Negligent Care and Malpractice Claiming Behavior in Utah and Colorado

Department of Health Policy and Management, Harvard School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Medical Care (Impact Factor: 3.23). 03/2000; 38(3):250-60. DOI: 10.1097/00005650-200003000-00002
Source: PubMed

ABSTRACT Previous studies relating the incidence of negligent medical care to malpractice lawsuits in the United States may not be generalizable. These studies are based on data from 2 of the most populous states (California and New York), collected more than a decade ago, during volatile periods in the history of malpractice litigation.
The study objectives were (1) to calculate how frequently negligent and nonnegligent management of patients in Utah and Colorado in 1992 led to malpractice claims and (2) to understand the characteristics of victims of negligent care who do not or cannot obtain compensation for their injuries from the medical malpractice system.
We linked medical malpractice claims data from Utah and Colorado with clinical data from a review of 14,700 medical records. We then analyzed characteristics of claimants and nonclaimants using evidence from their medical records about whether they had experienced a negligent adverse event.
The study measures were negligent adverse events and medical malpractice claims.
Eighteen patients from our study sample filed claims: 14 were made in the absence of discernible negligence and 10 were made in the absence of any adverse event. Of the patients who suffered negligent injury in our study sample, 97% did not sue. Compared with patients who did sue for negligence occurring in 1992, these nonclaimants were more likely to be Medicare recipients (odds ratio [OR], 3.5; 95% CI [CI], 1.3 to 9.6), Medicaid recipients (OR, 3.6; 95% CI, 1.4 to 9.0), > or =75 years of age (OR, 7.0; 95% CI, 1.7 to 29.6), and low income earners (OR, 1.9; 95% CI, 0.9 to 4.2) and to have suffered minor disability as a result of their injury (OR, 6.3; 95% CI, 2.7 to 14.9).
The poor correlation between medical negligence and malpractice claims that was present in New York in 1984 is also present in Utah and Colorado in 1992. Paradoxically, the incidence of negligent adverse events exceeds the incidence of malpractice claims but when a physician is sued, there is a high probability that it will be for rendering nonnegligent care. The elderly and the poor are particularly likely to be among those who suffer negligence and do not sue, perhaps because their socioeconomic status inhibits opportunities to secure legal representation.

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    • "According to previous studies, male patients and elderly patients are less likely to claim for damages (Studdert et al. 2000, Pukk et al. 2003, Bismark et al. 2006, Järvelin et al. 2009), while patients with increased comorbidity are more likely to do so (Järvelin et al. 2009). We hypothesized that this would also be the case with regard to THA and TKA. "
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    ABSTRACT: Factors associated with malpractice claims are poorly understood. Knowledge of these factors could help to improve patient safety. We investigated whether patient characteristics and hospital volume affect claims and compensations following total hip arthroplasty (THA) and knee arthroplasty (TKA) in a no-fault scheme. A retrospective registry-based study was done on 16,646 THAs and 17,535 TKAs performed in Finland from 1998 through 2003. First, the association between patient characteristics-e.g., age, sex, comorbidity, prosthesis type-and annual hospital volume with filing of a claim was analyzed by logistic regression. Then, multinomial logistic regression was applied to analyze the association between these same factors and receipt of compensation. For THA and TKA, patients over 65 years of age were less likely to file a claim than patients under 65 (OR = 0.57, 95% CI: 0.46-0.72 and OR = 0.65, CI: 0.53-0.80, respectively), while patients with increased comorbidity were more likely to file a claim (OR = 1.17, CI: 1.04-1.31 and OR = 1.14, CI: 1.03-1.26, respectively). Following THA, male sex and cemented prosthesis reduced the odds of a claim (OR = 0.74, CI: 0.60-0.91 and OR = 0.77, CI: 0.60-0.99, respectively) and volume of between 200 and 300 operations increased the odds of a claim (OR = 1.29, CI: 1.01-1.64). Following TKA, a volume of over 300 operations reduced the probability of compensation for certain injury types (RRR = 0.24, CI: 0.08-0.72). Centralization of TKA to hospitals with higher volume may reduce the rate of compensable patient injuries. Furthermore, more attention should be paid to equal opportunities for patients to file a claim and obtain compensation.
    Acta Orthopaedica 03/2012; 83(2):190-6. DOI:10.3109/17453674.2012.672089 · 2.77 Impact Factor
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    • "Dismissing Fear: Fear is the single most powerful factor suppressing exploration of more constructive alternatives (Lamb et al. 2003)—fear of inviting litigation, fear of complicating litigation, and fear of making a mistake that will lead to a catastrophic claims outcome. Physicians fear the patient's reaction, and some rationalize away the need to tell a patient about an error if the patient does not seem aware of it already—essentially, the doctrine of "Let sleeping dogs lie" (Wu et al. 1997; Gallagher et al. 2003; Studdert et al. 2000). Fear prompts the medical community to rely almost exclusively on a legal system that does not serve their needs and is expensive financially and emotionally. "
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    ABSTRACT: In mid-2001 and early 2002, the University of Michigan Health System systematically changed the way it responded to patient injuries and medical malpractice claims. Michigan adopted a proactive, principle-based approach, described as an "open disclosure with offer" model, built on a commitment to honesty and transparency. Implementation was followed by steady reduction in the number of claims and various other metrics, such as elapsed time for processing claims, defense costs, and average settlement amounts. Though the model continues to evolve, it has retained its core components and the culture it nurtured while spurring other initiatives such as a unique approach to peer review. In this article we review our experience, identify the essential practical components of our model, offer suggestions for tailoring the approach to other settings, and present some thoughts as to the future of this approach.
    Frontiers of health services management 03/2012; 28(3):13-28.
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    • "Claims data in the United States are primarily used by litigation managers, attorneys, and others for determining legal liability. Previous studies have shown little relationship between errors and malpractice claims [22]. The no-fault system in Sweden, in contrast, does not place the responsibility for a medical error on an individual practitioner and may reduce barriers to filing for compensation and increase the probability that an error is disclosed [13]. "
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    ABSTRACT: Objective data on the incidence and pattern of adverse events after orthopaedic surgical procedures remain scarce, secondary to the reluctance for encompassing reporting of surgical complications. The aim of this study was to analyze the nature of adverse events after orthopaedic surgery reported to a national database for patient claims in Sweden. In this retrospective review data from two Swedish national databases during a 4-year period were analyzed. We used the "County Councils' Mutual Insurance Company", a national no-fault insurance system for patient claims, and the "National Patient Register at the National Board of Health and Welfare". A total of 6,029 patient claims filed after orthopaedic surgery were assessed during the study period. Of those, 3,336 (55%) were determined to be adverse events, which received financial compensation. Hospital-acquired infections and sepsis were the most common causes of adverse events (n = 741; 22%). The surgical procedure that caused the highest rate of adverse events was "decompression of spinal cord and nerve roots" (code ABC**), with 168 adverse events of 17,507 hospitals discharges (1%). One in five (36 of 168; 21.4%) injured patient was seriously disabled or died. We conclude that patients undergoing spinal surgery run the highest risk of being severely injured and that these patients also experienced a high degree of serious disability. The most common adverse event was related to hospital acquired infections. Claims data obtained in a no-fault system have a high potential for identifying adverse events and learning from them.
    Patient Safety in Surgery 01/2012; 6(1):2. DOI:10.1186/1754-9493-6-2
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