Studdert DM, Mello MM, Gawande AA, Gandhi TK, Kachalia A, Yoon C, Puopolo AL, Brennan TA, et al.
The New England journal of medicine. Date of publication 2006 May 11;volume 354(19):2024-33.
1. N Engl J Med. 2006 May 11;354(19):2024-33. doi: 10.1056/NEJMsa054479.
Claims, errors, and compensation payments in medical malpractice litigation.
Studdert DM(1), Mello MM, Gawande AA, Gandhi TK, Kachalia A, Yoon C, Puopolo AL,
Brennan TA.
Author information:
(1)Department of Health Policy and Management, Harvard School of Public Health,
Boston, MA 02115, USA. studdert@hsph.harvard.edu
Comment in
N Engl J Med. 2006 Aug 17;355(7):734-5; author reply 736. doi:
10.1056/NEJMc061571.
N Engl J Med. 2006 Aug 17;355(7):735; author reply 736.
N Engl J Med. 2006 Aug 17;355(7):735; author reply 736.
BACKGROUND: In the current debate over tort reform, critics of the medical
malpractice system charge that frivolous litigation--claims that lack evidence
of injury, substandard care, or both--is common and costly.
METHODS: Trained physicians reviewed a random sample of 1452 closed malpractice
claims from five liability insurers to determine whether a medical injury had
occurred and, if so, whether it was due to medical error. We analyzed the
prevalence, characteristics, litigation outcomes, and costs of claims that
lacked evidence of error.
RESULTS: For 3 percent of the claims, there were no verifiable medical injuries,
and 37 percent did not involve errors. Most of the claims that were not
associated with errors (370 of 515 [72 percent]) or injuries (31 of 37 [84
percent]) did not result in compensation; most that involved injuries due to
error did (653 of 889 [73 percent]). Payment of claims not involving errors
occurred less frequently than did the converse form of inaccuracy--nonpayment of
claims associated with errors. When claims not involving errors were
compensated, payments were significantly lower on average than were payments for
claims involving errors (313,205 dollars vs. 521,560 dollars, P=0.004). Overall,
claims not involving errors accounted for 13 to 16 percent of the system's total
monetary costs. For every dollar spent on compensation, 54 cents went to
administrative expenses (including those involving lawyers, experts, and
courts). Claims involving errors accounted for 78 percent of total
administrative costs.
CONCLUSIONS: Claims that lack evidence of error are not uncommon, but most are
denied compensation. The vast majority of expenditures go toward litigation over
errors and payment of them. The overhead costs of malpractice litigation are
exorbitant.
Copyright 2006 Massachusetts Medical Society.
DOI: 10.1056/NEJMsa054479
PMID: 16687715 [Indexed for MEDLINE]
