Sunday, September 13, 2015

Malpractice - Myth or Reality

A recent NY Times Op-Ed piece entitled "Legislative Malpractice" prompted a number of contrary Letters-to-the Editor.  These included critiques of juries of lay people who, the writer, averred, do not possess the proper credentials to adequately judge complex medical cases.  Another noted that defending malpractice suits costs the health care system "hundreds of millions of dollars each year," and many are without merit.  Myths or reality?

Some facts:

1.  Researchers at Harvard School of Public Health have found that 97% of malpractice suits were meritorious.  There is little "frivolous litigation" in malpractice suits.
2.  The Institute of Medicine has estimated that 98,000 patients die each year as a result of preventable medical errors and hundreds of thousands more suffer nonfatal injuries.  Other estimates are as high as 210,000-400,000 such deaths each year (Journal of Patient Safety 2013).  Despite these numbers, malpractice suits comprise only 3% of all tort caseload.  Only 30% result in a lawsuit.  There are, then, far more instances of documented malpractice than there are malpractice lawsuits.
3.  No more than 0.5% of malpractice payments resulted in an award of $1 million or more.
4.  Despite the non-possession of "proper credentials" by jurors, a 2006 study discovered that juries found for the  plaintiffs only 21% of the time.  (By the way, "improperly credentialed" juries are also asked to decide complex financial issues, contracts, and other forms of very involved civil litigation.)
5.  Medical negligence compensation accounts for only 0.3% of national healthcare costs.
6.  So called defensive-medicine expenditures (ordering "unnecessary tests" to counter potential malpractice suits) do not result in a significant cost increase compared to total health expenditures.
7.  Malpractice premiums, which are primarily driven by the general economic insurance cycle rather than by large malpractice awards, cost a typical physician just 3.2% of total revenue - far less than his/her rent.
8.  Since 1987 medical costs have increased by 113%, while malpractice insurance has increased by just 52%.
9.  Some states have adopted "collateral-source offsets" - costs covered by health insurance not recoverable by malpractice plaintiffs.  With increased insurance coverage, greater "offsets" are expected, resulting in lower total indemnity payouts.

Last fact:

Many so-called malpractice issues are clearly more myth than reality.  Competent physicians, who know what they are doing and how to do it, need have no malpractice qualms!


Anonymous said...

Interesting blog, Carl. I wonder what the numbers are for obstetricians. I understand that malpractice insurance for them is very high, and that they have a higher rate of lawsuits. I haven't done the research, though.


Carl Steeg said...

Thanks for your comment Dorothy. OB_GYN physicians rank 7th among specialists when it comes to rate of lawsuits. According to an article in the New England Journal of Medicine (2011) about 11.5% of OB_GYNs get sued annually, but only 2% actually result in awards.