The Doctors Company, which is the largest physician-owned medical malpractice insurer in the United States, analyzed 1,215 written demands for payment (medical malpractice claims) filed on behalf of pediatric patients that closed from 2008 through 2017. The study included all medical malpractice claims and lawsuits against physicians in medical and surgical specialties in 52 specialties and medical subspecialties but excluded dentists and oral surgeons.
The study found that obstetricians were most frequently involved with neonatal patients. Pediatricians, orthopedic surgeons, emergency medicine physicians, and family medicine physicians were most frequently named as defendants in claims filed on behalf of children older than one month of age. The top 10 physician specialties named as defendants represented 72 percent of all pediatric patient claims.
Of the 1,215 claims in the study, 446 (37 percent) resulted in a payment to the claimant. The median indemnity payment was $250,000 and the median expense to defend these claims was $99,984. Neonates had the highest mean indemnity ($936,843) and median indemnity payment ($300,000), and the highest mean expense ($187,117) and the highest median expense ($119,311).
76.7 percent of the pediatric medical malpractice claims were filed within three years of the event. 85.1 percent of the pediatric medical malpractice claims had been filed by five years, 96.7 percent of the claims were filed within ten years, and 1.9 percent of the claims were filed 11 through 15 years after the patient was harmed. Only 1.1 percent of pediatric malpractice claims were filed 16 through 20 years after the event.
The study found that children less than one year of age experienced high-severity injuries at almost twice the rate of children older than one year. Children older than one year experienced more injuries from trauma, communicable disease, and malignancies. Teenagers experienced trauma and illness, and teenaged females may also face the dangers of pregnancy and childbirth.
Location, Location, Location
The study found that neonates were most often treated in labor and delivery (60 percent) and a physician’s office or clinic (14 percent). Children in their first year were most often treated in a physician’s office or clinic (45 percent) or a hospital room (14 percent). Children ages one through nine years received most treatment in their physician’s office or clinic (37 percent) or in the emergency department (14 percent). Teenagers received their care most often in a physician’s office or clinic (40 percent), ambulatory surgery (16 percent), and emergency department (12 percent).
The most common patient injury was to the brain (neonates – 48%; first year of life patients – 36%; children ages one through nine – 15%; teenagers – 11%).
Patient deaths occurred in 13 percent of claims filed for neonatal patients, 30 percent for patients in their first year of life, 15 percent for children ages one through nine, and 13 percent for teenaged patients. The study found that younger patients suffer high-severity injuries at a higher rate (neonate: 75 percent; first year: 65 percent) compared with older patients (child: 44 percent; teenager: 32 percent).
The most common allegation for neonates was obstetrics-related treatment for injuries that occurred during labor and delivery (63 percent). Diagnosis-related allegations were the most common allegation in all but the neonate age group: age groups older than neonates experienced diagnosis-related claims in 34 to 44 percent of all claims and lawsuits in their age group. In older age groups, the most common diagnoses in cases with a diagnosis-related allegation included fractures and dislocations, malignant neoplasms (brain, mediastinum, eye, genital organs, skin, lymph nodes, etc.), torsion of testis, meningitis, pneumonia, acute appendicitis, viral and bacterial infections (MRSA and septicemia, for example), and cardiac conditions. For pediatric patients other than neonates, allegations related to diagnosis (failure, delay, or wrong) have remained high each year, ranging from 29 percent to 47 percent over 10 years.
The two most common factors contributing to neonatal patient injuries were selection and management of therapy (39 percent) and patient assessment issues (37 percent). Selection and management of therapy refers to clinical decisions related to delivery: vaginal, operative vaginal, and cesarean section.
In children older than neonates, issues involving patient assessment were the most common factor contributing to patient harm (36 to 42 percent of the claims in each age group). In these cases, inadequate assessments were often identified by physician experts in cases with incorrect diagnoses. Important information was not collected or was not factored into the diagnosis.
Communication breakdowns between patients/families and providers occurred in 15 to 22 percent of pediatric patient claims, depending on the age group. System failures accounted for a significant number of patient injuries. Failing to track orders for diagnostic tests resulted in lost test results. Failing to call critical test results or diagnostic findings to treating physicians delayed treatments.
If your child may have been injured due to medical malpractice in the United States, you should promptly find a medical malpractice lawyer in your state who may investigate your pediatric malpractice claim for you and represent you and your child in a pediatric medical malpractice case, if appropriate.
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