BACKGROUND AND METHODS. By matching the medical records of a random sample of 31,429 patients hospitalized in New York State in 1984 with statewide data on medical-malpractice claims, we identified patients who had filed claims against physicians and hospitals. These results were then compared with our findings, based on a review of the same medical records, regarding the incidence of injuries to patients caused by medical management (adverse events). RESULTS. We identified 47 malpractice claims among 30,195 patients' records located on our initial visits to the hospitals, and 4 claims among 580 additional records located during follow-up visits. The overall rate of claims per discharge (weighted) was 0.13 percent (95 percent confidence interval, 0.076 to 0.18 percent). Of the 280 patients who had adverse events caused by medical negligence as defined by the study protocol, 8 filed malpractice claims (weighted rate, 1.53 percent; 95 percent confidence interval, 0 to 3.2 percent). By contrast, our estimate of the statewide ratio of adverse events caused by negligence (27,179) to malpractice claims (3570) is 7.6 to 1. This relative frequency overstates the chances that a negligent adverse event will produce a claim, however, because most of the events for which claims were made in the sample did not meet our definition of adverse events due to negligence. CONCLUSIONS. Medical-malpractice litigation infrequently compensates patients injured by medical negligence and rarely identifies, and holds providers accountable for, substandard care.
Source Information
Center for Biostatistics and Epidemiology, Penn State University College of Medicine, Hershey 17033.
This article has been cited by other articles:
Pukk-Harenstam, K, Ask, J, Brommels, M, Thor, J, Penaloza, R V, Gaffney, F A
(2008). Analysis of 23 364 patient-generated, physician-reviewed malpractice claims from a non-tort, blame-free, national patient insurance system: lessons learned from Sweden. Qual Saf Health Care
17: 259-263
[Abstract][Full Text]
Barringer, P. J., Studdert, D. M., Kachalia, A. B., Mello, M. M.
(2008). Administrative Compensation of Medical Injuries: A Hardy Perennial Blooms Again. Journal of Health Politics, Policy and Law
33: 725-760
[Abstract]
Elliott, E. D., Narayan, S. A., Nasmith, M. S.
(2008). Administrative "Health Courts" for Medical Injury Claims: The Federal Constitutional Issues. Journal of Health Politics, Policy and Law
33: 761-798
[Abstract]
Aoki, N., Uda, K., Ohta, S., Kiuchi, T., Fukui, T.
(2008). Impact of miscommunication in medical dispute cases in Japan. Int J Qual Health Care
0: mzn028v1-5
[Abstract][Full Text]
Hayes, B.
(2008). Medical errors - a hospital in Nepal searches for answers. Trop Doct
38: 45-48
[Abstract][Full Text]
Morris, L. G. T., Ziff, D. J. S., DeLacure, M. D.
(2008). Malpractice Litigation After Surgical Injury of the Spinal Accessory Nerve: An Evidence-Based Analysis. Arch Otolaryngol Head Neck Surg
134: 102-107
[Abstract][Full Text]
Baicker, K., Fisher, E. S., Chandra, A.
(2007). Malpractice Liability Costs And The Practice Of Medicine In The Medicare Program. Health Aff (Millwood)
26: 841-852
[Abstract][Full Text]
Crosby, E.
(2007). Medical malpractice and anesthesiology: literature review and role of the expert witness: [Fautes medicales et anesthesiologie : revue de la litterature et role du temoin expert]. Canadian J. Anesthesia
54: 227-241
[Abstract][Full Text]
Studdert, D. M., Mello, M. M., Gawande, A. A., Brennan, T. A., Wang, Y. C.
(2007). Disclosure Of Medical Injury To Patients: An Improbable Risk Management Strategy. Health Aff (Millwood)
26: 215-226
[Abstract][Full Text]
Hellinger, F. J., Encinosa, W. E.
(2006). The Impact of State Laws Limiting Malpractice Damage Awards on Health Care Expenditures. Am. J. Public Health
96: 1375-1381
[Abstract][Full Text]
McLean, T. R.
(2006). Risk Management Observations From Litigation Involving Laparoscopic Cholecystectomy. Arch Surg
141: 643-648
[Abstract][Full Text]
Studdert, D. M., Mello, M. M., Gawande, A. A., Gandhi, T. K., Kachalia, A., Yoon, C., Puopolo, A. L., Brennan, T. A.
(2006). Claims, errors, and compensation payments in medical malpractice litigation.. NEJM
354: 2024-2033
[Abstract][Full Text]
Guirguis-Blake, J., Fryer, G. E., Phillips, R. L. Jr, Szabat, R., Green, L. A.
(2006). The US Medical Liability System: Evidence for Legislative Reform. Ann Fam Med
4: 240-246
[Abstract][Full Text]
Oyebode, F.
(2006). Clinical errors and medical negligence. Adv. Psychiatr. Treat.
12: 221-227
[Abstract][Full Text]
Duclos, C. W., Eichler, M., Taylor, L., Quintela, J., Main, D. S., Pace, W., Staton, E. W.
(2005). Patient perspectives of patient-provider communication after adverse events. Int J Qual Health Care
17: 479-486
[Abstract][Full Text]
Bhattacharyya, T., Yeon, H., Harris, M. B.
(2005). The Medical-Legal Aspects of Informed Consent in Orthopaedic Surgery. JBJS
87: 2395-2400
[Abstract][Full Text]
Baker, T.
(2005). Reconsidering the Harvard Medical Practice Study Conclusions about the Validity of Medical Malpractice Claims. J Law Med Ethics
33: 501-514
Robinson, P., Xu, X., Keeton, K., Fenner, D., Johnson, T. R. B., Ransom, S.
(2005). The Impact of Medical Legal Risk on Obstetrician-Gynecologist Supply. Obstet Gynecol
105: 1296-1302
[Abstract][Full Text]
Schmidek, J M, Weeks, W B
(2005). Relationship between tort claims and patient incident reports in the Veterans Health Administration. Qual Saf Health Care
14: 117-122
[Abstract][Full Text]
Bhattacharyya, T., Yeon, H.
(2005). "Doctor, Was This Surgery Done Wrong?" Ethical Issues in Providing Second Opinions. JBJS
87: 223-225
[Full Text]
Boxwala, A. A., Dierks, M., Keenan, M., Jackson, S., Hanscom, R., Bates, D. W., Sato, L.
(2004). Organization and Representation of Patient Safety Data: Current Status and Issues around Generalizability and Scalability. J. Am. Med. Inform. Assoc.
11: 468-478
[Abstract][Full Text]
Borrell-Carrio, F., Epstein, R. M.
(2004). Preventing Errors in Clinical Practice: A Call for Self-Awareness. Ann Fam Med
2: 310-316
[Abstract][Full Text]
Studdert, D. M., Yang, Y. T., Mello, M. M.
(2004). Are Damages Caps Regressive? A Study Of Malpractice Jury Verdicts In California. Health Aff (Millwood)
23: 54-67
[Abstract][Full Text]
Troyer, J. L., Thompson, H. G. Jr.
(2004). The Impact of Litigation on Nursing Home Quality. Journal of Health Politics, Policy and Law
29: 11-42
[Abstract]
Studdert, D. M., Mello, M. M., Brennan, T. A.
(2004). Medical Malpractice. NEJM
350: 283-292
[Full Text]
Schoenbaum, S. C., Bovbjerg, R. R.
(2004). Malpractice Reform Must Include Steps To Prevent Medical Injury. ANN INTERN MED
140: 51-53
[Abstract][Full Text]
Waters, T M, Lefevre, F V, Budetti, P P
(2003). Medical school attended as a predictor of medical malpractice claims. Qual Saf Health Care
12: 330-336
[Abstract][Full Text]
Brennan, T. A., Mello, M. M.
(2003). Patient Safety and Medical Malpractice: A Case Study. ANN INTERN MED
139: 267-273
[Abstract][Full Text]
Davis, P, Lay-Yee, R, Briant, R, Scott, A
(2003). Preventable in-hospital medical injury under the "no fault" system in New Zealand. Qual Saf Health Care
12: 251-256
[Abstract][Full Text]
Murff, H. J., Forster, A. J., Peterson, J. F., Fiskio, J. M., Heiman, H. L., Bates, D. W.
(2003). Electronically Screening Discharge Summaries for Adverse Medical Events. J. Am. Med. Inform. Assoc.
10: 339-350
[Abstract][Full Text]
Dulworth, S.
(2003). Commentary: Exploiting the Overlap: Using Utilization Management to Reduce Medical Malpractice. American Journal of Medical Quality
18: 128-132
[Abstract]
Ransom, S. B., Studdert, D. M., Dombrowski, M. P., Mello, M. M., Brennan, T. A.
(2003). Reduced Medicolegal Risk by Compliance With Obstetric Clinical Pathways: A Case-Control Study. Obstet Gynecol
101: 751-755
[Abstract][Full Text]
Polivka, L., Salmon, J. R., Hyer, K., Johnson, C., Hedgecock, D.
(2003). The Nursing Home Problem in Florida. Gerontologist
43: 7-18
[Abstract][Full Text]
Studdert, D. M., Gresenz, C. R.
(2003). Enrollee Appeals of Preservice Coverage Denials at 2 Health Maintenance Organizations. JAMA
289: 864-870
[Abstract][Full Text]
Gawande, A. A., Studdert, D. M., Orav, E. J., Brennan, T. A., Zinner, M. J.
(2003). Risk Factors for Retained Instruments and Sponges after Surgery. NEJM
348: 229-235
[Abstract][Full Text]
Rothschild, J. M., Federico, F. A., Gandhi, T. K., Kaushal, R., Williams, D. H., Bates, D. W.
(2002). Analysis of Medication-Related Malpractice Claims: Causes, Preventability, and Costs. Arch Intern Med
162: 2414-2420
[Abstract][Full Text]
Davis, P., Lay-Yee, R., Fitzjohn, J., Hider, P., Briant, R., Schug, S.
(2002). Compensation for Medical Injury in New Zealand: Does "No-Fault" Increase the Level of Claims Making and Reduce Social and Clinical Selectivity?. Journal of Health Politics, Policy and Law
27: 833-854
[Abstract]
Lauer, M. S.
(2002). Cardiologist on trial: reflections on credible evidence. J Am Coll Cardiol
40: 563-564
[Abstract][Full Text]
Newhouse, J. P.
(2002). Why Is There A Quality Chasm?. Health Aff (Millwood)
21: 13-25
[Abstract][Full Text]
Forster, H. P., Schwartz, J., DeRenzo, E.
(2002). Reducing Legal Risk by Practicing Patient-Centered Medicine. Arch Intern Med
162: 1217-1219
[Full Text]
Committee on Medical Liability,
(2002). Guidelines for Expert Witness Testimony in Medical Malpractice Litigation. Pediatrics
109: 974-979
[Abstract][Full Text]
Eggimann, P., Pittet, D.
(2001). Infection Control in the ICU. Chest
120: 2059-2093
[Abstract][Full Text]
Sage, W. M.
(2001). Principles, Pragmatism, and Medical Injury. JAMA
286: 226-228
[Full Text]
Holloway, R. G., Panzer, R. J.
(2001). Lawyers, litigation, and liability: Can they make patients safer?. Neurology
56: 991-993
[Full Text]
Glick, T. H.
(2001). Malpractice claims: Outcome evidence to guide neurologic education?. Neurology
56: 1099-1100
[Abstract][Full Text]
Fraser Jr, J. J., the Committee on Medical Liability,
(2001). Technical Report: Alternative Dispute Resolution in Medical Malpractice. Pediatrics
107: 602-607
[Abstract][Full Text]
Hebert, P. C., Levin, A. V., Robertson, G.
(2001). Bioethics for clinicians: 23. Disclosure of medical error. CMAJ
164: 509-513
[Abstract][Full Text]
Meisel, A., Snyder, L., Quill, T., for the American College of Physicians-American So,
(2000). Seven Legal Barriers to End-of-Life Care: Myths, Realities, and Grains of Truth. JAMA
284: 2495-2501
[Abstract][Full Text]
Hughes, C. M., Honig, P., Phillips, J., Woodcock, J., Anderson, R. E., McDonald, C. J., Weiner, M., Hui, S. L.
(2000). How Many Deaths Are Due to Medical Errors?. JAMA
284: 2187-2187
[Full Text]
Lefevre, F. V., Waters, T. M., Budetti, P. P.
(2000). A Survey of Physician Training Programs in Risk Management and Communication Skills for Malpractice Prevention. J Law Med Ethics
28: 258-266
Kakaiya, R., Migden, D., Van Oeveren, E. L., Mohr, J. C., Gostin, L. O.
(2000). The Past and Future of Medical Malpractice Litigation. JAMA
284: 827-829
[Full Text]
McDonald, C. J., Weiner, M., Hui, S. L.
(2000). Deaths Due to Medical Errors Are Exaggerated in Institute of Medicine Report. JAMA
284: 93-95
[Full Text]
Mohr, J. C.
(2000). American Medical Malpractice Litigation in Historical Perspective. JAMA
283: 1731-1737
[Abstract][Full Text]
Kraman, S. S., Hamm, G.
(1999). Risk Management: Extreme Honesty May Be the Best Policy. ANN INTERN MED
131: 963-967
[Abstract][Full Text]
Wu, A. W.
(1999). Handling Hospital Errors: Is Disclosure the Best Defense?. ANN INTERN MED
131: 970-972
[Full Text]
Anderson, R. E.
(1999). Billions for Defense: The Pervasive Nature of Defensive Medicine. Arch Intern Med
159: 2399-2402
[Full Text]
Wells, W. J.
(1999). AND JUSTICE FOR WHOM?. J. Thorac. Cardiovasc. Surg.
117: 211-219
[Full Text]
Darchy, B., Le Miere, E., Figueredo, B., Bavoux, E., Domart, Y.
(1999). Iatrogenic Diseases as a Reason for Admission to the Intensive Care Unit: Incidence, Causes, and Consequences. Arch Intern Med
159: 71-78
[Abstract][Full Text]
Rodwin, M. A.
(1999). Backlash: As Prelude to Managing Managed Care. Journal of Health Politics, Policy and Law
24: 1115-1126
Meadow, W., Lantos, J.
(1998). A Proactive, Data-based Determination of the Standard of Medical Care in Pediatrics. Pediatrics
101
: e6-e6
[Abstract][Full Text]
Mant, J., Dineen, M., Couves, J., Imhof, R.
(1998). Experience of clinical risk management in obstetrics in Oxford. BMJ
316: 73-73
[Full Text]
Emanuel, E. J., Goldman, L.
(1998). Protecting Patient Welfare in Managed Care: Six Safeguards. Journal of Health Politics, Policy and Law
23: 635-659
[Abstract]
Anderson, R. E., Grove, E., Ferrara, M. A., Rubin, R. I., Brennan, T. A.
(1997). Outcomes of Medical-Malpractice Litigation. NEJM
336: 1680-1681
[Full Text]
Meadow, W., Bell, A., Lantos, J.
(1997). Physicians' Experience With Allegations of Medical Malpractice in the Neonatal Intensive Care Unit. Pediatrics
99: e10-e10
[Abstract][Full Text]
Brennan, T. A., Sox, C. M., Burstin, H. R.
(1996). Relation between Negligent Adverse Events and the Outcomes of Medical-Malpractice Litigation. NEJM
335: 1963-1967
[Abstract][Full Text]
Bovbjerg, R. R., Dubay, L. C., Kenney, G. M., Norton, S. A.
(1996). Defensive Medicine and Tort Reform: New Evidence in an Old Bottle. Journal of Health Politics, Policy and Law
21: 267-288
[Abstract]
Spurr, S. J., Simmons, W. O.
(1996). Medical Malpractice in Michigan: An Economic Analysis. Journal of Health Politics, Policy and Law
21: 315-346
[Abstract]
Kinney, E. D.
(1996). Communications. Journal of Health Politics, Policy and Law
21: 153-158
[Abstract]
Pianelli, J. V., Perry, R. F., McGehee, J. E., Brunetti, L. L., Rush, J. C., Feingold, J. L., Todd, J. S.
(1994). The Malpractice Mess. NEJM
330: 1236-1237
[Full Text]
Bovbjerg, R. R.
(1994). Promoting Quality and Preventing Malpractice: Assessing the Health Security Act. Journal of Health Politics, Policy and Law
19: 207-216
Epstein, A. M.
(1993). Changes in the Delivery of Care under Comprehensive Health Care Reform. NEJM
329: 1672-1676
[Full Text]
Bronstein, J. M., Nelson, L. J.
(1992). The U.S. Medical Liability System: Conceptual Model and Proposals for Reform. Med Care Res Rev
49: 399-434
Lawthers, A. G., Laird, N. M., Lipsitz, S., Hebert, L., Brennan, T. A., Localio, A. R.
(1992). Physicians' Perceptions of the Risk of Being Sued. Journal of Health Politics, Policy and Law
17: 463-482
[Abstract]
(1991). LITTLE RELATION BETWEEN MALPRACTICE SUITS AND MEDICAL NEGLIGENCE. JWatch General
1991: 1-1
[Full Text]
Previous
