Medical Malpractice Environment Research Articles

Experiences of neurological surgeons with malpractice lawsuits.

As a specialty that treats acute pathology and refractory pain, neurosurgery is at risk for high liability, making the practice of defensive medicine quite common. The extent to which the practice of defensive medicine is linked to experience with malpractice lawsuits remains unclear. The aims of this study were to clarify this by surveying neurosurgeons about the frequency of experiencing medical lawsuits and to show how neurosurgeons reflect on facing such lawsuits. A survey consisting of 24 questions was distributed among members of the Congress of Neurological Surgeons. The survey consisted of four parts: 1) demographics of participants; 2) the way malpractice lawsuits affect the way respondents practice medicine; 3) experiences with medical malpractice lawsuits; and 4) the effect of the medical malpractice environment on one's own practice of medicine. There were a total of 490 survey respondents, 83.5% of whom were employed in the US. Of the respondents, 39.5% stated they were frequently or always concerned about being sued, and 77.4% stated their fear had led to a change in how they practice medicine. For 58.4%, this change led to the practice of defensive medicine, while for others it led to more extensive documentation (14.3%) and/or to referring or dropping complex cases (12.4%).Among the respondents, 80.9% at some time were named in a medical malpractice lawsuit and 12.3% more than 10 times. The main concerns expressed about being sued included losing confidence and practicing defensive medicine (17.8%), personal assets being at risk (16.9%), and being named in the National Practitioner Data Bank (15.6%). Given the medical malpractice environment, 58.7% of respondents considered referring complex patient cases, whereas 36.5% considered leaving the practice of medicine. The fear of being sued (OR 4.06, 95% CI 2.53-6.51) and the consideration of limiting the scope of practice (OR 3.08, 1.80-5.20) were both independently associated with higher odds of considering leaving the practice of medicine. The current medicolegal landscape has a profound impact on neurosurgical practice. The fear of being sued, the financial aspects of practicing defensive medicine, and the proportion of neurosurgeons who are considering leaving the practice of medicine emphasize the need for a shift in the medicolegal landscape to a system in which fear of being sued does not play a dominant role and the interests of patients are protected.

The Financial Impact of Medical Malpractice Claims After the Affordable Care Act on the Property & Casualty Insurance Industry

In 2010, the Affordable Care Act was signed into law with various provisions taking effect over the following years, specifically the individual mandate in 2014. This reform drastically impacted the entire insurance industry, not simply health insurance. Many prior studies, however, focused only on how ACA impacted health insurance. Early estimates indicated that health insurers might transfer costs to property and casualty insurers, which would significantly impact the profitability of these companies. Despite the association of medical malpractice with healthcare, property and casualty insurers actually write the policies for medical malpractice incidents. Therefore, I chose to exclusively examine how the Affordable Care Act impacts the practices of property and casualty insurers that write medical malpractice policies. My study worked to answer three questions: (i) the change in the number of medical malpractice reports, especially in Medicaid expansion states, (ii) the change in the dollar amount of these claims, and (iii) the impact to the industry’s net income. Using statistical tests and regressions based on sample data of the number of medical malpractice reports and the inflation-adjusted dollar amounts of these claims in each of the 50 states from 2003 to 2018, healthcare consumption expenditures, and the number of individuals with health insurance, I concluded that the number of malpractice reports has increased and the dollar amount of claims has decreased since the enactment of the Affordable Care Act. However, only a portion of these changes can be attributed to the Affordable Care Act, as the additional number of people insured played a small role in the variations of the medical malpractice environment; rather, healthcare consumption expenditures substantially altered the medical malpractice statistics. Ultimately, I concluded that the changes that occurred in the medical malpractice claims after the passage and enactment of the Affordable Care Act had very little impact on the profitability of the property and casualty insurance industry.

Contemporary Risk Management for Radiologists.

Although radiologists want to avoid being sued for malpractice, their primary objective is to treat patients in the best way possible. Good risk management safeguards both patients and radiologists. The main objective is not to wait until an untoward event occurs and then manage it retrospectively, but rather to anticipate what may go wrong or cause an injury, so that it can be avoided. Thus, good risk management is characterized by two words: anticipate and avoid. Although avoiding lawsuits is the apparent objective of risk management, the real objective is to optimize the care and treatment of patients. Potential causes of error and injury must be identified to prevent such problems from occurring so that the conduct of radiologists allows patients to benefit from their knowledge and technology. If radiologic diagnoses and treatment are beyond reproach, then malpractice suits are less likely. The most common and potentially injurious risks that should be anticipated and avoided are closely entwined with radiologic diagnosis, incidental findings, communication of findings to referring physicians, "curbstone consultations," disclosure of and apology for errors, breast density laws, American College of Radiology parameters, radiation exposure, the Health Insurance Portability and Accountability Act, electronic health records, and imaging traumatic brain injury with functional MRI. Peer review and the current status of the medical malpractice environment are also relevant. ©RSNA, 2018.

The net effects of medical malpractice tort reform on health insurance losses: the Texas experience

In this paper, we examine the influence of medical malpractice tort reform on the level of private health insurance company losses incurred. We employ a natural experiment framework centered on a series of tort reform measures enacted in Texas in 2003 that drastically altered the medical malpractice environment in the state. The results of a difference-in-differences analysis using a variety of comparison states, as well as a difference-in-difference-in-differences analysis, indicate that ameliorating medical malpractice risk has little effect on health insurance losses incurred by private health insurers.

Association Between State Medical Malpractice Environment and Postoperative Outcomes in the United States

The US medical malpractice system assumes that the threat of liability should deter negligence, but it is unclear whether malpractice environment affects health care quality. We sought to explore the association between state malpractice environment and postoperative complication rates. This observational study included Medicare fee-for-service beneficiaries undergoing one of the following operations in 2010: colorectal, lung, esophageal, or pancreatic resection, total knee arthroplasty, craniotomy, gastric bypass, abdominal aortic aneurysm repair, coronary artery bypass grafting, or cystectomy. The state-specific malpractice environment was measured by 2010 medical malpractice insurance premiums, state average award size, paid malpractice claims/100 physicians, and a composite malpractice measure. Outcomes of interest included 30-day readmission, mortality, and postoperative complications (eg sepsis, myocardial infarction [MI], pneumonia). Using Medicare administrative claims data, associations between malpractice environment and postoperative outcomes were estimated using hierarchical logistic regression models with hospital random-intercepts. Measures of malpractice environment did not have significant, consistent associations with postoperative outcomes. No individual tort reform law was consistently associated with improved postoperative outcomes. Higher-risk state malpractice environment, based on the composite measure, was associated with higher likelihood of sepsis (odds ratio [OR] 1.22; 95% CI 1.07 to 1.39), MI (OR 1.14; 95% CI 1.06 to 1.23), pneumonia (OR 1.09; 95% CI 1.03 to 1.16), acute renal failure (OR 1.15; 95% CI 1.08 to 1.22), deep vein thrombosis/pulmonary embolism (OR 1.22; 95% CI 1.13 to 1.32), and gastrointestinal bleed (OR 1.18; 95% CI 1.08 to 1.30). Higher risk malpractice environments were not consistently associated with a lower likelihood of surgical postoperative complications, bringing into question the ability of malpractice lawsuits to promote health care quality.

Association Between State Medical Malpractice Environment and Surgical Quality and Cost in the United States.

The US medical malpractice system is designed to deter negligence and encourage quality of care through threat of liability. To examine whether state-level malpractice environment is associated with outcomes and costs of colorectal surgery. Observational study of 116,977 Medicare fee-for-service beneficiaries who underwent colorectal surgery using administrative claims data. State-level malpractice risk was measured using mean general surgery malpractice insurance premiums; paid claims per surgeon; state tort reforms; and a composite measure. Associations between malpractice environment and postoperative outcomes and price-standardized Medicare payments were estimated using hierarchical logistic regression and generalized linear models. thirty-day postoperative mortality; complications (pneumonia, myocardial infarction, venous thromboembolism, acute renal failure, surgical site infection, postoperative sepsis, any complication); readmission; total price-standardized Medicare payments for index hospitalization and 30-day postdischarge episode-of-care. Few associations between measures of state malpractice risk environment and outcomes were identified. However, analyses using the composite measure showed that patients treated in states with greatest malpractice risk were more likely than those in lowest risk states to experience any complication (OR: 1.31; 95% CI: 1.22-1.41), pneumonia (OR: 1.36; 95%: CI, 1.16-1.60), myocardial infarction (OR: 1.44; 95% CI: 1.22-1.70), venous thromboembolism (OR:2.11; 95% CI: 1.70-2.61), acute renal failure (OR: 1.34; 95% CI; 1.22-1.47), and sepsis (OR: 1.38; 95% CI: 1.24-1.53; all P < 0.001). There were no consistent associations between malpractice environment and Medicare payments. There were no consistent associations between state-level malpractice risk and higher quality of care or Medicare payments for colorectal surgery.

Impact of Medical Malpractice Environment on Surgical Quality and Outcomes

Received July 23, 2013; Revised August 30, 2013; Accepted 2013. From the Surgical Outcomes andQuality Improvement Cen of Surgery, Feinberg School of Medicine, Northwes and Northwestern Memorial Hospital (Minami, Chung, H and the Center for Healthcare Studies, Feinberg Schoo Northwestern University, Chicago, IL. Correspondence address: Karl Y Bilimoria, MD, MS, Outcomes and Quality Improvement Center, Departm Feinberg School of Medicine, Northwestern University Memorial Hospital, 676 St Clair St, Arkes Pavilion Suite IL 60611. email: k-bilimoria@northwestern.edu

The effect of medical malpractice liability on rate of referrals received by specialist physicians

Using nationally representative data from the United States, this paper analyzed the effect of a state’s medical malpractice environment on referral visits received by specialist physicians. The analytic sample included 12,839 ambulatory visits to specialist care doctors in office-based settings in the United States during 2003–2007. Whether the patient was referred for the visit was examined for its association with the state’s malpractice environment, assessed by the frequency and severity of paid medical malpractice claims, medical malpractice insurance premiums and an indicator for whether the state had a cap on non-economic damages. After accounting for potential confounders such as economic or professional incentives within practices, the analysis showed that statutory caps on non-economic damages of $250,000 were significantly associated with lower likelihood of a specialist receiving referrals, suggesting a potential impact of a state’s medical malpractice environment on physicians’ referral behavior.

Pediatrics: A unique and volatile risk

Pediatric risk is both unique and volatile. Children are more vulnerable when treated in any healthcare environment, but especially in the acute care setting. Children with chronic healthcare conditions are more challenging to treat and more susceptible to medical errors. Despite marked improvement in the national medical malpractice environment, the most volatile claims involve severely injured patients under age eighteen and especially those patients in the first year of life. This article provides the context of pediatric care in reviewing the demographics of children and the healthcare delivery system. The unique factors of pediatric care that create increased risk are also reviewed. Low frequency/high severity claims involving children are discussed in detail as well as physician claims in the specialty of general pediatrics. Risk management solutions for pediatric issues are proposed.

Medical Malpractice Liability in Clinical Urology: A Survey of Practicing Urologists

The current medical malpractice environment is in crisis. Costs associated with litigation as well as medical malpractice insurance premiums have increased during the last decade. In fact as of March 2004 the American Medical Association has identified 19 states as crisis states. We investigated the way in which the medical malpractice environment has affected urologists and the manner in which they practice medicine. A survey of 31 questions was electronically mailed to the American Urological Association's database of practicing urologists in the United States. Data were gathered on each urologist's malpractice history as well as their clinical practice. A total of 5,919 surveys were mailed and 683 (12%) were returned. Urologists from 47 states responded. The mean medical malpractice premium in 2003 was 30,665 dollars (median 22,500 dollars, range 6,000 dollars to 120,000 dollars). Of responding urologists 63% report being named in a medical malpractice lawsuit a mean of 2.1 times. Mean length of time practicing urology was 19 years. Of the lawsuits 28% involved urological oncology, 12% involved endourology and 10% involved female urology. All other urological specialties individually generated less than 10% of the lawsuits. In only 3.5% of the cases was the patient successful at trial, compared to 13.2% of the cases where the urologist was successful at trial. The case was dropped or dismissed without financial settlement 46.9% of the time. However, 36.3% of the time the case was settled with a pretrial financial settlement. The mean amount awarded to a patient at trial was 213,855 dollars (median 100,000 dollars, range 2,400 dollars to 1,000,000 dollars). When a patient was awarded pain and suffering at trial, the mean amount awarded was 270,000 dollars (median 85,000 dollars, range 30,000 dollars to 900,000 dollars). The mean amount given to the patient as pretrial settlement was 196,706 dollars (median 70,000 dollars, range 1,500 dollars to 5,000,000). The mean time a urologist spent defending their first lawsuit was 21.8 days. Given the current medical malpractice environment, 58% of responding urologists are considering referring difficult cases, 60% are considering limiting the scope of their practice, 26% are considering changing the state in which they practice and 41% are considering leaving the practice of medicine. Our experience has shown that the medical malpractice crisis has had a profound and real effect on the urological community. When the data are stratified according to those urologists who practice in a crisis state, we consistently see a pattern whereby the crisis state urologists are carrying a larger proportion of the malpractice burden. Most concerning is how the malpractice environment has changed the way in which urologists approach their practice. A larger percentage of urologists from crisis states are reporting that they are considering limiting the scope of their practice, moving their practice to a state with a more favorable malpractice environment and considering leaving the practice of urology altogether. Clearly the urologist is not immune from the current malpractice environment.

The current medical malpractice environment: An analysis of causes and solutions*1

Nurse practitioners (NPs) and other health care providers are all too familiar with the fact that, since the turn of the last century, premiums for medical malpractice insurance have significantly increased in certain states and disciplines. The current medical malpractice environment has provoked heated political debate at the state and federal levels among interest groups representing health providers, trial lawyers, insurance companies, and consumers. However, few have systematically examined the root causes of increased premium rates and the spectrum of available policy solutions. Thus, the purpose of this paper is to provide stakeholders with an overview of the current medical malpractice environment with some understanding of its causes and highlight various policy options to reform the current medical malpractice situation.

The current medical malpractice environment: An analysis of causes and solutions

Nurse practitioners (NPs) and other health care providers are all too familiar with the fact that, since the turn of the last century, premiums for medical malpractice insurance have significantly increased in certain states and disciplines. The current medical malpractice environment has provoked heated political debate at the state and federal levels among interest groups representing health providers, trial lawyers, insurance companies, and consumers. However, few have systematically examined the root causes of increased premium rates and the spectrum of available policy solutions. Thus, the purpose of this paper is to provide stakeholders with an overview of the current medical malpractice environment with some understanding of its causes and highlight various policy options to reform the current medical malpractice situation.

Medical malpractice and head and neck cancer.

The purpose of this review is to evaluate medical malpractice involving patients with head and neck cancer. In the United States, problems associated with the medical malpractice environment are reaching proportions that threaten the delivery of health care. Several methods to learn more about the trends and ramifications of litigation have been developed. Although patients with cancer of the head and neck bring suits rarely, when they do several themes seem prevalent. Delays in diagnosis are common allegations. Plaintiffs are frequently much younger than expected, and the oncologic outcome is frequently poor. Defendant physicians occasionally unwittingly add to the delay by not expecting the younger patient. The poor oncologic outcome may be related to the delay or to a biologically more aggressive disease. Relationships between these factors are explored. Consent issues are also relatively common. Physicians must strive to know as much as possible about tort reform, and to contribute to the process. Litigation analysis and other tools to expand our understanding can be used to educate ourselves and the legal community. Scientific standards must be developed along with clinical pathways to guide ourselves to prevent litigation. They may also guide the legal community to establish more rational standards of care based on a consensus of expert opinions.