policies, procedures, and protocols.

A 40-Year Litigation Review of Transurethral Surgeries for Benign Prostatic Hyperplasia

ObjectiveTo describe litigation patterns of transurethral surgery in the treatment of benign prostatic hyperplasia including verdicts, types of lawsuits, plaintiff claims, and timing of the claims. MethodsData was gathered by searching for litigation cases between January 1, 1980 and December 1, 2021 in the Westlaw legal database using keywords for transurethral surgeries for benign prostatic hyperplasia. Extracted data included case type, general description of the plaintiffs and defendants, plaintiff claims, and whether the claim involved preoperative, perioperative, or postoperative management, verdict, and indemnity awards. ResultsThe Westlaw search yielded 44 unique cases after removing duplicate and irrelevant cases. The most common surgery resulting in a lawsuit was transurethral resection of the prostate (70%) and urologists were the most frequently named defendant (80%). The most common plaintiff claims were sexual dysfunction (36%), irritative lower urinary tract symptoms (32%), and lack of consent (27%). Among malpractice cases, the verdict was in favor of the defendant in most cases (71%) and among Eighth Amendment violation cases, the verdict was in favor of the defendant in every case. The average indemnity payment was $565,845 and the highest indemnity payment was $1,020,000. ConclusionComplications of transurethral surgeries and lack of consent are common reasons for patient's filing a lawsuit. Healthcare providers should ensure patient understanding of surgical risks and thoroughly document the conversation. Providers should be aware of the causes for litigation among transurethral surgeries for benign prostatic hyperplasia and of the possibility of Eighth Amendment violation lawsuits when treating prison inmates.

Medical malpractice in stress urinary incontinence management: A 30-year legal database review.

Background:The purpose of this study is to investigate the most common reasons for and judicial outcomes of malpractice claims related to stress urinary incontinence (SUI) management.Materials and methods:Using the Westlaw database, a search was performed using the terms “medical malpractice” or “negligence” in combination with “stress incontinence” or “stress urinary incontinence” between January 1, 1990 and January 1, 2020. Extracted information included trial date, demographic information, defendant profession, procedure performed, procedure complications, alleged malpractice, trial outcome, and monetary award. Data were analyzed using descriptive statistics.Results:The Westlaw search yielded 79 case results. Of the cases, 70.4% (n = 38/54) had a defense verdict, 22.2% (n = 12/54) had a plaintiff verdict, and 7.4% (n = 4/54) were settled. The most commonly implicated procedure was mid-urethral sling (63.2%, n = 36/57). Among the plaintiffs, 48.4% (n = 61/126) claimed negligence in preoperative care, 33.3% (n = 42/126) claimed negligence in surgical performance, and 18.3% (n = 23/126) claimed negligence in postoperative care. Lack of informed consent was the most common complaint related to negligence in preoperative care (42.6%, n = 26/61). The average indemnity payment was $1,253,644 for preoperative care negligence, $1,254,491 for surgical performance negligence, and $2,239,198 for postoperative care negligence. Of the defendants, 63.4% (n = 52) were gynecologists and 36.6% (n = 30) were urologists.Conclusions:Negligent preoperative care, with a particular emphasis on failure to obtain informed consent, and negligent surgical performance are the leading causes of malpractice claims during SUI management. Mid-urethral sling was the most commonly litigated procedure. This study highlights key factors to consider in minimizing malpractice risk during SUI management.

Characteristics of Medical Professional Liability Claims in Pediatric Orthopedics.

Medical malpractice is burdensome to the U.S. healthcare system. The following is an epidemiological analysis of the closed medical professional liability (MPL) claims in pediatric orthopedics using data maintained by the Physician Insurers Association of America. The Physician Insurers Association of America registry of MPL claims from 1985 to 2013 for all specialties included 286,021 closed claims in the United States. All closed MPL claims for orthopedic surgery in patients younger than 18 years were retrospectively reviewed (N = 2,671). The error categories, result of the claim, the most common procedures, severity of injury, and the most common presenting and resultant medical conditions were reported with the paid-to-close ratios, average indemnity payment, and average cost of litigation. The pediatric orthopedic population was compared with all orthopedics. The data were adjusted for inflation and trended for the 29-year period. Of the 2671 pediatric orthopedic claims, 881 resulted in a payment and the average indemnity was U.S. $317,574 with adjustment for inflation - significantly higher than for all of orthopedics at U.S. $268,817 (P = 0.0013). The paid-to-close ratio was 33.0%, compared with 28.7% for all of orthopedics (P = 0.023). Costs to defend individual medical malpractice claims and the average indemnity payment per claim have both increased over time, and pediatric (versus adult) orthopedic claims are more likely to result in payment and result in a higher payment. Knowledge of the details of liability claims should assist practicing general and pediatric orthopedic surgeons in improving patient safety and quality of care, reducing patient injury, and reducing the incidence of MPL claims.

Trends in malpractice claims for obstetric and gynecologic procedures, 2005 through 2014

Interest in medical malpractice and areas of medicolegal vulnerability for practicing obstetricians and gynecologists has grown substantially, and many providers report changing surgical practice out of fear of litigation. Furthermore, education on medical malpractice and risk management is lacking for obstetrics and gynecology trainees. Recent obstetric and gynecologic malpractice claims data are lacking. We report on recent trends in malpractice claims for obstetrics and gynecology procedures, and compare these trends to those of other medical specialties. We sought to evaluate recent trends in malpractice claims for obstetrics and gynecology procedures and compare these to other medical specialties. A search was performed on all medicolegal claims data for obstetrics and gynecology procedures from Jan. 1, 2005, through Dec. 31, 2014, using the Physician Insurers' Association of America data-sharing project, which was created to identify medical professional liability trends. Data from 20 insurance carriers were reviewed based on a search using International Classification of Diseases, Ninth Revision codes and unique database-specific codes. Of the 10,915 total claims closed from 2005 through 2014, the majority (59.5%) were dropped, withdrawn, or dismissed. The average indemnity of the remaining paid claims (31.1%) was $423,250. The most frequently litigated procedure was operative procedures on the uterus; 27.8% of cases were paid with an average indemnity of $279,384. The procedure associated with the highest proportion of paid claims was vacuum extraction. The average indemnity for paid obstetrics and gynecology procedural claims was 27% higher than that for all medical specialties combined. Obstetrics and gynecology procedural claims had the second highest average indemnity payment and the fifth highest paid-to-closed ratio of all medical specialties. Litigation claims for obstetrics and gynecology procedures have higher average indemnity payments and higher paid-to-closed ratios than most other medical specialties. Claims most frequently relate to gynecologic surgery, but obstetric procedures are more expensive. Possible factors may include procedural experience and unique perioperative complications. We encourage efforts addressing procedures, litigation, and quality interventions to improve outcomes, mitigate risk, and potentially lower indemnity payments.

Lawsuits After Primary and Revision Total Hip Arthroplasties: A Malpractice Claims Analysis

BackgroundAs the prevalence of total hip arthroplasty (THA) expands, so too will complications and patient dissatisfaction. The goal of this study was to identify the common etiologies of malpractice suits and costs of claims after primary and revision THAs. MethodsAnalysis of 115 malpractice claims filed for alleged neglectful primary and revision THA surgeries by orthopedic surgeons insured by a large New York state malpractice carrier between 1983 and 2011. ResultsThe incidence of malpractice claims filed for negligent THA procedures is only 0.15% per year in our population. In primary cases, nerve injury (“foot drop”) was the most frequent allegation with 27 claims. Negligent surgery causing dislocation was alleged in 18 and leg length discrepancy in 14. Medical complications were also reported, including 3 thromboembolic events and 6 deaths. In revision cases, dislocation and infection were the most common source of suits. The average indemnity payment was $386,153 and the largest single settlement was $4.1 million for an arterial injury resulting in amputation after a primary hip replacement. The average litigation cost to the insurer was $61,833. ConclusionNerve injury, dislocation, and leg length discrepancy are the most common reason for malpractice after primary THA. Orthopedic surgeons should continue to focus on minimizing the occurrence of these complications while adequately incorporating details about the risks and limitations of surgery into their preoperative education.

Urological Malpractice: Claim Trend Analysis and Severity of Injury

IntroductionIn the current malpractice environment all urologists are at risk. Claim trend data on costs, types of urological errors and severity of injury in urological surgery malpractice claims are lacking. MethodsWe analyzed physician level claim data from a large professional liability insurer with a nationwide client base. Available data included records on closed malpractice claims from 1985 to 2013. We evaluated insured demographics, total number of closed claims, costs of indemnity payments, costs of defense, types of errors resulting in closed claims and severity of injury in urological claims. ResultsCompared to other medical specialties urology ranks 13th in total claims and 15th in average cost of indemnity payments in the last decade. Most urological claims are dropped, dismissed or withdrawn without indemnity payment. Of closed urological claims 27.2% result in an indemnity payment to the plaintiff. Adjusting for inflation, urological indemnity payments have increased by 60% since the 1980s and average payouts are now greater than $350,000. Improper performance of a procedure is the most prevalent urological error resulting in closed claims (875 closed claims in the last decade). Procedures involving the kidney (245 closed claims) and prostate (244 closed claims) are most frequently implicated. The majority of urological errors result in temporary or minor permanent injury. Errors resulting in grave injury are the most costly, with average indemnity payments of $514,844. ConclusionsAwareness of claim trends and errors implicated can help urologists better understand the current malpractice environment.

Twenty-five years of professional liability in pediatric ophthalmology and strabismus: the OMIC experience

To summarize the claims statistics of the Ophthalmic Mutual Insurance Company (OMIC) in the field of pediatric ophthalmology and strabismus (POS). Internal OMIC case summaries and defense counsel case evaluations of all claims in the field of POS closed between December 1, 1988, and February 19, 2013 were retrospectively analyzed. A total of 140 claims were closed over the 25-year study period, of which 44 were closed with an indemnity payment. Claims related to strabismus and retinopathy of prematurity (ROP) were most common, and claims related to ROP resulted in the highest indemnity and expense payments. Issues related to follow-up represented the most significant risk factor among system-related claims. Claims in pediatric ophthalmology and strabismus were infrequent but associated with three times higher average indemnity payments relative to all claims paid by OMIC during the course of the study.

A retrospective review of medical errors adjudicated in court between 2002 and 2012 in Spain

This paper describes verdicts in court involving injury-producing medical errors in Spain. A descriptive analysis of 1041 closed court verdicts from Spain between January 2002 and December 2012. It was determined whether a medical error had occurred, and among those with medical error (n = 270), characteristics and results of litigation were analyzed. Data on litigation were obtained from the Thomson Reuters Aranzadi Westlaw databases. All verdicts involving health system were reviewed and classified according to the presence of medical error. Among those, contributory factors, medical specialty involved, health impact (death, disability and severity) and results of litigation (resolution, time to verdict and economic compensations) were described. Medical errors were involved in 25.9% of court verdicts. The cause of medical error was a diagnosis-related problem in 25.1% and surgical treatment in 22.2%, and Obstetrics-Gynecology was the most frequent involved specialty (21%). Most of them were of high severity (59.4%), one-third (32%) caused death. The average time interval between the occurrence of the error and the verdict was 7.8 years. The average indemnity payment was €239 505.24; the highest was psychiatry (€7 585 075.86) and the lowest was Emergency Medicine (€69 871.19). This study indicates that in Spain medical errors are common among verdicts involving the health system, most of them causing high-severity adverse outcomes. The interval between the medical error and the verdict is excessive, and there is a wide range of economic compensation.

Medical Malpractice Claims in Radiation Oncology: A Population-Based Study 1985-2012

The purpose of this study was to determine trends in radiation oncology malpractice claims and expenses during the last 28 years and to compare radiation oncology malpractice claims to those of other specialties. We performed a retrospective analysis of closed malpractice claims filed from 1985 to 2012, collected by a nationwide medical liability insurance trade association. We analyzed characteristics and trends among closed claims, indemnity payments (payments to plaintiff), and litigation expenses. We also compared radiation oncology malpractice claims to those of 21 other medical specialties. Time series dollar amounts were adjusted for inflation (2012 was the index year). There were 1517 closed claims involving radiation oncology, of which 342 (22.5%) were paid. Average and median indemnity payments were $276,792 and $122,500, respectively, ranking fifth and eighth, respectively, among the 22 specialty groups. Linear regression modeling of time trends showed decreasing total numbers of claims (β = -1.96 annually, P=.003), increasing average litigation expenses paid (β = +$1472 annually, P ≤ .001), and no significant changes in average indemnity payments (β = -$681, P=.89). Medical professional liability claims filed against radiation oncologists are not common and have declined in recent years. However, indemnity payments in radiation oncology are large relative to those of many other specialties. In recent years, the average indemnity payment has been stable, whereas litigation expenses have increased.

MP11-17 UROLOGIC MALPRACTICE: INCREASING FREQUENCY AND COST OF PROSTATE CANCER RELATED CLAIMS

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness II1 Apr 2014MP11-17 UROLOGIC MALPRACTICE: INCREASING FREQUENCY AND COST OF PROSTATE CANCER RELATED CLAIMS Benjamin A. Sherer, Kalyan C. Latchamsetty, and Christopher L. Coogan Benjamin A. ShererBenjamin A. Sherer More articles by this author , Kalyan C. LatchamsettyKalyan C. Latchamsetty More articles by this author , and Christopher L. CooganChristopher L. Coogan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.432AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The risk of medical malpractice litigation creates real concern for practicing Urologists. We seek to identify the errors and procedure types most commonly resulting in closed claims in the past decade. We also quantify associated costs of litigation based on error implicated. METHODS An analysis of claims was performed on data from 22 member companies of the Physician Insurers Association of America (PIAA) from 1985-2012. Data included 6,751 closed claims in Urologic surgery. RESULTS The most prevalent error in Urologic surgery in the past decade was “improper performance of a procedure”, accounting for 880 (34%) closed claims. Of these, procedures involving the prostate were most frequently implicated (110 claims) and 36% resulted in an indemnity payment (average indemnity payment: $451,421). Other common errors included "error in diagnosis" (329 closed claims) and "failure to recognize a complication" (141 closed claims). Errors in the management of kidney stones accounted for the most closed claims in the past decade (245). In the past three years, prostate cancer (26 closed claims in 2012) has become the most likely presenting patient condition to result in closed claims. Errors in the management of prostate cancer now account for the highest average indemnity payments ($459,545 in 2012). CONCLUSIONS Costs of urologic litigation continue to rise at an alarming rate. Improper performance of a procedure is the most likely Urologic error to result in litigation. Traditionally, error in the management of nephrolithiasis resulted in the most closed claims. However, in the past five years, error in the management of prostate cancer has resulted in the most claims and highest average indemnity payment. This may correlate with the increasing use of robotic assisted surgery in the management of prostate cancer. Understanding the most common errors and procedure types leading to malpractice claims can help Urologists with risk management and potentially lead to improved patient care. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e102 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Benjamin A. Sherer More articles by this author Kalyan C. Latchamsetty More articles by this author Christopher L. Coogan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

High and low-risk specialties experience with the U.S. medical malpractice system

Background“High-liability risk specialties” tend to be the focus of medical malpractice system research and debate, but concerns and fears are not limited to this group. The objective of this study was to examine whether “high-liability risk” medical specialties have a different experience with the malpractice system than “low-liability risk” specialties.MethodsWe reviewed claims data from the Physician Insurers Association of America’s Data Sharing Project between January 1985 and December 2008. We used linear regression, controlling for year, to determine how liability risk affected outcomes of interest.ResultsIn high-liability risk specialties, 33% of claims result in indemnity payments compared to 28% for low-liability risk specialties (p < 0.001). The average indemnity payment for high-liability risk specialties was $315,314 compared to $267,146 for low-liability risk specialties (p = 0.25). Although only a small percentage of claims go to trial, low-liability risk specialties have significantly more claims that are ultimately dropped, withdrawn or dismissed, while high-liability risk specialties have significantly more claims that result in plaintiff settlement (p < 0.001).ConclusionsMalpractice risk exists for all specialties. Variability in indemnity costs are found in both high- and low-liability risk specialties. Differences in the reasons for which claims are initiated for high- and low-liability risk specialties likely necessitate different risk management solutions.

Thyroidectomy‐Related Malpractice Claims

Little information is available regarding the frequency of thyroidectomy-related malpractice claims. Previous studies have not assessed claims that were settled or dropped before trial, providing only a limited view of the medical-legal environment. We sought to determine the frequency of thyroid surgery-related malpractice claims, their causes, and outcomes. Database assessment. Academic medical center. The database of the Physician Insurers Association of America was reviewed. These data are estimated to represent 25% of medical malpractice claims in the United States. Claims from 1985 to 2008 with thyroid-related procedure codes were evaluated for claimant information, insured's specialty, loss description, causation, and claim outcomes. During the 24-year period reviewed, 380 claims related to thyroid surgery were reported. 128 claims (33.7% of total claims) resulted in an indemnity payment either due to settlement or a finding against the defendant. The average indemnity payment was $185,366 (range, $363 to $2,000,000). Among cases in which a specific outcome was reported, 55 were related to laryngeal nerve injury or voice disturbance. No substantial change occurred in the incidence of claims across the study period. During this time, approximately 2,585,000 thyroidectomies were performed. Extrapolating from the Physician Insurers Association of America data, this represents an estimated 5.9 claims per 10,000 cases. Malpractice claims related to thyroid surgery are surprisingly infrequent. While the rates of thyroid surgery have risen steadily, there has not been a corresponding increase in the rate of related malpractice claims.

Abstract P282: Medical Professional Liability Claims Involving Cardiologists: A Descriptive Study of 4,527 Cases

Objectives: In this study we present data which describe a large cohort of closed cardiovascular medical professional liability claims. The purpose of this report is to provide information for cardiologists which will be useful in improving the quality of cardiovascular care and in reducing the incidence of patient injury and the consequent frequency of medical professional liability claims. Background: In 1985 The Physician Insurers Association of America (PIAA) established the Data Sharing Project, a registry of medical professional liability claims. This registry contains data voluntarily submitted by participating PIAA member professional liability insurance companies describing 239,756 closed claims through 2008. The registry is maintained for educational programs to improved quality of care and to reduce patient injury and consequent medical professional liability claims. Methods: Descriptive techniques are used to present summary information for the medical cardiovascular claims in the PIAA registry. Results: Of 239,756 closed claims, 4,527 (1.9%) involve cardiologists. Of the 4,527 closed claims, 836 (18.5%) resulted in an indemnity payment, and the average indemnity payment for these cases was $251,024. In the entire database, 29.5% of closed claims were paid, and the average indemnity payment was $209,156. The most prevalent allegation among cardiovascular closed claims was diagnostic error (931 cases, 20.6% of all closed claims), and the most prevalent diagnosis was acute myocardial infarction, representing 105 of 931 cases of diagnostic error (11.3% of diagnostic error closed claims.) The average indemnity paid for errors in diagnosis was $306,273. Aortic aneurysms and dissections, while relatively infrequent as clinical events, represent a substantial medical professional liability diagnostic error risk because of the high percentage of paid claims (38.2%), and the high average indemnity payment of $444,859. Conclusions: Medical professional liability issues are common and are important to all practicing cardiologists. Detailed knowledge of risks associated with liability claims should assist practicing cardiologists in improving quality of care, reducing patient injury and reducing the incidence of claims.

Thyroidectomy Related Malpractice Claims Are Rare

Objective: Little information is available regarding the frequency of thyroidectomy related malpractice claims. Previous studies have not assessed claims that were settled or dropped before trial, providing only a limited view of the medical-legal environment. We sought to determine the frequency of thyroid surgery related malpractice claims, their causes and outcomes. Method: The database of the Physician Insurers Association of America (PIAA) was reviewed. This data is estimated to represent 25% of medical malpractice claims in the United States. Claims from 1985 to 2008 with thyroid-related procedure codes were evaluated for claimant information, insured’s specialty, loss description and causation, and claim outcomes. Results: During the 23-year period reviewed, 381 claims related to thyroid surgery were reported. 128 claims (33.6% of total claims) resulted in an indemnity payment either due to settlement or a finding against the defendant. The average indemnity payment was $185,366 (range $363 to $2,000,000). Among cases in which a specific outcome was reported, 55 were related to laryngeal nerve injury or voice disturbance. No marked change occurred in the incidence of claims across the study period. During this time, approximately 2,585,000 thyroidectomies were performed. Extrapolating from PIAA data, this works out to an estimated 1.5 claims per 10,000 cases. Conclusion: Malpractice claims related to thyroid surgery are surprisingly infrequent. While the rates of thyroid surgery have risen steadily, there has not been a corresponding increase in related malpractice claims.

Characteristics of medical professional liability claims against dermatologists: Data from 2704 closed claims in a voluntary registry

The Physician Insurers Association of America established a voluntary registry in 1985 that contains 239,756 closed claims. The registry is maintained for educational programs to reduce patient injury and medical professional liability (MPL) claims. This report provides a description of MPL claims against dermatologists. Descriptive techniques are used to present summary information for the dermatologic claims in the registry. Of 239,756 closed claims, 2704 (1.1%) involve dermatologists. Of the 2704 closed claims, 775 (28.7%) resulted in an average indemnity payment of $137,538. The most common allegation was improper procedure performance. The most prevalent procedure was operative procedures on the skin. Error in diagnosis was the next most common allegation. The most common diagnosis was malignant melanoma. Malignant melanoma claims were paid in 42.2% of cases with an average indemnity payment of $436,843. The data are subject to selection and reporting biases. In addition, the registry does not contain exposure data, so incidences and prevalences are not calculable. MPL issues are important to all practicing dermatologists. The most common allegation against dermatologists in this study was improper performance of operative procedures on the skin, excluding skin grafts. Error in diagnosis of malignant melanoma was the next most common allegation. Malignant melanoma claims were paid in 42.2% of cases with an average indemnity payment of $436,843. By focusing on the risk management of these procedures and this diagnosis, dermatologists can have the largest impact on reducing patient injuries and consequent MPL claims.

Nurse Practitioner Professional Liability: A Synopsis of the CNA HealthPro Claims Study and NSO Survey

This article presents highlights of a study authored by two major providers of nurse practitioner (NP) professional liability insurance. CNA HealthPro described CNA-insured NP liability claims between 1998-2008. Nurses Service Organization (NSO) surveyed its insured APNs (95% NPs) to compare APNs with and without claims on a variety of factors. An increase in ultimate average indemnity and expense payments for NPs was identified, and strategies to mitigate risk were suggested. The NSO survey response rate was 12.8% (n = 3,037) and included 287 APNs reporting a claim within 5 years and 2,750 non-claim responses. APNs with claims were more likely than non-claim APNs to respond that their state regulations require direct physician supervision. As NPs continue to occupy a central role in healthcare, it is important to explore NP liability claims in order to develop useful risk-management strategies.

An Epidemiologic Study of Closed Emergency Department Malpractice Claims in a National Database of Physician Malpractice Insurers

The objective was to perform an epidemiologic study of emergency department (ED) medical malpractice claims using data maintained by the Physician Insurers Association of America (PIAA), a trade association whose participating malpractice insurance carriers collectively insure over 60% of practicing physicians in the United States. All closed malpractice claims in the PIAA database between 1985 and 2007, where an event in an ED was alleged to have caused injury to a patient 18 years of age or older, were retrospectively reviewed. Study outcomes were the frequency of claims and average indemnity payments associated with specific errors identified by the malpractice insurer, as well as associated health conditions, primary specialty groups, and injury severity. Indemnity payments include money paid to claimants as a result of settlement or court adjudication, and this financial obligation to compensate a claimant constitutes the insured's financial liability. These payments do not include the expenses associated with resolving a claim, such as attorneys' fees. The study examined claims by adjudicatory outcome, associated financial liability, and expenses of litigation. Adjudicatory outcome refers to the legal disposition of a claim as it makes its way into and through the court system and includes resolution of claims by formal verdict as well as by settlement. The study also investigated how the number of claims, average indemnity payments, paid-to-close ratios (the percentage of closed claims that resolved with a payment to the plaintiff), and litigation expenses have trended over the 23-year study period. The authors identified 11,529 claims arising from an event originating in an ED, representing over $664 million in total liability over the 23-year study period. Emergency physicians (EPs) were the primary defendants in 19% of ED claims. The largest sources of error, as identified by the individual malpractice insurer, included errors in diagnosis (37%), followed by improper performance of a procedure (17%). In 18% of claims, no error could be identified by the insurer. Acute myocardial infarction (AMI; 5%), fractures (6%), and appendicitis (2%) were the health conditions associated with the highest number of claims. Over two-thirds of claims (70%) closed without payment to the claimant. Most claims that paid out did so through settlement (29%). Only 7% of claims were resolved by verdict, and 85% of those were in favor of the clinician. Over time, the average indemnity payments and expenses of litigation, adjusted for inflation, more than doubled, while both the total number of claims and number of paid claims decreased. Emergency physicians were the primary defendants in a relatively small proportion of ED claims. The disease processes associated with the highest numbers of claims included AMI, appendicitis, and fractures. The largest share of overall indemnity was attributed to errors in the diagnostic process. The financial liability of medical malpractice in the ED is substantial, yet the vast majority of claims resolve in favor of the clinician. Efforts to mitigate risk in the ED should include the diverse clinical specialties who work in this complex environment, with attention to those health conditions and potential errors with the highest risk.

Characteristics of Medical Professional Liability Claims in Patients With Cardiovascular Diseases

This report presents data describing a large cohort of closed cardiovascular medical professional liability (MPL) claims. The Physician Insurers Association of America established a registry of closed MPL claims in 1985. This registry contains data describing 230,624 closed claims for 28 medical specialties through 2007. The registry is maintained to support educational programs designed to improve the quality of care and to reduce patient injury and MPL claims. In this report, descriptive techniques are used to present summary information for the medical cardiovascular claims in the registry. Of 230,624 closed claims, 4,248 (1.8%) involved cardiovascular medical physicians. Of the 4,248 closed cardiovascular medical claims, 770 (18%) resulted in indemnity payments, and the average indemnity payment was $248,291. In the entire database, 30% of closed claims were paid, and the average indemnity payment was $204,268. The most common allegation among cardiovascular closed claims was diagnostic error, and the most prevalent diagnosis was coronary atherosclerosis. Claims involving cardiac catheterization and coronary angioplasty represented 12% and 7% of the cardiovascular closed claims. Aortic aneurysms and dissections, although relatively infrequent as clinical events, represent a substantial MPL risk because of the high percentage of paid claims (30%) and the very high average indemnity payment of $417,298. In conclusion, MPL issues are common and are important to all practicing cardiologists. Detailed knowledge of risks associated with liability claims should assist practicing cardiologists in improving the quality of care, reducing patient injury, and reducing the incidence of claims.

Missed Diagnoses by Urologists Resulting in Malpractice Payment

Missed diagnoses are a patient safety concern and they can result in malpractice allegation. The specialist physician may be liable for missed or delayed diagnoses even if an abnormality in the physician area of expertise is ruled out. We approached this largely unstudied area of medical malpractice in an effort to increase physician awareness and identify opportunities for prevention. Working with the Medical Liability Mutual Insurance Company of New York State, we evaluated malpractice claims in urology that were closed with indemnity payment between 1985 and 2004. We identified all such claims resulting from alleged missed or delayed diagnoses by urologists. Claims were divided into 2 main categories based on whether the missed diagnosis was primarily urological, ie testis torsion, or not urological, ie appendicitis. A total of 75 missed diagnosis claims were identified, representing 15% of claims overall. The total indemnity payment for missed diagnosis claims was $32,591,013, which represented 27% of all indemnity payments for the study period. They were divided into 58 missed urological diagnoses and 17 missed nonurological diagnoses. Cancer represented 71% of missed urological diagnoses and 41% of missed nonurological diagnoses. Urological cancer missed diagnosis claims were associated with the highest average indemnity payment of $526,460. The average indemnity payment for missed diagnosis claims was 92% greater than the average indemnity payment for all other claims ($434,546 vs $226,133). An increase in the frequency of missed diagnosis claims closed with indemnity payment and in the amount of payment for missed diagnosis claims were observed during the 20-year study period. Indemnity payments resulting from missed diagnosis claims represent a disproportionately high percent of total indemnity payments (27%) due to a high average payment for such claims. Liability for the urologist resulted from missed diagnoses not only of urological conditions, but also of nonurological conditions.