The Risk of Medical Liability
Abstract & Commentary
The Risk of Medical Liability
By Michael H. Crawford, MD, Editor
Source: Mangalmurti S, et al. Medical professional liability risk among US cardiologists. Am Heart J 2014;167:690-696.
Medical professional liability studies most often use aggregated data across all physicians in a specialty and lack data on those who were not sued. Thus, this study focuses on individual physician data using all liability claims from a large nationwide insurer from 1991-2005. They report the risk of a claim against cardiologists, the characteristics of lawsuits, their likelihood of success, and the associated defense costs. They analyzed closed claims against more than 40,000 physicians, including 781 cardiologists. The annual risk of a claim against a cardiologist was 8.6% vs 7.4% for all physicians (P < 0.01). Of 530 claims against cardiologists, 14% resulted in payments to the plaintiffs averaging $165,000 and defense costs averaging $84,000. Patient death accounted for 304 of the 530 claims (57%) and most of the plaintiffs were inpatients (72%). Also, most of the patients had cardiovascular disease (78%) with acute coronary syndrome being frequent, but 13% were for non-cardiovascular conditions, including mechanical falls and failure to diagnose cancer. The authors concluded that the rates of lawsuits against cardiologists are higher than other physicians and that a significant minority of them are for noncardiovascular issues.
Commentary
Although there are several recent studies on malpractice claims against cardiologists, the strengths of this study are the large database from one of the largest insurers of physicians in the country and the clinical data available. Perhaps the most surprising result is the significant number of claims against cardiologists for noncardiovascular disease issues (13% of total claims). Also, these claims were more likely to result in indemnity payments and high defense costs. In addition, almost half of these claims were for mechanical falls while under the care of the cardiologist (2.3%) or failed cancer diagnosis (2.5%). One limitation of this study is that we don’t know if the cardiologist was one of many physicians sued and whether they were later dropped. However, it appears that in many cases the cardiologist was acting as the patient’s primary care doctor. This is probably not a good idea.
Among the cardiovascular (CV) disease-related claims, acute coronary syndromes (ACS) were the most frequent; 44% overall and two-thirds of the CV claims. This is not surprising and has been shown in other studies. However, ACS cases are least likely to result in an indemnity payment (7%) and are among the lowest average payments ($213,000). Unfortunately, they took the longest time to resolve on average, which has time and emotional costs for the defendant.
The remainder of the claims fall into three groups. First is a claim involving procedures, surgery, or cardiopulmonary resuscitation (about 10%). One of these is negligent preoperative clearance, which amounted to 6% of overall claims. It is my practice to never "clear" patients for surgery, but rather to give the surgeons my estimate of the patient’s risk of a major CV event (death, MI, cardiac arrest). The surgeons then need to add this to the other risks of the procedure and make their own decision about whether to operate. Second are claims involving cardiac medications (5%), which mainly involve bleeding complications and acute kidney injury. Third is failure to diagnose aortic dissection or aneurysm. Other failed diagnoses involve the misreading of ECGs or echocardiograms (1.3%) and missed pulmonary embolism (0.9%).
Although this study involves only one large insurance carrier and ended in 2005, because of the time it takes to resolve medical malpractice cases, it is probably fairly representative of today’s claims activity. The lessons to be learned are don’t practice outside your specialty, resist diagnostic complacency, and beware of medication adverse effects.
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