Medical Malpractice: Causes and Outcomes of Claims Against Hospitalists

1Brigham and Women's Hospital, Harvard Medical School, Boston, MA
2CRICO/Risk Management Foundation of the Harvard Medical Institutions, Cambridge, MA
3CRICO/Risk Management Foundation of the Harvard Medical Institutions, Cambridge, MA
4Brigham and Women's Hospital, Harvard Medical School, Boston, MA

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 517

Background:

Information on the types and causes of medical malpractice claims may help to reduce legal malpractice risk and inform patient safety efforts. Research has shown that the most common medical malpractice allegations include missed and delayed diagnoses and medication‐ and treatment‐related injuries and that an estimated 22%–56% of claims receive payment. However, no published research exists on the types and outcomes of medical malpractice claims made against hospitalists in the United States. We sought to identify the types, contributing factors, and outcomes of liability claims against hospitalists.

Methods:

We conducted a retrospective observational analysis. Using a medical liability carrier–maintained database of more than 30,000 closed claims covering all medical specialties (and including academic medical centers, community hospitals, and private physician groups across the United States), we identified the claims in which a hospitalist was the attending of record. We analyzed these claims to ascertain the main allegation, contributing factors, and outcomes.

Results:

We identified 272 claims; these claims covered the period from 1997 to 2011. The mean age of the claimants was 56 years (SD, 22 years). Claimants were 51.8% female and 44.5% male (data not available for 3.7%). The most common claims were related to allegations of errors in medical treatment (n = 113, 41.5%), diagnosis (n = 98, 36.0%), and medication use (n = 26, 9.6%); see Table 1. The most common factors contributing to the claims were issues relating to clinical judgment (n = 148, 54.4%), communication (n = 99, 36.4%), and documentation (n = 53, 19.5%); see Table 2. Payment was made on 32.0% (n = 87) of all claims. The mean payment amount on the claims paid was $367,863.

Conclusions:

The types of liability claims asserted against hospitalists appear to be generally similar to claims for all physicians, suggesting that hospitalists may not be subject to different types of legal risk compared with other physicians. Efforts directed at supporting and improving clinical judgment and communication may potentially reduce the liability risk for hospitalists.

Table 1.Types of Claims Asserted in Hospitalist Medical Malpractice Cases (n = 272)



Allegation No. of Cases % of Cases Definition orEexample
Error in medical treatment 113 41.5 Improper management or treatment course; failure to treat or a delay in treatment
Missed or delayed diagnosis 98 36.0 Failure to order a diagnostic test
Medication-related error 26 9.6 Incorrect medication regimen; ordering the wrong medication or wrong dose of medication
Inadequate monitoring 12 4.4 Inadequate monitoring of patient's physiological status
Error in surgical treatment 9 3.3 Error in management during or after surgery

Table 2.Contributing Factors in Hospitalist Medical Malpractice Cases* (n = 272)



Contributing factor No. of Cases % of Cases Definition or Example
Clinical judgment 148 54.4 Problems with patient assessment or choice of therapy; failure/delay in obtaining consult/referral
Communication 99 36.4 Issues with communication among clinicians or between the clinicians and the patient or family
Documentation 53 19.5 Insufficient or lack of documentation
Administrative 47 17.3 Problems with staffing or hospital policies and protocols
Clinical systems 44 16.2 Failure or delay in scheduling a recommended test or failure to identify the provider coordinating care
Patient adherence 28 10.3 Patient not following provider recommendations; seeking other providers due to dissatisfaction with care
*An individual case may have multiple contributing factors.

To cite this abstract:

Schaffer A, Raman S, Puopolo A, Kachalia A. Medical Malpractice: Causes and Outcomes of Claims Against Hospitalists. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 517. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/medical-malpractice-causes-and-outcomes-of-claims-against-hospitalists/. Accessed December 15, 2019.

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