President's Message - Let's Get Off the Pot!

A. Allen Seals, M.D., President
 

A recent review of medical malpractice data clearly shows that the claims are steadily becoming more severe, and we had best prepare ourselves for the next medical malpractice crisis. The extent of the pending crisis depends on how well we respond to the indicators, and how fast organized medicine mounts an aggressive organized comprehensive plan of action. We cannot afford to sit back and allow the situation to reach the crisis stage of the 80's. We must be proactive now and not reactive sometime in the near future. The issue of medical malpractice must be elevated to a top priority NOW.

Cliff Rapp, LHRM, Director of Risk Management, Southern Region for ProNational Insurance Company, has analyzed recent medical malpractice data and provides us with the following report which begins to build the case for our discussion.

PIAA Claim Trend Analysis

The recently published Physicians Insurers Association of America (PIAA) Claim Trend Analysis provides a comprehensive analysis of medical malpractice data. Compiled from 146,000 closed malpractice claims and suits reported by more than 20 professional liability insurers, the PIAA study proves insightful from a risk management standpoint given its identification of claim trends and payment patterns. Over 30 major medical and dental specialties comprise the closed claim data, which spans a 14-year period since 1985.

Claim Trend Analysis by Year

The average indemnity paid on behalf of physicians in 1998 was $240,914, a 30% increase in the average indemnity paid in 1993. An indemnity payment was made on behalf of the practitioner in over 31% of the claims closed in 1998. The average cost to defend these claims was $34,800, more than twice the average cost 10 years ago. Even after adjusting for inflation, both indemnity and expense payments have risen 37% and 57%, respectively, over the last decade. Perhaps the most telling trend is that of median payment value of paid claims, which has risen to $125,000 from $49,000 in 1988.

Comparative Payment by Specialty

Fifty-four percent of all paid claims closed between 1996 and 1998 had an indemnity payment of $100,000 or more. The highest average indemnity during that period was for neurology, at $376,800. Oral surgery had the lowest average indemnity, at $14,476. As a medical specialty, OB/GYNs had the most closed and paid claims cumulatively since 1985, followed by internal medicine, family practice, and general surgery.

Comparative Payment Analysis by Year

The percentage of $1,000,000 claims has increased from 0.64% in 1995 to 4.57% in 1998. Indemnity payments of $500,000 or more increased from 3.74% in 1985 to 15.34% in 1998. Even after adjusting for inflation, a larger percentage of claims resulted in payment of $1,000,000 or more in 1998 than in any previous year.

Claims by Adjudication Status

Since 1985, less than 7% of claims were adjudicated by way of a verdict. However, of those cases, a jury found in favor of the physician 81% of the time. In 1998, almost 84% of the cases tried resulted in a defense verdict. Of those cases in which the plaintiff prevailed in 1998, the average payment was $390,900. The average cost to defend such cases through trial was $83,600. Over 93% of malpractice claims closed between 1985 and 1998 were dismissed, withdrawn or dropped. Of these, payment was made in 32% of the claims. Since 1985, less than 2% of cases were resolved by alternative means such as medication or arbitration.

Most Prevalent Medical Conditions

The top five medical conditions presented to physicians at the time of the alleged incident were breast cancer, neurologically impaired newborns, pregnancy, and acute myocardial infarction. Of these, claims involving neurologically impaired newborns had the highest average indemnity payment at $473,600.

Most Prevalent Medical Misadventures

The most prevalent medical misadventure was an improperly performed procedure. More than 26% of the claims included improper performance of a procedure as the primary allegation. Errors in diagnosis, failure to supervise or monitor the case, and medication errors were also among the top medical misadventures in claims closed between 1985 and 1998. Of these medical misadventures, diagnostic errors resulted in the highest median indemnity paid at $290,000. However, claims alleging a failure to supervise or monitor were the most expensive to defend, had the highest average indemnity, and resulted in the greatest number of patient deaths.

Further information regarding the PIAA Claim Trend Analysis study may be obtained by contacting Emily Odenwald at ProNational's Risk Management Department, 1-800-282-1036, ext 6228.

November, 2000/ Jacksonville Medicine

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