Australian Doctors’ Fund Blog

Claims, Errors, and Compensation Payments in Medical Malpractice Litigation

March 7th, 2009

Full Article: http://content.nejm.org/cgi/reprint/354/19/2024.pdf

The new england journal of medicine 2024 n engl j med 354;19 www.nejm.org may 11, 2006
Claims, Errors, and Compensation Payments in Medical Malpractice Litigation
David M. Studdert, LL.B., Sc.D., M.P.H.,
Michelle M. Mello, J.D., Ph.D., M.Phil.,
Atul A. Gawande, M.D., M.P.H., Tejal K. Gandhi, M.D., M.P.H.,
Allen Kachalia, M.D., J.D., Catherine Yoon, M.S.,
Ann Louise Puopolo, B.S.N., R.N., and
Troyen A. Brennan, M.D., J.D., M.P.H.

Abstract
From the Harvard School of Public Health (D.M.S., M.M.M., A.A.G., A.L.P., T.A.B.), Brigham and Women’s Hospital (A.A.G., T.K.G., A.K., C.Y., T.A.B.), and the Harvard Risk Management Foundation (A.L.P.- all in Boston. Address reprint requests to Dr. Studdert at the Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02115, or at studdert@ hsph.harvard.edu. N Engl J Med 2006;354:2024-33. Copyright © 2006 Massachusetts Medical Society.

Background
In the current debate over tort reform, critics of the medical malpractice system charge that frivolous litigation - claims that lack evidence of injury, substandard care, or both - is common and costly.

Methods
Trained physicians reviewed a random sample of 1452 closed malpractice claims from five liability insurers to determine whether a medical injury had occurred and, if so, whether it was due to medical error. We analyzed the prevalence, characteristics, litigation outcomes, and costs of claims that lacked evidence of error.

Results
For 3 percent of the claims, there were no verifiable medical injuries, and 37 percent did not involve errors. Most of the claims that were not associated with errors (370 of 515 [72 percent]) or injuries (31 of 37 [84 percent]) did not result in compensation; most that involved injuries due to error did (653 of 889 [73 percent]). Payment of claims not involving errors occurred  less frequently than did the converse form of inaccuracy - nonpayment of claims associated with errors. When claims not involving errors were compensated, payments were significantly lower on average than were payments for claims involving errors ($313,205 vs. $521,560, P = 0.004).
Overall, claims not involving errors accounted for 13 to 16 percent of the system’s total monetary costs. For every dollar spent on compensation, 54 cents went to administrative expenses (including those involving lawyers, experts, and courts). Claims involving errors accounted for 78 percent of total administrative costs.

Conclusions
Claims that lack evidence of error are not uncommon, but most are denied compensation. The vast majority of expenditures go toward litigation over errors and payment of them. The overhead costs of malpractice litigation are exorbitant.

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Full Article: http://content.nejm.org/cgi/reprint/354/19/2024.pdf

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