Malpractice Claims Rates Research Articles

Obstetric Delivery Practices and Malpractice Claims: Is There a Correlation? [26R

INTRODUCTION: This study assesses the correlation in trends between obstetric delivery practices and liability claims over 30 years. METHODS: A retrospective chart review was performed at a single Colorado hospital, averaging 4,690 deliveries per year, from alternating years between 1978 and 2012. The number of cesarean sections (CS), operative vaginal deliveries (OVD) and vaginal lacerations (3rd and 4th degree) were recorded. A database of obstetrics liability claims, provided by COPIC Insurance, was tabulated and correlated with delivery data. All liability data was occurrence based and aggregated per year. Analysis was performed with Pearson correlation coefficients. RESULTS: The CS rate for singletons increased from 13% to 25% from 1978 to 2012. OVDs decreased from 14% to 2.5%. Lacerations decreased from 10.2% to 1.5%. The number of obstetric claims increased steadily until 2006 and then decreased. There was a significant positive correlation between CS rates and obstetrics claims (P =.006). No significant correlation was found between OVD rates and liability claims (P =.073) or lacerations and liability claims (P = .052). CONCLUSION: A positive correlation between CS rates and liability claims was noted, while no correlation in OVD or laceration rates to liability claims was found. Together, these trends suggest that abandonment of OVD has not been protective from a liability perspective. The decreasing rates of CS and malpractice claims starting in 2006 are likely explained by Colorado's medical tort reform in 2003. Undoubtedly fear of malpractice affects obstetricians' management, however abandoning OVD in favor of CS has not proven to be a protective solution.

Analysis of 11 years of clinical negligence claims in esophagogastric cancer in England

In the National Health Service (NHS), clinical negligence claims and associated compensations are constantly rising. The aim of this study is to identify the size, trends, and causes of litigations claims in relation to esophagogastric (EG) cancer in the NHS. Data requests were submitted to the NHS Litigation Authority (NHSLA) for the period of January 2003 to December 2013. Data were reviewed, categorized clinically, and analyzed in terms of causes and costs behind claims. In this time period, there were 163 claims identified from the NHSLA database. Ninety-five (58.3%) claims were successful with a pay out of £6.25 million. An increasing overall claim frequency and success rate were found over the last few years. Majority of the claims were from gastric cancer 84 (88.4%). The commonest cause of complaint in successful claims was delay or failure in diagnosis (21.1%) and treatment (17.9%). There were only 10.5% successful intraoperative claims, of which 50% were due to unnecessary or additional procedures. The frequency and success rates of malpractice claims in EG cancer are rising. The failure or delay in diagnosing and treatment in EG malignancy are the common cause for successful litigation claims. The findings further reinforce the need to improve early diagnosis.

Rates and Characteristics of Paid Malpractice Claims Among US Physicians by Specialty, 1992-2014

ImportanceAlthough physician concerns about medical malpractice are substantial, national data are lacking on the rate of claims paid on behalf of US physicians by specialty.ObjectiveTo characterize paid malpractice claims by specialty.Design, Setting, and ParticipantsA comprehensive analysis was conducted of all paid malpractice claims, with linkage to physician specialty, from the National Practitioner Data Bank from January 1, 1992, to December 31, 2014, a period including an estimated 19.9 million physician-years. All dollar amounts were inflation adjusted to 2014 dollars using the Consumer Price Index. The dates on which this analysis was performed were from May 1, 2015, to February 20, 2016, and from October 25 to December 16, 2016.Main Outcomes and MeasuresFor malpractice claims (n = 280 368) paid on behalf of physicians (in aggregate and by specialty): rates per physician-year, mean compensation amounts, the concentration of paid claims among a limited number of physicians, the proportion of paid claims that were greater than $1 million, severity of injury, and type of malpractice alleged.ResultsFrom 1992-1996 to 2009-2014, the rate of paid claims decreased by 55.7% (from 20.1 to 8.9 per 1000 physician-years; P < .001), ranging from a 13.5% decrease in cardiology (from 15.6 to 13.5 per 1000 physician-years; P = .15) to a 75.8% decrease in pediatrics (from 9.9 to 2.4 per 1000 physician-years; P < .001). The mean compensation payment was $329 565. The mean payment increased by 23.3%, from $286 751 in 1992-1996 to $353 473 in 2009-2014 (P < .001). The increases ranged from $17 431 in general practice (from $218 350 in 1992-1996 to $235 781 in 2009-2014; P = .36) to $114 410 in gastroenterology (from $276 128 in 1992-1996 to $390 538 in 2009-2014; P < .001) and $138 708 in pathology (from $335 249 in 1992-1996 to $473 957 in 2009-2014; P = .005). Of 280 368 paid claims, 21 271 (7.6%) exceeded $1 million (4304 of 69 617 [6.2%] in 1992-1996 and 4322 of 54 081 [8.0%] in 2009-2014), and 32.1% (35 293 of 109 865) involved a patient death. Diagnostic error was the most common type of allegation, present in 31.8% (35 349 of 111 066) of paid claims, ranging from 3.5% in anesthesiology (153 of 4317) to 87.0% in pathology (915 of 1052).Conclusions and RelevanceBetween 1992 and 2014, the rate of malpractice claims paid on behalf of physicians in the United States declined substantially. Mean compensation amounts and the percentage of paid claims exceeding $1 million increased, with wide differences in rates and characteristics across specialties. A better understanding of the causes of variation among specialties in paid malpractice claims may help reduce both patient injury and physicians’ risk of liability.

Variations by state in physician disciplinary actions by US medical licensure boards

ObjectiveTo investigate the variation in the rate of state medical board physician disciplinary actions between US states.MethodsLongitudinal study of state medical board physician disciplinary action rates using the US National...

The Association between Medical Malpractice Risk and Healthcare Quality: Evidence from Texas

According to tort law theory, medical malpractice liability may deter negligence by healthcare providers. However, advocates of malpractice reform often argue that most malpractice claims are unrelated to provider performance. We study the connection between hospital adverse events and malpractice claim rates in the two states with public datasets on med mal claim rates: Florida and Texas. We use Patient Safety Indicators (“PSIs”), developed by the Agency for Healthcare Research and Quality, to measure rates for 17 types of adverse events. Hospitals with high rates for one PSI usually have high rates for other PSIs. We find a strong association between PSI rates and malpractice claim rates with extensive control variables and hospital fixed effects (in Florida) or county fixed effects (in Texas). Our results, if causal, provide evidence that malpractice claims leading to payouts are not random events. Instead, hospitals that improve patient safety can reduce malpractice payouts.We also study local variation in adverse event rates, in the spirit of the Dartmouth Atlas work on variation in treatment intensity. We find large variations, both across counties and across hospitals within counties. This suggests that many adverse hospital events are avoidable at reasonable cost, since some hospitals are avoiding them.

The Association between Patient Safety Indicators and Medical Malpractice Risk: Evidence from Florida and Texas

AbstractAccording to tort law theory, medical malpractice liability may deter negligence by health-care providers. However, advocates of malpractice reform often argue that most malpractice claims are unrelated to provider performance. We study the connection between hospital adverse events and malpractice claim rates in the two states with public data sets on medical malpractice claim rates: Florida and Texas. We use Patient Safety Indicators (PSIs), developed by the Agency for Healthcare Research and Quality, to measure rates for 17 types of adverse events. Hospitals with high rates for one PSI usually have high rates for other PSIs. We find a strong association between PSI rates and malpractice claim rates with extensive control variables and hospital fixed effects (in Florida) or county fixed effects (in Texas). Our results, if causal, provide evidence that malpractice claims leading to payouts are not random events. Instead, hospitals that improve patient safety can reduce malpractice payouts. We als...

Will Full Practice Authority Mean Higher Malpractice Premiums for Nurse Practitioners?

Will Full Practice Authority Mean Higher Malpractice Premiums for Nurse Practitioners?

Do Written Disclosures of Serious Events Increase Risk of Malpractice Claims? One Health Care System's Experience.

This study aimed to determine whether Pennsylvania ACT 13 of 2002 (Mcare) requiring the written and verbal disclosure of "serious events" was accompanied by increased malpractice claims or compensation costs in a large U.S. health system. The primary outcome was the rate of malpractice claims. The secondary outcome was the amount paid for compensation of malpractice claims. The analyses tested the relationship between the rate of serious event disclosures and the outcome variables, adjusted for the year of the event, category of claim, and the degree of "harm" related to the event. There were 15,028 serious event disclosures and 1302 total malpractice claims among 1,587,842 patients admitted to UPMC hospitals from May 17, 2002, to June 30, 2011. As the number of serious event disclosures increased, the number of malpractice claims per 1000 admissions remained between 0.62 and 1.03. Based on a matched analysis of claims that were disclosed and those that were not (195 pairs), disclosure status was significantly associated with increased claim payout (disclosures had 2.71 times the payout; 95% confidence interval, 1.56-4.72). Claims with higher harm levels H and I were independently associated with higher payouts than claims with lower harm levels A to D (11.15 times the payout; 95% confidence interval, 2.30-54.07). Implementation of a mandated serious event disclosure law in Pennsylvania was not associated with an overall increase in malpractice claims filed. Among events of similar degree of harm, disclosed events had higher compensation paid compared with those that had not been disclosed.

Medical malpractice claims in relation to colorectal malignancy in the National Health Service

Under the current increased financial constraints affecting the National Health Service (NHS), clinical negligence claims and associated compensations are constantly rising. Our aim was to identify the magnitude, trends and causes of malpractice claims in relation to a common pathology such as colorectal malignancy in the NHS. Data requests were submitted to the NHS Litigation Authority (NHSLA) and to the Medical Defence Union (MDU) and Medical Protection Society (MPS). Data were reviewed, categorized clinically and analysed in terms of causes and costs behind claims. Data from the MPS and MDU were unavailable. In all, 169 claims were identified from the NHSLA database between 2003 and 2012; 123 (73%) cases had been closed, 80 (65%) of which were successful. An increasing overall claim frequency and success rate were found over the last few years. Total litigation expenses were £8.6 million, with 39% paid out as legal expenses. The commonest cause of complaint in successful claims was in relation to diagnostic delays or failures (58%, £5.1 million), with a delay or failure by the clinician to take action in response to an abnormal investigation result being a major factor. The occurrence of peri-operative complications (20%, £1.6 million) was the second commonest cause. Average frequency and success rates of malpractice claims in secondary care in the NHS are rising, leading to significant overall payouts. The failure or delay in diagnosing colorectal malignancy or its postoperative complications is a common cause behind malpractice claims. Improvement in these areas could enhance patient care and reduce future claims.

The Receding Tide of Medical Malpractice Litigation: Part 2—Effect of Damage Caps

We study the effect of damage caps adopted in the 1990s and 2000s on medical malpractice claim rates and payouts. Prior studies found some evidence that caps reduce payout per claim, but mixed and weak evidence on whether caps reduce paid claim rates and payout per physician. However, most prior studies do not allow for the gradual phase‐in of damage caps, which usually apply only to lawsuits filed after the reform's effective date, or only to injuries after the effective date. Once we allow for phase‐in, we find strong evidence that damage caps reduce both claim rates and payout per claim, with a large combined impact on payout per physician. The drop in claim rates is concentrated in claims with larger payouts—the ones that we expect to be most affected by a damages cap. Stricter caps have larger effects. Some prior studies also find a large impact of tort reforms other than damage caps. Once we allow for phase‐in, we find that these other reforms have no significant impact on either claim rates or payout per claim.

Medical Malpractice Reform Measures and Their Effects

New rules and methods for medical injury dispute resolution have been launched in New Hampshire and New York, and demonstration projects are underway elsewhere. This article describes major medical malpractice reforms undertaken and proposed in recent years. Reforms are classified as (1) liability-limiting initiatives favoring health-care providers; (2) procedural innovations promoted as improving dispute resolution processes, such as patient compensation funds, "sorry" laws, disclosure and early offer laws, health courts, and safe harbor laws; and (3) major conceptual reforms to move liability away from physicians to hospitals or administrative no-fault compensation systems. Empirical evidence about the practical effects of already-implemented reforms, such as damage caps, is reviewed. In light of declining malpractice claim rates, heavier adverse impacts of damage caps on vulnerable groups (people who have severe injuries, who are elderly, and who are unemployed) and repeated findings of state law unconstitutionality, the rationale for nationwide damage caps is questioned. Attention to innovative reform proposals such as patient compensation funds, disclosure and early offer laws, safe harbor laws, enterprise insurance and no-fault compensation systems, is encouraged.

Capsule Commentary on Victoroff et al., Impact of Electronic Health Records on Malpractice Claims in a Sample of Physician Offices in Colorado: A Retrospective Cohort Study

Electronic Health Record (EHR) use is growing exponentially in the United States.1 Patient benefits may include improved quality, better care coordination and reduced medical error.2,3 EHRs have the potential to reduce provider liability, since delayed diagnoses as well as diagnostic and medication errors are leading reasons for primary care lawsuits.4 In this issue of JGIM, Victoroff et al. examine whether or not the use of EHR was associated with lower rates of malpractice claims in a sample of Colorado physicians.5 Among 473 respondents to a survey of physicians insured through a specific insurance company, 53 % used EHR. Victoroff et al. found that the unadjusted risk of claims was not different between those with and without EHRs (IRR: 0.69, 95 % CI: 0.41–1.16), although it was lower for users when compared to before EHR adoption (IRR: 0.51, 95 % CI: 0.27–0.96), an effect that disappeared with adjustment for other factors. In addition, the authors also found that a very low percentage of claims were “EHR-sensitive,” reporting that only 3 % of claims could have been affected by EHR use. There are a number of problems with this study that warrant caution in interpretation. First, the study was underpowered to demonstrate a clinically important reduction in malpractice. Secondly, this study occurred during a period of EHR adoption. EHRs have a steep learning curve and the full benefit may not be seen during initial use. Third, there are no patient level data available, limiting the ability to explore the effect of EHRs on malpractice. Fourth, it is difficult to believe that only 3 % of malpractice claims were sensitive to EHR use; this conclusion must be tempered by low rates of inter-rater agreement on EHR sensitivity. It might have been interesting to explore whether EHR was effective at reducing liability in the group of claims felt to be ER sensitive. Finally, it is not clear what EHR modalities were being used. Some uses and applications of EHR might be more effective at reducing liability than others, and this is a question worthy of further research. At present, it is premature to conclude from current studies, and particularly this one, that the EHR offers no benefit in terms of reduced liability risk, particularly within primary care.

Clinical, demographic, and medicolegal factors associated with geographic variation in inferior vena cava filter utilization: An interstate analysis

Geographic variability exists in the use of IVC filters (IVCF). We hypothesized that variation in IVCF use is incompletely explained by variation in the prevalence of deep-vein thrombosis (DVT) and pulmonary embolism (PE) and may result from different practice patterns regarding prophylactic IVCF use. We characterize geographic variation in IVCF use at the state level and evaluate its association with clinical factors, patient demographics, and the medicolegal environment. Healthcare Cost and Utilization Project State Inpatient Database records were accessed to identify 230,445 IVCFs placed from 2006 to 2008 in 33 states. Similar queries were performed for DVT and PE. Additional state data were obtained from public sources. Analyses included descriptive statistics, Spearman Correlation (SC), Wilcoxon rank-sum test, and characterization of variability. Overall, IVCF use correlated with the prevalence of DVT (SC = 0.89, P < .01). States on the East coast have significantly greater rates of IVCF use per 100K (mean ± SD = 41.2 ± 16.7 vs 27.8 ± 11.1, P < .05) and greater rates of IVCF per DVT (20.2 ± 4.5% vs 15.2 ± 2.9%; P < .005), despite similar rates of DVT per 100K (198.1 ± 51.2 vs 177.7 ± 46.7, P = NS) compared with all other states. Overall, states with the greatest rate of IVCF per DVT were (in descending order): Rhode Island, New Jersey, Florida, New York, and West Virginia. Rates of detected PE per 100K in these states were not significantly different from all other states (95.6 ± 16.6 vs 90.4 ± 16.1, P = NS). In these states, a greater percentage of IVCF recipients were older than 85 (15.3% vs 11.8%; P < .01); fewer were pediatric (0.3% vs 0.7%; P < .05) or aged 45 to 64 (26.1% vs 32.4%; P < .001). There were no differences in patient sex, race, insurance type, hospital size, or teaching status. States with high rates of IVCF per DVT were noted to have significantly greater rates of paid malpractice claims per 100K (4.9 ± 2.51 vs 1.1 ± 0.8; P = .001), and annual general surgeon liability insurance premiums ($78,630 ± 34,822 vs $43,989 ± 17,794; P < .05). Variation in IVCF use is incompletely explained by clinical factors. High rates of IVCF per DVT in some states may represent increased use of prophylactic IVCF in states with litigious medicolegal environments.

The Demography of Medical Malpractice Suits against Radiologists

To delimit demographic characteristics of malpractice claims against radiologists in the United States by sex and location and to note the varying percentages of favorable outcomes and award amounts to plaintiffs by state. This HIPAA-compliant study was institutional review board-approved. All radiologists enrolled in One-Call Medical, a specialized preferred provider organization, go through an initial and recurrent credentialing process, which records state of residence, age, sex, and malpractice history. For each radiologist, a record of unfavorable outcomes and payment awards is derived from narratives provided by the National Practitioner's Data Bank. All other suits are self-reported. Rates of malpractice claims per state were calculated with a zero-inflated negative binomial regression model allowing for differences in years at risk. Poisson regression was used to calculate the incidence rate ratio (IRR) for any payment as a result of a malpractice claim compared with the average of all 36 states, adjusted for sex. To determine the association of age, sex, and state with amount of payment, we used a general linear model assuming a gamma family distribution. In August 2010, 8401 radiologists from 47 states composed One-Call Medical's panel. During their careers, 30.9% (2600 of 8401) had been the subject of at least one malpractice claim. Median payment awards varied by 14-fold from Maine ($350 000) to Colorado ($24 105), while mean payments varied ninefold from Oregon ($715 707) to Nebraska ($74 373). Adjusted for age and state, radiologists in Alabama had the lowest rate of malpractice suits per 100 practice-years for men (0.95; 95% confidence interval [CI]; 0.73, 1.28) and women (0.70; 95% CI: 0.52, 0.96) compared with those in New York, who had the highest rate of suits for men (5.65; 95% CI: 5.09, 6.26) and women (4.13; 95% CI: 3.54, 4.80). Overall, male radiologists had a higher rate of being sued than did their female counterparts (IRR = 1.37; 95% CI: 1.20, 1.56). The likelihood of a radiologist being the defendant in at least one suit is 50% by age 60, yet the difference in frequency and average number of suits accrued varies widely by state of residence and sex. Among resolved suits, the percentage of cases in which payment was made to the plaintiff differs markedly by state, as do median and mean award amount. Men are more likely than women to be sued during the course of their careers.

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.

Currents in contemporary bioethics. Health care reform and medical malpractice claims.

The seemingly interminable debates about health care reform in the last few years have focused mainly on health care access, quality, and cost. Debates on the medical malpractice component of the issue have focused almost entirely on cost. The familiar arguments in favor of limiting liability include the financial and health costs of defensive medicine; decreased physician supply in certain specialties and geographic areas; excessive awards; and high transaction costs, including attorney and expert witness fees. The equally familiar arguments in favor of maintaining tort liability include the need to promote civil justice, deter substandard care, identify incompetent practitioners, and encourage systemic quality improvement.Numerous studies have explored the possible effects of damage caps and other measures on malpractice premiums, health care costs, and other financial endpoints. One relatively under-examined aspect of the issue is how federal legislation expanding access to health care might alter the number of medical malpractice claims. With the enactment of the Patient Protection and Affordable Care Act of 2010 (PPACA), it is especially appropriate to consider what effect, if any, the new law will have on the rate of medical malpractice claims.

Assessing Legislative Potential to Institute Error Transparency: A State Comparison of Malpractice Claims Rates

The prevalence of medical errors and malpractice claims has been attributed to deficits in error reporting and disclosure. Increasingly, states are adopting error reporting and apology laws to reduce these information gaps thereby instituting error-transparent medical cultures. At the same time, doubts have been expressed about the capacity for legislation to influence medical professionals. In order to assess legislative potential to establish error transparency, a cross-sectional research design compared differences in malpractice claim rates among states adopting different legislative approaches. Two one-way analysis of variance tests were performed. The first analysis indicated that there are no significant mean differences in claims rates between states enacting only an apology law, only an error reporting law, both laws, and neither law, F (3,47)=1.13, p=.34. The second analysis indicated that there are no significant mean differences in claims rates between states enacting both laws, either law, and neither law, F (2,48)=1.08, p=.35. The findings show that legislation does not have a significant capacity to regulate malpractice claims rates. This suggests that laws governing error transparency are too remote from the delivery of healthcare services to regulate disclosure behavior and that fundamental changes in our medical culture should be initiated at an organizational level.

Medical Malpractice in Gastroenterology

Gastroenterologists commonly perceive themselves to be at increased legal risk because they perform invasive procedures. However, there is little published information about gastroenterology (GI) malpractice claims. The goal of this study was to evaluate available malpractice claim data within GI. This study was a database analysis of GI claims submitted by insurance companies to the Physician Insurers Association of America Data Sharing Project from January 1, 1985, to December 31, 2005. Another analysis from 2005 compared GI claims with other subspecialties. Sixty-six percent of physicians involved in claims had previous claims experience. The most common reasons for claims were errors in diagnosis (28%) and improper performance of a procedure (25%). Seventy-two percent of reported closed claims were settled out of court. Of 12,367 total claims in 2005, only 233 (1.8%) were within GI. GI ranked below other procedurally based subspecialties in numbers of claims per physician. GI does not rank highly among subspecialties in malpractice claims and only a minority of claims are procedure-related. Physicians with claims experience are likely to have further claims against them and should consider evaluating their practices.

Cultures of Claiming: Local Variation in Malpractice Claim Frequency

Several studies have examined rates of malpractice claims at state levels, but there is little systematic work looking at variations of claiming rates within a state. This study reports on small‐area variations in malpractice claim rates within New York State over a 14‐year period. Counties with high rates generally had high rates over the entire period, while counties with low rates maintained low rates. Rates across counties varied considerably, with an almost five‐times difference between the rates for the lowest county and the highest county. In a multivariate analysis using claim data from five years, we found median family income was one of the strongest factors positively associated with the claim rate. A measure of the risk of hospital admissions for an adverse outcome also had a strong association with the county's malpractice claim rate, but the risk factor was negatively associated with high claim rates, perhaps suggesting an association with quality of care and malpractice claims.

Cultures of Claiming: Local Variation in Malpractice Claim Frequency

While several studies have examined rates of malpractice claims at state levels, there is little systematic work looking at variations of claiming rates within a state. This study reports on small area variations in malpractice claims rates within New York State over a 14 year period. Counties with high rates generally had high rates over the entire period, while counties with low rates maintained low rates. Rates across counties varied considerably, with an almost 5 times difference between the rates for the lowest county and the highest county. In a multivariate analysis of potential factors influencing a county's rate, median family income was one of the strongest factors positively associated with the claims rate. A measure of the risk of hospital admissions for an adverse outcome also had a strong association with the county's malpractice claims rate, but the risk factor was negatively associated with high claims rates, perhaps suggesting an association with quality of care and malpractice claims. The number of lawyers per capita was weakly, but positively, associated with the claims rate.