PEDIATRICS Vol. 99 No. 5 May 1997,
p. e10
Copyright ©1997 by the American Academy of Pediatrics
ELECTRONIC ARTICLE:
Physicians' Experience With Allegations of Medical Malpractice
in the Neonatal Intensive Care Unit
Received Jan 19, 1996; accepted Oct 1, 1996.
,, §
From the * Department of Pediatrics, MacLean Center for
Clinical Medical Ethics, § La Rabida Children's Hospital, The
University of Chicago, Chicago, Illinois.
Objective. To assess the personal experience of all practitioners of neonatal intensive care unit (NICU) medicine in the United States with the medical malpractice system; in particular, to assess the circumstances of malpractice allegations in which they themselves had personal experience, and to extrapolate from their individual experiences to the field of neonatology in general.
Design. Written survey of all MDs practicing NICU medicine in the US.
Participants. Two thousand four hundred ninety-eight NICU physicians as determined from three sources: a) the American Board of Medical Specialists; b) the American Academy of Pediatrics Section of Neonatal/Perinatal Medicine; and c) a listing of neonatologists provided by Ross Laboratories.
Main Outcome Measures. Responses to survey questions.
Results. We received 1813 responses, representing ~75%
of all physicians practicing NICU medicine in the US. Overall, 43% of
respondents had experienced at least one claim of malpractice against
them. The probability of a malpractice allegation increased with years
in practice, from ~20% for NICU physicians in practice 
5 years
(65/337), to ~60% for NICU physicians in practice >15 years
(276/469). Men and women were equally likely to have been sued,
accounting for years in practice. Physicians practicing in community
NICUs were more likely to be sued than those in university settings. On
a scale of 1 to 4 (4 being most reasonable) the median assessment of
the reasonableness of malpractice allegations was 1, mean 1.2. On a
scale of 1 to 4 (4 being the highest) the median assessment of
effectiveness of the current system in identifying true malpractice was
1, mean 1.4. The respondents believed that approximately 80% of
malpractice allegations were inappropriate; conversely, they believed
that approximately 80% of true medical malpractice escaped detection.
On a scale of 1 to 4 (4 being the highest), the median assessment of
the detrimental effect of the present malpractice system on health care
was 4, mean 3.4.
Conclusions. Most NICU physicians will be sued if they practice long enough. In this context, efforts to use malpractice claims to seek out evildoers (such as underlie the National Practitioners Data Bank) appear ill-conceived. Similarly, exhortations for physicians to become either more educated or more sensitive are unlikely to reduce malpractice claims. Our data suggest that malpractice in the NICU appears to function more like a lottery than like a mechanism for either quality assurance or just retribution. medical malpractice, NICU, standard of care, neonatologists.
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