Effects of a Malpractice Crisis on Specialist Supply and Patient Access to Care

Studdert, David M.; DesRoches, Catherine M.; Peugh, Jordon; Zapert, Kinga; Brennan, Troyen A.; Sage, William M.

doi:10.1097/01.sla.0000182957.54783.9a

Cited by 75 publications

(54 citation statements)

References 8 publications

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“…Past studies have been limited to physician surveys 12,13,15,20 and singleinstitution experiences, 5,14 have solely focused on the size of malpractice claims, 5,7,12,14,17 or have been multicenter studies of specific US regions or data subgroups. 3,12,17,19 In contrast, the present investigation specifically evaluated spine surgery data by including the specialties of neurosurgery and orthopedic surgery and by using claims data from litigation cases from around the country.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have evaluated neurosurgical and orthopedic malpractice claims data; 1,[3][4][5][6][7][9][10][11][12][13][14]17,19,20 however, none has focused specifically on spine surgery. Past studies have been limited to physician surveys 12,13,15,20 and singleinstitution experiences, 5,14 have solely focused on the size of malpractice claims, 5,7,12,14,17 or have been multicenter studies of specific US regions or data subgroups.…”

Section: Discussionmentioning

confidence: 99%

“…The average patient age was 48.1 ± 15.8 years (mean ± SD; 224 patients; age was not available for 10 cases). In total, 158 cases (67.5% all cases) were filed in 5 states: New York (57), California (49), Texas (26), Massachusetts (13), and Ohio (13). The remaining 76 cases were filed in 17 other states and Washington, DC.…”

Section: Case Characteristicsmentioning

confidence: 99%

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Malpractice litigation following spine surgery

Daniels

Ruttiman

Eltorai

et al. 2017

Journal of Neurosurgery: Spine

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OBJECTIVEAdverse events related to spine surgery sometimes lead to litigation. Few studies have evaluated the association between spine surgical complications and medical malpractice proceedings, outcomes, and awards. The aim of this study was to identify the most frequent causes of alleged malpractice in spine surgery and to gain insight into patient demographic and clinical characteristics associated with medical negligence litigation.METHODSA search for “spine surgery” spanning February 1988 to May 2015 was conducted utilizing the medicolegal research service VerdictSearch (ALM Media Properties, LLC). Demographic data for the plaintiff and defendant in addition to clinical data for the procedure and legal outcomes were examined. Spinal cord injury, anoxic/hypoxic brain injury, and death were classified as catastrophic complications; all other complications were classified as noncatastrophic. Both chi-square and t-tests were used to evaluate the effect of these variables on case outcomes and awards granted.RESULTSA total of 569 legal cases were examined; 335 cases were excluded due to irrelevance or insufficient information. Of the 234 cases included in this investigation, 54.2% (127 cases) resulted in a defendant ruling, 26.1% (61) in a plaintiff ruling, and 19.6% (46) in a settlement. The awards granted for plaintiff rulings ranged from $134,000 to $38,323,196 (mean $4,045,205 ± $6,804,647). Awards for settlements ranged from $125,000 to $9,000,000 (mean $1,930,278 ± $2,113,593), which was significantly less than plaintiff rulings (p = 0.022). Compared with cases without a delay in diagnosis of the complication, the cases with a diagnostic delay were more likely to result in a plaintiff verdict or settlement (42.9% vs 72.7%, p = 0.007) than a defense verdict, and were more likely to settle out of court (17.5% vs 40.9%, p = 0.008). Similarly, compared with cases without a delay in treatment of the complication, those with a therapeutic delay were more likely to result in a plaintiff verdict or settlement (43.7% vs 68.4%, p = 0.03) than a defense verdict, and were more likely to settle out of court (18.1% vs 36.8%, p = 0.04). Overall, 28% of cases (66/234) involved catastrophic complications. Physicians were more likely to lose cases (plaintiff verdict or settlement) with catastrophic complications (66.7% vs 37.5%, p < 0.001). In cases with a plaintiff ruling, catastrophic complications resulted in significantly larger mean awards than noncatastrophic complications ($6.1M vs $2.9M, p = 0.04). The medical specialty of the provider and the age or sex of the patient were not associated with the case outcome or award granted (p > 0.05). The average time to a decision for defendant verdicts was 5.1 years; for plaintiff rulings, 5.0 years; and for settlements, 3.4 years.CONCLUSIONSDelays in the diagnosis and the treatment of a surgical complication predict legal case outcomes favoring the plaintiff. Catastrophic complications are linked to large sums awarded to the plaintiff and are predictive of rulings against the physician. For physician defendants, the costs of settlements are significantly less than those of losing in court. Although this study provides potentially valuable data from a large series of postoperative litigation cases, it may not provide a true representation of all jurisdictions, each of which has variable malpractice laws and medicolegal environments.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Malpractice litigation following spine surgery

Daniels

Ruttiman

Eltorai

et al. 2017

Journal of Neurosurgery: Spine

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“…Several studies have attempted to characterize malpractice claims in spine surgery [6][7][8][9][10][11][12][13][14][15][16][17]. These reports are in the context of the broader specialty (neurosurgery or orthopedics) and do not focus on spine surgery.…”

Section: Introductionmentioning

confidence: 99%

Spine surgery and malpractice liability in the United States

Missios

Bekelis

2015

The Spine Journal

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“…Algunos estudios recogen la existencia de una alta tasa de abandono de la actividad asistencial en las especialidades legalmente más reclamadas, e incluso el traslado a zonas donde la presión de los pacientes y el marco legal no son tan estrictos [8][9][10] .…”

Section: Introductionunclassified