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.
Background In the current debate over tort reform, critics ofthe 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 1452closed malpractice claims from five liability insurers to determinewhether a medical injury had occurred and, if so, whether itwas due to medical error. We analyzed the prevalence, characteristics,litigation outcomes, and costs of claims that lacked evidenceof error.
Results For 3 percent of the claims, there were no verifiablemedical injuries, and 37 percent did not involve errors. Mostof the claims that were not associated with errors (370 of 515[72 percent]) or injuries (31 of 37 [84 percent]) did not resultin compensation; most that involved injuries due to error did(653 of 889 [73 percent]). Payment of claims not involving errorsoccurred less frequently than did the converse form of inaccuracy— nonpayment of claims associated with errors. When claimsnot involving errors were compensated, payments were significantlylower on average than were payments for claims involving errors($313,205 vs. $521,560, P=0.004). Overall, claims not involvingerrors accounted for 13 to 16 percent of the system's totalmonetary costs. For every dollar spent on compensation, 54 centswent to administrative expenses (including those involving lawyers,experts, and courts). Claims involving errors accounted for78 percent of total administrative costs.
Conclusions Claims that lack evidence of error are not uncommon,but most are denied compensation. The vast majority of expendituresgo toward litigation over errors and payment of them. The overheadcosts of malpractice litigation are exorbitant.
Source Information
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{at}hsph.harvard.edu.
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
20: 358-362
[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]
Widman, A., Hochberg, F. A.
(2008). Federal Administrative Health Courts Are Unconstitutional: A Reply to Elliott, Narayan, and Nasmith. Journal of Health Politics, Policy and Law
33: 799-832
[Abstract]
Mongan, J. J., Ferris, T. G., Lee, T. H.
(2008). Options for Slowing the Growth of Health Care Costs. NEJM
358: 1509-1514
[Full Text]
Pate, B.
(2008). Trainee Errors & Malpractice Claims. AAP Grand Rounds
19: 34-35
[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]
Murthy, K., Grobman, W. A., Lee, T. A., Holl, J. L.
(2007). Association Between Rising Professional Liability Insurance Premiums and Primary Cesarean Delivery Rates. Obstet Gynecol
110: 1264-1269
[Abstract][Full Text]
Singh, H., Thomas, E. J., Petersen, L. A., Studdert, D. M.
(2007). Medical Errors Involving Trainees: A Study of Closed Malpractice Claims From 5 Insurers. Arch Intern Med
167: 2030-2036
[Abstract][Full Text]
Ambrose, J. M., Carroll, A.
(2007). Medical Malpractice Reform and Insurer Claims Defense: Unintended Effects?. Journal of Health Politics, Policy and Law
32: 843-865
[Abstract]
Donn, S. M., McAbee, G.
(2007). Pediatricians and Medical Malpractice. Pediatrics
120: 173-174
[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]
Barbieri, R. L., Tesoro, M., Frigoletto, F. D. Jr
(2007). Twin Goals: Continuing Professional Development and Improved Patient Care: Report of an ACOG District I Retreat Focused on the Future of Obstetrics and Gynecology. Obstet Gynecol
109: 435-440
[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]
Fischler, R. S.
(2006). Pediatric Malpractice. Pediatrics
118: 2266-2267
[Full Text]
Gandhi, T. K., Kachalia, A., Thomas, E. J., Puopolo, A. L., Yoon, C., Brennan, T. A., Studdert, D. M.
(2006). Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims.. ANN INTERN MED
145: 488-496
[Abstract][Full Text]
Volpintesta, E. J., Avraham, R., Marcus, H. R., Greenberg, J. A., Studdert, D. M., Mello, M. M., Annas, G. J.
(2006). Medical Malpractice and Patient Safety.. NEJM
355: 734-736
[Full Text]
Previous
