Abstract:Just as radiologic studies allow us to see past the surface to the vulnerable and broken parts of the human body, medical malpractice claims help us see past the surface of medical errors to the deeper vulnerabilities and potentially broken aspects of our healthcare delivery system. And just as the insights we gain through radiologic studies provide focus for a treatment plan for healing, so too can the analysis of malpractice claims provide insights to improve the delivery of safe patient care. We review 1325 coded claims where Radiology was the primary service provider to better understand the problems leading to patient harm, and the opportunities most likely to improve diagnostic care in the future.Keywords: diagnostic error; malpractice claims; radiology. OverviewThe medical diagnostic process involves a complex network of interactions between the patient and the healthcare system. This process is also dynamic, requiring one or more cycles of patient interaction, informationgathering and data synthesis in order to understand the intricacies of each patient's clinical picture and pathology. Failures can occur at any point along the continuum of care, each of which has the potential to result in inaccurate or delayed diagnosis as well as inappropriate treatment. While radiology typically does not play the initial role in the diagnostic process, misinterpretation or delayed communication of imaging findings can certainly lead to a breakdown in the progression towards clarity of diagnosis and appropriate patient care.Analysis of the CRICO Comparative Benchmarking System (CBS) determined that 29,777 medical malpractice cases, asserted between 2010 and 2014, had completed an in-depth review by CRICO's team of Clinical Taxonomy Specialists. Reviewing the medical and legal files of each of these cases, an experienced clinician used CRICO's propriety coding taxonomy to capture and code multiple case attributes including allegation, patient demographics, diagnosis and injury, location, tests and services, and the key causation factors contributing to the clinical error or failure.Of the 29,777 medical malpractice cases available for analysis, 1325 cases named Radiology as the Primary Responsible Service -42% resulted in high severity (based on National Associationn of Insurance Commissioners clinical injury severity score) clinical injuries including 235 deaths (Figure 1). Diagnostic related events represent nearly 60% of the 1325 radiology claims, followed by procedural issues (22%), equipment issues, (7%) and falls and safety issues (6%). In those cases involving diagnostic radiology, nearly 50% of the cases involved one of these four modalities: computed tomography (CT) scans (20%), mammography (11%), magnetic resonance imaging (MRI) (10%) and diagnostic ultrasound (4%). Cases occurred in a variety of settings though ambulatory cases were the most common at 63% followed by inpatient (26%) and emergency department (11%).In many cases, Radiology is not the only clinical service identified as "responsible" o...
Objective: We aimed to study the contributing factors and costs of malpractice claims involving the surgical management of benign biliary disease given the emotional, physical, and financial toll of these claims on patients, providers, and the healthcare system. Summary Background Data: Cholecystectomy complications carry significant morbidity and rank among the leading sources of surgical malpractice claims. Methods: Using the CRICO Strategies’ Comparative Benchmarking System database, representing approximately 30% of all paid and unpaid malpractice claims in the United States, 4081 closed claims filed against general surgeons from 1995 to 2015 were reviewed to isolate 745 cholecystectomy-related claims. A multivariable model was used to determine factors associated with claim outcome. Results: The most common associated complications included bile duct injury (n = 397), bowel perforation (n = 96), and hemorrhage (n = 78). Bile duct injuries were recognized intraoperatively only 19% of the time and required biliary reconstruction surgery 77% of the time. The total cost for all claims over the study period was over $128 M and the median time from event to case close was over 3 years. 40% of claims resulted in patient payout; of these, most claims were settled out of court and the median cost per claim was $264,650. For the 60% of claims not resulting in patient payout, most cases were denied, dropped, or dismissed, yet still averaged over $15,000 per claim in legal and administrative fees. On multivariable analysis, bile duct injury, bowel perforation, and high clinical severity were associated with patient payout, while a resident or fellow being named in a claim was negatively associated with patient payout (P < 0.05). Conclusion: Cholecystectomy-related claims are costly and time-consuming. Strategies that reduce the risk and aid in recognition of cholecystectomy complications, as well as advance support of patients and families after poor outcomes, may improve clinical care and reduce claim burden.
Background Given their profound emotional, physical, and financial toll on patients and surgeons, we studied the characteristics, costs, and contributing factors of thyroid and parathyroid surgical malpractice claims. Methods Using the Controlled Risk Insurance Company Strategies' Comparative Benchmarking System database, representing *30% of all US paid and unpaid malpractice claims, 5384 claims filed against general surgeons and otolaryngologists from 1995-2015 were reviewed to isolate claims involving the surgical management of thyroid and parathyroid disease. These claims were studied, and multivariable regression analysis was performed to identify factors associated with plaintiff payout. Results One hundred twenty-eight thyroid and parathyroid surgical malpractice claims were isolated. The median time from alleged harm event to closure of a malpractice case was 39 months. The most common associated complications were bilateral recurrent laryngeal nerve (RLN) injury (n = 23) and hematoma (n = 18). Complications led to death in 18 cases. Patient payout occurred in 33% of claims (n = 42), and the median cost per claim was $277,913 (IQR $87,663). On multivariable analysis, bilateral RLN injury was predictive of patient payout (OR 3.58, p = 0.03), while procedure, death, and surgeon specialty were not. Conclusion Though rare, malpractice claims related to thyroid and parathyroid surgery are costly, time-consuming, and reveal opportunities for early surgeon-patient resolution after poor outcomes.
BackgroundThe threat of medical liability can influence physician behavior and lead to the practice of “defensive medicine.” Concern for malpractice liability has been cited as a cause of inappropriate antibiotic prescribing. Data on malpractice claims related to antibiotic use (AU) are lacking. The objectives of this analysis were to describe malpractice claims associated with AU.MethodsWe conducted a retrospective analysis of pooled closed antibiotic-related claims from a malpractice carrier representing 30% of US malpractice cases from January, 2007 to December, 2016. We described antibiotic-related, malpractice claims, patient demographics, amount of indemnity paid, clinical severity, settings, responsible services, initial diagnoses, drug classes, and causes of allegation.ResultsFrom 2007 to 2016, 767 antibiotic-related claims were identified and represented less than 1% of overall claims. A total of $123 million were paid for antibiotic-related claims. Claims classified as medium to high clinical severity constituted 97% of all claims, with 35% having permanent injury and 24% leading to death. Of all patients, 56% were female, 8% were < 20 years of age, and 32% were ≥ 60 years old. Most claims (51%) were associated with outpatient settings, 37% with inpatient, and 11% with emergency department settings. Responsible services with the highest number of claims were medicine (44%), surgery (27%) and the emergency medicine (9%). The most common infection cited as an initial diagnosis was respiratory (10%), followed by urinary (7%) and skin and soft-tissue infections (6%). The most common class cited was β-lactams (19%), followed by fluoroquinolones (14%) and sulfa-drugs (11%). Allegations associated with antibiotic administration and management constituted 62% of all claims, 19% were related to failure or delay in diagnosis or treatment, and 19% were due to other causes.ConclusionClaims related to AU were not a common cause of malpractice claims in these data source. Antibiotic administration and management was more commonly associated with malpractice claims than failure or delay in AU. A better understanding of malpractice claims associated with AU can help guide messaging on improving antibiotic prescribing.Disclosures All authors: No reported disclosures.
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