Published online July 2, 2007
PEDIATRICS Vol. 120 No. 1 July 2007, pp. 173-174 (doi:10.1542/peds.2007-0632)

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COMMENTARY

Pediatricians and Medical Malpractice

Steven M. Donn, MD, FAAP^a,b and Gary McAbee, DO, JD, FAAP, FACOP, FCLM^b,c

^a Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan Health System, Ann Arbor, Michigan
^b American Academy of Pediatrics Committee on Medical Liability and Risk Management
^c Department of Pediatrics (Neurology), Robert Wood Johnson School of Medicine, Camden, New Jersey

The recent Pediatrics articles by Carroll and Buddenbaum¹ and Kain and Caldwell-Andrews² analyzed pediatric medical malpractice claims from 2 important sources: the Physician Insurers Association of America data-sharing project and the National Practitioner Data Bank. The authors themselves note the limitations of these data, yet there are important aspects of the litigation process that can be gleaned from this work.

Pediatricians should not avoid perusing these types of articles. Because the law is based on precedent, an important risk-management technique is for the practitioner to be aware of the reasons for being sued (eg, errors in diagnosis), the medical conditions that place them at the highest risk for being sued, and the amounts of indemnity being paid so that adequate malpractice insurance is maintained. This information is important in implementing effective risk-management techniques to not only minimize the risk of being sued but also to result in improved patient safety. Anesthesiologists were one of the first groups to analyze their high rate of malpractice lawsuits by focusing on patient safety while assessing why lawsuits occurred. This resulted in the institution of strict internal standards and organized initiatives, with a dramatic reduction in number of lawsuits and indemnity paid (20th lowest of 28 specialties in median indemnity paid).³

These data also demonstrate issues that are relevant to effective tort reform. Over the 20-year period (1985–2005), 67% to 80% (mean: 72%) of lawsuits were either dropped or settled without payment. Although the defense costs were lower than in cases in which payments were made, the total costs involved in these unsuccessful lawsuits are staggering. Better efforts to monitor these cases (eg, oversight of expert witnesses) might result in significant savings. Furthermore, it takes 5 years to settle a pediatric malpractice case, and 54% of cases settle for less than $100000. For these reasons, alternative dispute-resolution systems should be studied. One apparently successful approach bypasses the litigation process by instituting procedures with which mistakes are acknowledged, apologies are made, and settlements are paid internally.⁴

Only 6% of cases involved "no medical misadventure," which suggests that frivolous lawsuits uncommonly result in payment to the plaintiff. This confirms what others⁵ have found, and this information should be disseminated to the legal community.

The enlightening news from the Physician Insurers Association of America study is that only 5% of cases go to trial (and verdict), and only 20% result in a plaintiff verdict. This should assuage some of the emotional burden of pediatrician defendants, because most lawsuits are not likely to become publicized, and details can be maintained within the practice or hospital setting.

Unfortunately, medical malpractice lawsuits have become part of professional life. Lawsuits are not uncommon in business, and they are a burden that will continue to occur as part of the business end of medical practice. Our tort system is outcomes based and, as such, practitioners will continue to be sued. Tort reform is only a partial solution. Perhaps a better approach would be focusing on patient safety and quality improvement while simultaneously using sound risk-management principles; communicating effectively among providers, patients and families; and improving medical chart documentation.

	FOOTNOTES

 
Accepted Mar 1, 2007.

Address correspondence to Steven M. Donn, MD, FAAP, F5790 C.S. Mott Children's Hospital/0254, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0254. E-mail: smdonnmd{at}med.umich.edu

The authors have indicated they have no financial relationships relevant to this article to disclose.

Opinions expressed in these commentaries are those of the authors and not necessarily those of the American Academy of Pediatrics or its Committees.

	REFERENCES

TOP REFERENCES

 

1. Carroll AE, Buddenbaum JL. Malpractice claims involving pediatricians: epidemiology and etiology. Pediatrics. 2007;120 :10 –17[Abstract/Free Full Text]
2. Kain ZN, Caldwell-Andrews AA. What pediatricians should know about child-related malpractice payments in the United States. Pediatrics. 2006;118 :464 –468[Abstract/Free Full Text]
3. Pierce EC Jr. Looking back on the anesthesia critical incident studies and their role in catalysing patient safety. Qual Saf Health Care. 2002;11 :282 –283[CrossRef][Medline]
4. Boothman RC. Apologies and a strong defense at the University of Michigan Health System. Physician Exec. 2006;32 :7 –10[Medline]
5. Studdert DM, Mello MM, Gawande AA, et al. Claims, errors and compensation payments in medical malpractice litigation. N Engl J Med. 2006;354 :2024 –2033[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Donn, S. M. Articles by McAbee, G. Search for Related Content PubMed Articles by Donn, S. M. Articles by McAbee, G. Related Collections Office Practice Social Bookmarking                         What's this?