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PubMed2005

Governmental studies on medical malpractice: the implications of rising premiums for healthcare and the allocation of health resources.

The United States may or may not be facing a "malpractice crisis" which can result in a loss of quality of medical care in certain specialties by virtue of non-performance or the exiting of certain physicians from certain high-risk specialties due to increases in premiums. Various studies have been performed by various governmental agencies on a federal level in the United States. The Department of Legal Medicine, part of the Armed Forces Institute of Pathology, began collecting veteran's affairs medical malpractice claims data and extracting information from the analysis from medical records and associated documents. During the 1993 fiscal year, 801 medical malpractice claims were filed against the Department of Veteran's Affairs. The Department of Veteran's Affairs had approximately 125,000 hospital discharges and 26 million outpatient visits during the same time period. The rate of claims per hospital discharge was less than 1/ 1000 hospital patient discharges (.864/1000). Subsequent to that report, several other reports have been issued including a report on medical malpractice insurance generated by the General Accounting Office in 2003, some ten years later. More recently, a report of medical malpractice having implications on rising premiums on and access to health care generated by the General Accounting Office was released in August of 2003. This paper will demonstrate areas of concern with regard to the area of medical malpractice as well as incidence of medical malpractice and claims upon the insurance industry, medical specialties and the impact upon the community generally in the United States.

Federal Government↗
PubMed1995

Maternity care in family medicine: economics and malpractice.

BACKGROUND: The number of family physicians delivering babies in Florida in 1991 was at an all-time low. Concerns about malpractice risk and insurance costs have resulted in only 2% of Florida's family practice residency graduates choosing to deliver babies. The purpose of this study was to compare the practices of family physicians in Florida who delivered babies in private practice (termed the "OB group") with those who did not (the "non-OB group"). METHODS: A potential study group of 293 family physicians was mailed an extensive survey that explored 132 variables related to medical practice economics and demographics, lifestyle and satisfactions, and malpractice costs and risks. RESULTS: The obstetrical (OB) group was significantly more likely than the non-OB group to perform a variety of procedures and report more patients under age 6 years (15% vs 5%; P = .003) and fewer patients 65 years or older (19% vs 33%; P < .001). Even though the number of patients seen and the number of hours worked were similar, the 1991 incomes were much higher for those practicing maternity care (mean = $164,000 vs $104,000; P = .04). Compared with the non-OB group, the OB group was more likely to report that their financial and psychological compensation was adequate (P < .001), would be more likely to choose medicine as a profession again (94% vs 60%, P < .05), paid more for malpractice insurance (mean = $22,000 vs $11,000; P = .01), and reported 30% fewer nonobstetrical malpractice claims. CONCLUSIONS: Family physicians in Florida who deliver babies, as compared with those who do not, are more likely to report (1) increased financial and psychological satisfaction for the same hours worked; (2) increased satisfaction with medicine and family practice; (3) more frequent performance of a wider range of procedures; (4) younger practices serving a greater number of complete families and fewer Medicare patients; (5) a more diverse and comprehensive hospital and office practice; and, despite paying significantly higher malpractice insurance premiums, (6) few obstetrical malpractice claims and lawsuits, and (7) fewer nonobstetrical malpractice claims and lawsuits.

Chi-Square Distribution↗
PubMed2005

Emergency physicians' fear of malpractice in evaluating patients with possible acute cardiac ischemia.

STUDY OBJECTIVE: We evaluate the association between emergency physicians' fear of malpractice and the triage and evaluation patterns of patients with symptoms suggestive of acute coronary syndrome. METHODS: We surveyed 33 emergency physicians of 2 university hospitals during the preintervention phase of an implementation trial of the Agency for Health Care Policy and Research Unstable Angina guideline in 1,134 study patients. The survey included a 6-item instrument that addressed concerns about malpractice and a measure of general risk aversion. We used hierarchical logistic regression to model emergency department (ED) triage decisions and diagnostic testing as a function of fear of malpractice, with adjustment for patient characteristics, Agency for Health Care Policy and Research guideline risk group, study site, and clustering by emergency physician. RESULTS: Overall, emergency physicians in the upper tertile of malpractice fear were less likely to discharge low-risk patients compared with emergency physicians in the lower tertile (adjusted odds ratio [OR] 0.34; 95% confidence interval [CI] 0.12 to 0.99; P=.05). Patients treated by emergency physicians in this group were also more likely to be admitted to an ICU or telemetry bed (adjusted OR 1.7; 95% CI 1.2 to 2.4). In addition, emergency physicians in the upper tertile of malpractice fear were more likely to order chest radiography, as well as cardiac troponin. Malpractice fear accounted for a similar amount of variance after controlling for emergency physicians' risk aversion. CONCLUSION: Malpractice fear accounts for significant variability in ED decisionmaking and is associated with increased hospitalization of low-risk patients and increased use of diagnostic tests.

Adult↗
PubMed1997

Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons.

OBJECTIVE: To identify specific communication behaviors associated with malpractice history in primary care physicians and surgeons. DESIGN: Comparison of communication behaviors of "claims" vs "no-claims" physicians using audiotapes of 10 routine office visits per physician. SETTINGS: One hundred twenty-four physician offices in Oregon and Colorado. PARTICIPANTS: Fifty-nine primary care physicians (general internists and family practitioners) and 65 general and orthopedic surgeons and their patients. Physicians were classified into no-claims or claims (> or =2 lifetime claims) groups based on insurance company records and were stratified by years in practice and specialty. MAIN OUTCOME MEASURES: Audiotape analysis using the Roter Interaction Analysis System. RESULTS: Significant differences in communication behaviors of no-claims and claims physicians were identified in primary care physicians but not in surgeons. Compared with claims primary care physicians, no-claims primary care physicians used more statements of orientation (educating patients about what to expect and the flow of a visit), laughed and used humor more, and tended to use more facilitation (soliciting patients' opinions, checking understanding, and encouraging patients to talk). No-claims primary care physicians spent longer in routine visits than claims primary care physicians (mean, 18.3 vs 15.0 minutes), and the length of the visit had an independent effect in predicting claims status. The multivariable model for primary care improved the prediction of claims status by 57% above chance (90% confidence interval, 33%-73%). Multivariable models did not significantly improve prediction of claims status for surgeons. CONCLUSIONS: Routine physician-patient communication differs in primary care physicians with vs without prior malpractice claims. In contrast, the study did not find communication behaviors to distinguish between claims vs no-claims surgeons. The study identifies specific and teachable communication behaviors associated with fewer malpractice claims for primary care physicians. Physicians can use these findings as they seek to improve communication and decrease malpractice risk. Malpractice insurers can use this information to guide malpractice risk prevention and education for primary care physicians but should not assume that it is appropriate to teach similar behaviors to other specialty groups.

Colorado↗
PubMed2005

Impact of malpractice reforms on the supply of physician services.

CONTEXT: Proponents of restrictions on malpractice lawsuits claim that tort reform will improve access to medical care. OBJECTIVE: To estimate the effects of changes in state malpractice law on the supply of physicians. DESIGN: Differences-in-differences regression analysis that matched data on the number of physicians in each state between 1985 and 2001 from the American Medical Association's Physician Masterfile with data on state tort laws and state demographic, political, population, and health care market characteristics. MAIN OUTCOME MEASURE: Effect on physician supply of "direct" malpractice reforms that reduce the size of awards (eg, caps on damages). RESULTS: The adoption of "direct" malpractice reforms led to greater growth in the overall supply of physicians. Three years after adoption, direct reforms increased physician supply by 3.3%, controlling for fixed differences across states, population, states' health care market and political characteristics, and other differences in malpractice law. Direct reforms had a larger effect on the supply of nongroup vs group physicians, on the supply of most (but not all) specialties with high malpractice insurance premiums, on states with high levels of managed care, and on supply through retirements and entries than through the propensity of physicians to move between states. Direct reforms had similar effects on less experienced and more experienced physicians. CONCLUSION: Tort reform increased physician supply. Further research is needed to determine whether reform-induced increases in physician supply benefited patients.

Compensation and Redress↗
PubMed1994

Malpractice in pediatric radiology: a survey in the United States and Canada.

A survey of the chairmen of pediatric radiology departments in children's hospitals in Canada and the United States was undertaken to gain data on the subject of malpractice in pediatric radiology. Sixty-two members of the Society of Chairmen of Radiology in Children's Hospitals (SCORCH) were surveyed. Forty-two surveys (65%) were returned for analysis. Malpractice premiums paid per pediatric radiologist per year ranged from $499-$29,000 (mean $8,630). Twenty-eight malpractice claims were reported from 1980 to 1992. The largest number of claims involved gastrointestinal/abdomen and chest examinations, areas that were perceived as low risk by the respondents. The incidence of lawsuits against pediatric radiologists in the midwest was statistically higher compared to Canada (p < 0.05). Private practice models had a statistically greater incidence of malpractice suits compared to university practice models (p < 0.04). No statistical difference between the number of malpractice suits and the number of examinations performed per year or the number of pediatric radiologists in the group was found. We concluded that pediatric radiologists run the risk of malpractice claims. This data may aid in lessening this risk in the future.

Analysis of Variance↗
PubMed1995

Physician malpractice: does the past predict the future?

OBJECTIVE: To assess whether there is a population of physicians who have consistently poor malpractice claims experiences over time. DESIGN: Retrospective cohort study. POPULATION: 12,730 physicians insured in New Jersey from 1977 to 1991. MAIN OUTCOME MEASURES: After adjusting for specialty, the physicians were grouped according to who had the highest, very high, and high rates of malpractice claims, approximating 1%, 5%, and 10% respectively, of the insured population. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated comparing the physicians in these high-risk categories with the other physicians. RESULTS: Of the 55 physicians who had the highest malpractice claims rates during the first four years, two (3.6%) were in the highest group during the subsequent three years (OR 2.8; 95% CI 0.7 to 10.8), five (9.1%) were in the very high group (OR 2.0; 95% CI 0.7 to 5.3), and 11 (20%) were in the high group (OR 2.3; 95% CI 1.1 to 4.6). Of the 260 physicians in the very high group during the first four years, 11 (4.2%) were in the highest group during the subsequent three years (OR 3.6; 95% CI 1.8 to 6.4), 26 (10.0%) were in the very high group (OR 2.3; 95% CI 1.5 to 3.6), and 46 (17.7%) were in the high group (OR 2.0; 95% CI 1.4 to 2.8). Of the 947 physicians in the high group during the first four years, 24 (2.5%) were in the highest group during the subsequent three years (OR 2.3; 95% CI 1.4 to 3.7), 62 (6.6%) were in the very high group (OR 1.5; 95% CI 1.1 to 1.9), and 118 (12.5%) were in the high group (OR 1.3; 95% CI 1.1 to 1.6). Similar results were found when using awards as the outcome. CONCLUSIONS: Most physicians who have high malpractice rates during their first four years improve over time. Physicians who have high rates of malpractice during one period should not be subjected to disciplinary action. However, carefully evaluating physicians who consistently have high rates of malpractice during two periods may represent an effective strategy for identifying problem physicians.

Cohort Studies↗
PubMed1992

Medical malpractice: a nonadversarial suggestion.

BACKGROUND: The current legal system for prosecuting medical malpractice claims has bred widespread discontent. It has increased costs, jeopardized the delivery of necessary medical services, and corroded the physician-patient relationship with mistrust and poor morale. METHODS: Analysis of fairness of compensation awards and deterrence of substandard medical services under the current system. RESULTS: Compensation awards are inconsistent and unfairly contingent on irrational, adventitious factors. The current system does not seem to have had a significant effect on detering poor medical practice or on improving medical practice in general. CONCLUSIONS: An alternative to the current litigation-oriented medical malpractice system should be established and centered around a four-member Medical Malpractice Tribunal composed of a general physician, an expert physician in the specialty area of the claim, an attorney, and a lay person. This tribunal would be empowered to investigate malpractice claims by gathering evidence and taking testimony from parties, experts, and witnesses. The tribunal could employ a table of treatment-related injuries in making findings as to physician liability and victim compensation. Such a system, through predictability, would likely increase malpractice prevention while decreasing legal costs and also costs associated with defensive medicine. Deterrence could be served by giving the tribunal power to recommend sanctions against substandard providers to appropriate licensing and disciplinary bodies and by requiring those found guilty of malpractice to contribute subsidies to a compensation fund.

Insurance, Liability↗
PubMed2005

The relation of patient satisfaction with complaints against physicians and malpractice lawsuits.

PURPOSE: A small number of physicians generate a disproportionate share of complaints from patients and of malpractice lawsuits. If these grievances relate to patients' dissatisfaction with care, it might be possible to use commonly distributed patient satisfaction surveys to identify physicians at high risk of complaints from patients and of malpractice lawsuits. We sought to examine associations among patients' satisfaction survey ratings of physicians' performance and complaints from patients, risk management episodes, and rates of malpractice lawsuits. SUBJECTS AND METHODS: We examined 353 physicians at a large US teaching hospital whose inpatient performance was rated by 10 or more patients between January 1, 2001, and March 31, 2003. Physicians were divided into 3 tertiles according to satisfaction on a commercial survey instrument administered to recently discharged patients. Records of unsolicited complaints from patients (January 1, 2000, to March 31, 2003) and risk management episodes (January 1, 1983, to March 31, 2003) were analyzed after adjusting for the physician's specialty and panel characteristics of the physician's patients. RESULTS: Decreases in physicians' patient satisfaction survey scores from the highest to the lowest tertile were associated with increased rates of unsolicited complaints from patients (200 vs 243 vs 492 complaints per 100,000 patient discharges; P <0.0001) and risk management episodes (29 vs 43 vs 56 risk management episodes per 100,000 patient discharges; P = 0.007). Compared with physicians with the top satisfaction survey ratings, physicians in the middle tertile had malpractice lawsuit rates that were 26% higher (rate ratio [RR] = 1.26; 95% confidence interval [CI]: 0.72 to 2.18; P = 0.41), and physicians in the bottom tertile had malpractice lawsuit rates that were 110% higher (RR = 2.10; 95% CI: 1.13 to 3.90; P = 0.019). CONCLUSION: Patient satisfaction survey ratings of inpatient physicians' performance are associated with complaints from patients and with risk management episodes. Commonly distributed patient satisfaction surveys may be useful quality improvement tools, but identifying physicians at high risk of complaints from patients and of malpractice lawsuits remains challenging.

Adult↗
PubMed2004

Malpractice--role of the forensic pathologist in Germany.

Medicolegal malpractice assessments have been an important part of the work of forensic pathologists. Not only botchers are concerned but also physicians of all clinical subjects, especially malpractice charges claiming a malpractice leading to death. Single long articles and book chapters have been published about malpractice assessments since the end of the 17th century by forensic pathologists. After World War II systematic studies of malpractice charges first were published in the 1960s. Meanwhile the attention focuses more and more on the role of forensic pathologists to help in prevention of malpractice.

Forensic Pathology↗
PubMed2003

Does full disclosure of medical errors affect malpractice liability? The jury is still out.

BACKGROUND: Mandatory disclosure of medical errors has been advocated to improve patient safety. Many resist mandatory disclosure policies because of concerns about increasing malpractice exposure. It has been countered that malpractice liability actually decreases when there is full disclosure of medical errors. A comprehensive literature search was conducted to determine what is known about the impact of full disclosure on malpractice liability. METHODS: Electronic searches of multiple databases were supplemented with hand searches of bibliographies and communication with recognized experts in the field. RESULTS: Screening the titles, abstracts, and, in many cases, the full articles from more than an estimated 5,200 citations resulted in identification of one published study directly examining malpractice liability when a policy of full disclosure was implemented. DISCUSSION: Despite extensive literature on the impact of disclosure on malpractice liability, few well-designed studies have focused on the real-world impact on the volume and cost of suits following implementation of a full disclosure policy. Many articles examine why patients sue their doctors, suggesting that some lawsuits may be averted by disclosure, but the articles do not allow us to estimate the additional suits that would be created by disclosure. Additional studies addressing the effect of disclosure on malpractice liability are needed.

Compensation and Redress↗
PubMed2000

Medical malpractice among physicians: who will be sued and who will pay?

This paper examines whether a physician's future claims of medical malpractice are predictable from information on the physician's recent claims history, training credentials, practice characteristics, and demographics. Data on the medical malpractice experience of 8,733 Michigan physicians between 1980 and 1989 is analyzed. We find strong evidence of repetition over time regarding who was sued and who paid claims. The worse a physician's malpractice litigation record during 1980-1984, the worse was his record during 1985-1989. Training credentials were also highly predictive of future malpractice experience. Physicians trained at lower ranked medical schools or who went through lower-ranked residency programs faced higher odds of developing adverse malpractice records, even after controlling for their previous litigation record. Growing internet access to information on these characteristics will help inform prospective patients if they wish to avoid physicians likely to be sued and likely to make payments in the future for malpractice.

Adult↗
PubMed2003

Medical school attended as a predictor of medical malpractice claims.

OBJECTIVES: Following earlier research which showed that certain types of physicians are more likely to be sued for malpractice, this study explored (1). whether graduates of certain medical schools have consistently higher rates of lawsuits against them, (2). if the rates of lawsuits against physicians are associated with their school of graduation, and (3). whether the characteristics of the medical school explain any differences found. DESIGN: Retrospective analysis of malpractice claims data from three states merged with physician data from the AMA Masterfile (n=30288). STUDY SUBJECTS: All US medical schools with at least 5% of graduates practising in three study states (n=89). MAIN OUTCOME MEASURES: Proportion of graduates from a medical school for a particular decade sued for medical malpractice between 1990 and 1997 and odds ratio for lawsuits against physicians from high and low outlier schools; correlations between the lawsuit rates of successive cohorts of graduates of specific medical schools. RESULTS: Medical schools that are outliers for malpractice lawsuits against their graduates in one decade are likely to retain their outlier status in the subsequent decade. In addition, outlier status of a physician's medical school in the decade before his or her graduation is predictive of that physician's malpractice claims experience (p<0.01). All correlations of cohorts were relatively high and all were statistically significant at p<0.001. Comparison of outlier and non-outlier schools showed that some differences exist in school ownership (p<0.05), years since established (p<0.05), and mean number of residents and fellows (p<0.01). CONCLUSIONS: Consistent differences in malpractice experience exist among medical schools. Further research exploring alternative explanations for these differences needs to be conducted.

Education, Medical↗
PubMed1990

Malpractice in psychotherapy: an overview.

This paper gives a capsule review of the major issues on the subject of malpractice for individual practitioners of psychotherapy. It examines the elements necessary to support a malpractice claim and presents examples of cases in specific areas of liability. Historically, the field of psychotherapeutic malpractice was largely inactive. However, recent court rulings reveal that psychotherapists are no longer immune to malpractice suits. In decreasing order of the likelihood of the plantiffs being successful in their suits are cases involving the misuse of the therapeutic relationship, breach of confidentiality, and cases that involve prevention of harm to third parties and to patients themselves. Malpractice suits based on negligence in providing appropriate treatment are beginning to emerge and will probably increase in frequency as the efficacy of biological treatment is demonstrated. Available solutions to the problems of malpractice are discussed. It is suggested that in addition to the existing external sanctions, there is a need for consultation plus educational programs to enhance our ability to practice within the boundaries that the courts have set for us.

Confidentiality↗
PubMed2004

Nursing and midwifery malpractice in Turkey based on the Higher Health Council records.

Medical malpractice has attracted the attention of people and the media all over the world. In Turkey, malpractice cases are tried according to both criminal and civil law. Nurses and midwives in Turkey fulfill important duties in the distribution of health services. The aim of this study was to reveal the legal procedures followed in malpractice allegations and malpractice lawsuits in which nurses and midwives were named as defendants. We reviewed 59 nursing and midwifery lawsuits reported to the Higher Health Council between 1993 and 1998. Health professionals were held liable in 59% of the lawsuits. Midwives had the highest percentage of malpractice liability (52%), followed by physicians (29%) and nurses (19%). To reduce potential liability, nurse education should be improved, a nursing malpractice law should be enacted, and instructions for nursing procedures should be formulated.

Female↗
PubMed1995

Malpractice and radiologists in Cook County, IL: trends in 20 years of litigation.

OBJECTIVE: The purpose of this article is to report the prevalence and nature of malpractice litigation involving radiology over a 20-year period and to identify trends among types of lawsuits filed. By recognizing where medicolegal risks lie in radiology, risk-management processes can be developed to minimize malpractice exposure and to improve patient care. MATERIALS AND METHODS: We conducted a retrospective study of all malpractice lawsuits (18,860) filed against physicians in the greater Chicago area between January 1, 1975, and December 31, 1994. About twelve percent (2219) involved radiologic procedures or radiologists. These lawsuits were divided into six groups: slip-and-fall, radiation oncology, failure to order a radiologic examination, complications, missed diagnoses, and miscellaneous. The yearly percentage of each category relative to the total number of radiology-related suits was determined, and then each group was further divided by specific diagnosis or incident. RESULTS: Along with all medical malpractice lawsuits, radiology-related suits rose dramatically until 1985, when there was a marked but temporary decline caused by tort reform measures enacted in Illinois. Since then, lawsuits have resumed their annual upward climb, although the overall percentage related to radiology has remained relatively constant (10-15%). The relative number of radiology-related lawsuits in specific categories has changed over the past two decades: the percentages of slip-and-fall, radiation oncology, and miscellaneous cases have decreased, but percentages for the remaining three groups have increased. Lawsuits related to missed diagnoses, which account for the largest category of radiology-related cases, have increased from 34% to 47% of the total. The greatest increase in this category is for breast cancer. Lawsuits claiming injury from complications, the largest subgroup of which is angiography, have grown slightly, but cases alleging failure to order a radiologic examination have shown the greatest percentage increase in the 20-year period, growing from 20% in 1975-1979 to 30% in 1990-1994. This rise is attributed to the greater number of claims involving mammography, CT, MR imaging, and angiography. The growth in failure-to-order lawsuits will have important ramifications as managed care and health reform proposals attempt to limit use of radiologic services. CONCLUSIONS: Notwithstanding the fact that tort reform measures in Illinois decreased the frequency of malpractice litigation temporarily in 1985 and will likely do so again in 1995, medical malpractice is likely to continue to plague radiologists unabatedly for many years to come.

Chicago↗
PubMedDate not supplied

Malpractice: a perspective for physiotherapists.

A malpractice action--one aspect of the application of legal principles known as the law of torts--is a means whereby an injured party may seek compensation for harm caused by another party. The primary function of the law of torts is to determine whether the injurer is under a legal obligation to provide compensation to the injured for some loss due to negligent or faulty conduct. A malpractice action against a physiotherapist involves a plaintiff patient who has been injured, a defendant physiotherapist who stands accused of having caused an injury, and a determination as to whether or not the physiotherapist should bear the loss. In order to establish the liability in negligence, a plaintiff must satisfy four requirements: duty of care, breach of standard of care, causation, and damage. In this paper, a case study of malpractice action against a physiotherapist is outlined as an example of the type of arguments used by both the plaintiff and the defendant. Malpractice actions are an important means of controlling the standards of all health professionals. Because increasingly complicated technology and increased pressures on health care professionals are unlikely to reduce the number of accidents, the malpractice action will continue to provide recourse for those patients injured by lapses from the requisite standards of a profession. The threat of a malpractice action alone, however, is not enough to ensure high professional and ethical standards.

Canada↗
PubMed2002

Anticipating and controlling rising malpractice insurance costs.

The unprecedented proliferation of large jury awards and settlements in medical malpractice cases over the past few years is expected to continue in 2002 and beyond. As a result, most major malpractice insurance carriers have experienced a deterioration of their loss ratios. Malpractice insurance premiums have skyrocketed, and in some cases, carriers have withdrawn from markets. Healthcare providers are challenged by malpractice-insurance-related expenses. Although providers may find it difficult to negotiate malpractice premium price breaks over the next few years as carriers attempt to restore their profitability, there are some measures they can take to control their malpractice expenses, including selecting a knowledgeable agent or broker, self-insuring, preparing a high-quality renewal submission, reinforcing their commitment to patient safety, and paying attention to carrier financial ratings.

Cost Control↗