Medical Malpractice Claims in Radiation Oncology: A Population-Based Study 1985-2012

Marshall, Deborah; Punglia, Rinaa S.; Fox, Dov; Recht, Abram; Hattangadi‐Gluth, Jona A.

doi:10.1016/j.ijrobp.2015.05.040

Cited by 6 publications

(5 citation statements)

References 20 publications

(26 reference statements)

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“…Thus, our results also raise a question as to whether physicians are more concerned about malpractice claims now than they were 16 years ago. The data from malpractice claims are conflicting, as some studies show an increasing amount of malpractice claims, while in others, there is a clear decrease 34 35. In contrast to our results, the law appeared to play a limited role in EOL medical decision-making with doctors prioritising patient-related clinical and ethical considerations in a recent study from Australia 36.…”

Section: Discussioncontrasting

confidence: 99%

“…The data from malpractice claims is conflicting, as some studies show an increasing amount of malpractice claims, while in others there is a clear decrease. [34,35] In contrast to our results, the law appeared to play a limited role in end-of-life medical decision-making with doctors prioritizing patient-related clinical and ethical considerations in a recent study from Australia. [36] On the other hand, that study is partly in line with our study, as ethical values were also considered to be highly influential by our responders.…”

Section: Factors Associated With Physicians' Decisionscontrasting

confidence: 99%

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Has there been a change in the end-of-life decision-making over the past 16 years?

Piili

Lehto

Metsänoja

et al. 2019

BMJ Support Palliat Care

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ObjectivesPhysicians’ decision-making in end-of-life (EOL) care includes many medical, ethical and juridical aspects. We studied the changes of these decisions over time and factors influencing them.MethodsA postal survey including two hypothetical patient scenarios was sent to 1258 Finnish physicians in 2015 and to 1182 in 1999. The attitudes, values and background factors of the physicians were also enquired.ResultsThe response rate was 56%. The physicians’ decisions to choose palliative approaches over active or intensive care increased from 1999 to 2015 when a terminally ill prostate cancer patient had probable iatrogenic gastrointestinal bleeding (53% vs 59%, p=0.014) and waited to meet his son (46% vs 60%, p<0.001) or a minister (53% vs 71%, p<0.001). Training in EOL care independently increased palliative approaches. Patient’s benefit (96% vs 99%, p=0.001), ethical values (83% vs 93%, p<0.001) and patient’s (68% vs 86%, p<0.001) or physician’s (44% vs 63%, p<0.001) legal protection were considered more influential to the decisions in 2015, while the family’s benefit was regarded as less influential to the decisions than it was in 1999 (37% vs 25%, p<0.001). Physicians were more willing to give a hospice voucher for an advanced breast cancer patient in 2015 (34% vs 58%, p<0.001).ConclusionsOur findings may reflect the transition to a stronger emphasis on patient-centred care and a stronger tendency to avoid futile therapies that have only short-term goals. The results highlight that education in all aspects of EOL care should be incorporated into the post-graduate training of medical specialties that take care of dying patients.

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Section: Discussioncontrasting

confidence: 99%

Section: Factors Associated With Physicians' Decisionscontrasting

confidence: 99%

Has there been a change in the end-of-life decision-making over the past 16 years?

Piili

Lehto

Metsänoja

et al. 2019

BMJ Support Palliat Care

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“…9 Medical liability insurance is a type of insurance that may protect physicians against claims of medical negligence. 10 Markets of medical liability insurance have occasionally experienced crisis, such as in the mid-1970s, mid-1980s, and early 2000s. 11 Since the 2000s, the medical liability insurance markets have been moderately stable.…”

Section: Introductionmentioning

confidence: 99%

The Association Between Medical Liability Insurance Coverage and Medical Disturbances in Tertiary Psychiatric Hospitals in China: A National Survey

Luo¹,

Liu²,

Liu³

et al. 2021

RMHP

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Background Medical disturbances (MD), a severe type of medical disputes, are common in Chinese hospitals. Medical liability insurances were introduced to establish a new system of conflict resolution and risk management. However, data are scarce on the effects of medical liability insurance coverage and MD in psychiatric hospitals. This study was set to address it based on a nationwide survey. Methods A national cross-sectional survey was conducted in March 2019. Physicians in 41 tertiary psychiatric hospitals participated in a smartphone based anonymous questionnaire. Experience of MD, sociodemographic and occupational characteristics, and job satisfaction information were reported by physicians. The hospital medical liability insurance status was reported by participating hospitals. Multi-level logistic regression analysis was used to examine the association between medical liability insurance coverage and MD. Results In total, 4511 physicians completed the survey, 3760/4511 (83.35%) physicians in 32 hospitals had medical liability insurance coverage, and 1401/4511 (31.06%) physicians had encountered medical disturbances in the previous year. After adjusting for confounding factors, medical liability insurance coverage was not significantly associated with MD (OR=1.28, 95% CI: 0.93–1.76). Female gender, working in West China, and higher job satisfaction were protective factors for MD. Higher outpatient volume/week (>50 patients/week) and longer working hours/week were risk factors for MD. Conclusion Nearly one-third of physicians in Chinese top-tier psychiatric hospitals reported experience of MD. There was no significant association between medical liability insurance coverage and MD experienced among physicians in Chinese psychiatric hospitals. Policymakers and hospital administrators need to tailor the scope of medical liability insurance and to focus on other factors to reduce MD, including reducing workload and improving the doctor–patient relationship.

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“…Improper performance claims also carried the highest average indemnity payment among the most frequent alleged errors. Reported error rates in radiation therapy are low (fewer than 2% of treatments) 23–29 , and studies suggest these events are decreasing over time 30,31 along with malpractice claims against radiation oncologists 13 . When errors do occur, most relate to human error or human-software interface 25,28,32 , especially among incidents with the potential to cause serious clinical harm 31 .…”

Section: Discussionmentioning

confidence: 99%

“…An important part of reducing legal risk to physicians is to understand why people sue 12 . A recent population-based study of malpractice claims involving radiation oncologists found that these claims are not common and have declined in recent years 13 . However, this study also found that indemnity payments in radiation oncology are large relative to other specialties, and the risk of being sued is relatively high compared to other nonsurgical specialties.…”

Section: Introductionmentioning

confidence: 99%

Nature of Medical Malpractice Claims Against Radiation Oncologists

Marshall

Tringale

Connor

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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Purpose/Objective(s) We examined characteristics of medical malpractice claims involving radiation oncologists closed during a 10-year period. Methods and Materials Malpractice claims filed against radiation oncologists from 2003 to 2012 collected by a nationwide liability insurance trade association were analyzed. Outcomes included the nature of claims and indemnity payments, including associated presenting diagnoses, procedures, alleged medical errors, and injury severity. We compared the likelihood of a claim resulting in payment in relation to injury severity categories (death as referent) using binomial logistic regression. Results There were 362 closed claims involving radiation oncology, 102 (28%) of which were paid, resulting in $38 million in indemnity payments. The most common alleged errors included: ‘improper performance’ (38% of closed claims, 18% were paid; 29% [$11 million] of total indemnity); ‘errors in diagnosis’ (25% of closed claims, 46% were paid; 44% [$17 million] of total indemnity); and, ‘no medical misadventure’ (14% of closed claims, 8% were paid; less than 1% [$148,000] of total indemnity). Another physician was named in 32% of claims, and consent issues/breach of contract were cited in 18%. Claims for injury resulting in death represented 39% of closed claims and 25% of total indemnity. ‘Improper performance’ was the primary alleged error associated with injury resulting in death. Compared to claims involving death, major temporary injury (OR 2.8, 95% CI 1.29–5.85, P=0.009), significant permanent injury (OR 3.1, 1.48–6.46, P =0.003) and major permanent injury (OR 5.5, 1.89–16.15, P =0.002) had higher likelihood of a claim resulting in indemnity payment. Conclusions Improper performance was the most common alleged malpractice error. Claims involving significant or major injury were more likely to be paid than those involving death. Insights into the nature of liability claims against radiation oncologists may help direct efforts to improve quality of care and minimize the risk of being sued.

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Medical Malpractice Claims in Radiation Oncology: A Population-Based Study 1985-2012

Cited by 6 publications

References 20 publications

Has there been a change in the end-of-life decision-making over the past 16 years?

Has there been a change in the end-of-life decision-making over the past 16 years?

The Association Between Medical Liability Insurance Coverage and Medical Disturbances in Tertiary Psychiatric Hospitals in China: A National Survey

Nature of Medical Malpractice Claims Against Radiation Oncologists

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