Research
Professional and legal issues
Malpractice
Many believe that our current medical liability system is broken, citing issues such as rising medical malpractice premiums, untimely and inequitable compensation for truly injured patients, and the questionable impact that litigation has on health care quality, cost, and access to care. While research has been conducted on many different aspects of medical malpractice, it is uneven, and has often resulted in mixed findings. In general, the majority of empirical research has either been conducted in aggregate or has focused on a small number of medical specialties which are viewed as having the highest level of risk for malpractice suits; these specialties include surgery, obstetrics and gynecology, radiology and emergency medicine. Therefore, we do not really have a clear understanding of how our current medical liability system is impacting primary care specialties such as internal medicine, family practice, or pediatrics.
CHPPR’s research in this area began by looking at the occurrence, frequency, types and results of malpractice claims involving pediatricians. The initial findings were published in Pediatrics in an article entitled “Malpractice Claims Involving Pediatricians: Epidemiology and Etiology.” This project utilized data from the Physician Insurers Association of America (PIAA), a trade association of medical malpractice insurance companies. Although this database is not universally comprehensive, it does contain information not available in other sources such as the National Practitioner Data Bank. This includes data such as information on claims that are not ultimately paid, and specialty of the defendant. During a 20-year period (1985–2005), there were 214,226 closed claims reported to the PIAA data-sharing project. Pediatricians accounted for 2.97% of these claims, making it 10th among the 28 specialties in terms of the number of closed claims. Pediatrics ranks 16th in terms of indemnity payment rate (28.13%). The mean indemnity payment for pediatrics between 1985 and 2005 was $261,263 with a median payment amount of $100,000, making it the seventh highest out of the 28 specialties. These data also demonstrated that indemnity payments have been steadily increasing over time for pediatrics. Using 2005 dollar values, the mean indemnity paid in 1985 was $232,987 with a median payment of $65,287. This had increased to a mean indemnity payment of $395,997 in 2005 and a median payment of $270,000. Only 5% of claims went to verdict, and only 20% of those claims (1% of claims overall) resulted in a verdict for the plaintiff. The most common medical misadventure cited for pediatric claims was error in diagnosis, followed by no medical misadventure. It is important to note, however, that significantly less of the no medical misadventure cases (only 6% of them) are actually paid.
We are currently working with PIAA to perform a similar analysis for the other primary care specialties of internal medicine and family practice. We are also currently planning a more targeted analysis looking at claims labeled as having “no medical misadventure” in the PIAA database. In the future, we hope to expand our work in this area by focusing on the economic impact of defensive medicine practices, and the impact of malpractice fears on physician satisfaction.
Publications:
Carroll AE, Buddenbaum J. “Malpractice Claims involving Pediatricians: Epidemiology and Etiology.” Pediatrics, 2007; 120(4): 10-7.
