ED and Urgent Care Medical Malpractice Claims 2001-15

In This Article

Abstract and Introduction

Abstract

Introduction: This study reviews malpractice, also called medical professional liability (MPL), claims involving adult patients cared for in emergency departments (ED) and urgent care settings.

Methods: We conducted a retrospective review of closed MPL claims of adults over 18 years, from the Medical Professional Liability Association's Data Sharing Project database from 2001–2015, identifying 6,779 closed claims. Data included the total amount, origin, top medical specialties named, chief medical factors, top medical conditions, severity of injury, resolution, average indemnity, and defense costs of closed claims.

Results: Of 6,779 closed claims, 65.9% were dropped, withdrawn, or dismissed. Another 22.8% of claims settled for an average indemnity of $297,709. Of the 515 (7.6%) cases that went to trial, juries returned verdicts for the defendant in 92.6% of cases (477/515). The remaining 7.4% of cases (38/515) were jury verdicts for the plaintiff, with an average indemnity of $816,909. The most common resulting medical condition cited in paid claims was cardiac or cardiorespiratory arrest (10.4%). Error in diagnosis was the most common chief medical error cited in closed claims. Death was the most common level of severity listed in closed (38.5%) and paid (42.8%) claims. Claims reporting major permanent injury had the highest paid-to-closed ratio, and those reporting grave injury had the highest average indemnity of $686,239.

Conclusion: This retrospective review updates the body of knowledge surrounding medical professional liability and represents the most recent analysis of claims in emergency medicine. As the majority of emergency providers will be named in a MPL claim during their career, it is essential to have a better understanding of the most common factors resulting in MPL claims.

Introduction

Among the challenges in emergency departments (ED) is providing quality care to patients with high-risk diagnoses under the pressures of limited information and increasing demands on time. This complex environment inherently lends itself to potential medical errors and possible resulting litigation. The threat of a malpractice lawsuit partially drives physicians' clinical decision-making in such environments. A survey performed by the Harvard School of Public Health and Columbia Law School found that 93% of physicians in high-risk specialties change their clinical decision-making due to concern of a malpractice suit, a behavior commonly referred to as "defensive medicine."^[1]

A prior study by Brown et al. in 2010 examined 11,529 closed medical professional liability (MPL) claims originating from EDs for adult patients between 1987–2007 using a database from the Physician Insurers Association of America (the former name of the MPL Association).^[2] The changing landscape of MPL due to tort reform, fluctuations in malpractice insurance premiums, and regulatory interference underscores the need for a more contemporary analysis of the MPL data. This study reviewed MPL claims involving adult patients (over 18 years old) cared for in ED and urgent care settings and provides an update of characteristics in closed MPL claims from 2001–2015.

Table 1. Summary of claims submitted to the Data Sharing Project of the Medical Professional Liability Association during a 15-year period (2001–2015).
Description	Closed claims	Paid claims	% Paid-to-closed	Average Indemnity	Average defense expense	% of all closed claims	% of all paid claims
All claims for patients 18+ years	110,447	30,720	27.8	$308,083	$41,033	81.5%	85.2%
Emergency Department and Urgent Care Claims	6,779	1,799	26.5	$309,908	$41,047	5.0%	5.0%
Emergency Department	5,737	1,499	26.1	$321,034	$42,602	5.2%	4.2%
Urgent Care	1,042	300	28.8	$254,315	$32,484	0.9%	0.8%

Table 2. Resolution and outcomes of closed claims in adult emergency departments or urgent care settings.
Resolution	Closed claims	Paid claims	% Paid-to-closed	Average indemnity	Average defense expense	% of all closed claims	% of all paid claims
Dropped, withdrawn, or dismissed	4,463	-	-	$0	$25,996	65.9%	0.0%
Settled	1,549	1,549	100.0	$297,709	$55,260	22.8%	86.1%
Verdict-defendant	477	-	-	$0	$111,446	7.0%	0.0%
Verdict-plaintiff	38	38	100.0	$816,909	$159,716	0.6%	2.1%
Alternative dispute resolution/Contract	222	193	86.9	$279,380	$70,986	3.3%	10.7%
Unknown	30	19	63.3	$600,526	$55,001	0.4%	1.1%
TOTAL	6,779	1,799	26.5

Table 3. Outcomes of the top five resulting medical conditions cited in closed claims in adult emergency departments or urgent care settings.
Top 5 resulting medical conditions	Closed claims	Paid claims	% Paid-to-closed	Average indemnity	Average defense expense	% of all closed claims	% of all paid claims
Cardiac or cardiorespiratory arrest	617	187	30.3	$340,622	$54,410	9.1%	10.4%
Myocardial infarction, acute	269	105	39.0	$306,487	$46,447	4.0%	5.8%
Aortic aneurysm	153	47	30.7	$369,872	$43,163	2.3%	2.6%
Pulmonary embolism	147	50	34.0	$302,996	$29,819	2.2%	2.8%
Appendicitis	134	39	29.1	$159,815	$28,432	2.0%	2.2%

Table 4. Outcomes based on top five chief medical factors cited in closed claims in adult emergency departments or urgent care settings.
Top 5 chief medical factors	Closed claims	Paid claims	% Paid-to-closed	Average Indemnity	Average defense expense	% of all closed claims	% of all paid claims
Errors in diagnosis	2,466	854	34.6	$338,362	$43,600	36.4%	47.5%
No medical misadventure	1,301	43	3.3	$294,140	$35,588	19.2%	2.4%
Improper performance	1,197	356	29.7	$289,941	$36,185	17.7%	19.8%
Failure to supervise or monitor case	352	119	33.8	$296,551	$41,761	5.2%	6.6%
Medication errors	232	58	25.0	$170,148	$33,834	3.4%	3.2%

Table 5. Outcomes according to severity of injury cited in closed claims in adult emergency departments or urgent care settings.
Severity of injury	Closed claims	Paid claims	% Paid-to-closed	Average indemnity	Average defense expense	% of all closed claims	% of all paid claims
Death	2,613	770	29.5	$326,350	$45,588	38.5%	42.8%
Grave injury	201	65	32.3	$686,239	$66,722	3.0%	3.6%
Major permanent injury	410	157	38.3	$505,965	$67,025	6.0%	8.7%
Significant permanent injury	617	162	26.3	$334,723	$47,168	9.1%	9.0%
Minor permanent injury	658	163	24.8	$248,662	$34,226	9.7%	9.1%
Major temporary injury	937	251	26.8	$215,244	$33,821	13.8%	14.0%
Minor temporary injury	1,027	188	18.3	$152,810	$27,376	15.1%	10.5%
Insignificant injury	179	27	15.1	$89,726	$14,914	2.6%	1.5%