February 24, 2022

A retrospective study of closed medical professional liability (MPL) claims involving adult patients cared for in emergency departments (ED) and urgent care settings from the Medical Professional Liability Association’s Data Sharing Project database from 2001 through 2015 identified 6,779 closed claims. The available data included the total amount, origin, top medical specialties named, chief medical factors, top medical conditions, severity of injury, resolution, average indemnity, and defense costs of closed claims.

Of 135,490 MPL claims and lawsuits closed between 2001–2015, 6,779 (5%) involved adult patients over 18 years old in a US hospital-based ED or ambulatory urgent care setting. The ED represented 5.2% of adult claims from all facilities, and urgent cares represented 0.9% of claims. Of hospital-based origins, the ED was the third most common origin (9.1%) for a claim, following operating rooms (40.7%) and inpatient rooms (15.8%).

The study found: “Of 6,779 closed claims, 65.9% were dropped, withdrawn, or dismissed. Another 22.8% of claims settled for an average indemnity of $297,709. Of the 515 (7.6%) cases that went to trial, juries returned verdicts for the defendant in 92.6% of cases (477/515). The remaining 7.4% of cases (38/515) were jury verdicts for the plaintiff, with an average indemnity of $816,909. The most common resulting medical condition cited in paid claims was cardiac or cardiorespiratory arrest (10.4%). Error in diagnosis was the most common chief medical error cited in closed claims. Death was the most common level of severity listed in closed (38.5%) and paid (42.8%) claims. Claims reporting major permanent injury had the highest paid-to-closed ratio, and those reporting grave injury had the highest average indemnity of $686,239.”

“For the 27.1% of closed MPL claims culminating in an indemnity payment (trial verdicts, verdicts for the plaintiff, ADR/contracts, and unknown), the resulting medical conditions most commonly cited were cardiac or cardiorespiratory arrest (9.1%), acute myocardial infarction (4.0%), aortic aneurysm (2.3%), pulmonary embolism (2.2%), and appendicitis (2.0%). Of these, acute myocardial infarction had the highest paid-to-closed ratio with 39% resulting in a payment. Claims for aortic aneurysms generated the highest average indemnity of $369,872 per claim.”

The American Medical Association found that 8.7% of respondents in emergency medicine faced a MPL claim in the prior year alone, and it is estimated that over 75% of EPs will be named in a malpractice suit by the end of their career. The average time to resolution is 16.7 months per claim. Compared to other specialties where physicians may avoid caring for high-risk patients in order to mitigate medical liability, EPs are limited in their ability to choose their patient population.

A survey of EPs’ most recent act of defensive medicine found that 63% of respondents ordered imaging (CT, MRI, or radiograph) that was not clinically indicated. Over-testing and over-imaging is not without risk either; one MPL study of imaging in the ED found that 37% of diagnostic errors resulting in patient harm involved the misinterpretation of diagnostic testing, with plain radiographs being the most common at 52%.

Emergency medicine was the most commonly named specialty in the study, followed by internal medicine, family practice, radiology, and general surgery.

Source

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