The Doctors Company, which is the largest physician-owned medical malpractice insurer in the United States, recently released its analysis of 464 medical malpractice claims against hospitalists that the insurer closed from 2007 through 2014. The study included all claims and medical malpractice lawsuits in which a hospitalist was named as a defendant. The Doctors Company insures more than 2,100 hospitalists in the United States.
According to the Society of Hospital Medicine, a hospitalist is a practitioner who is engaged in clinical care, teaching, research, and/or leadership in the field of hospital medicine, and includes physicians, nurse practitioners and physician assistants. Source
Seventy-eight percent (78%) of all medical malpractice claims against hospitalists included the three most common medical malpractice allegations: diagnosis-related claims (failure to diagnose, delay in diagnosis, and wrong diagnosis), improper management of treatment, and medication-related error.
Diagnosis-Related Claims Against Hospitalists
Thirty-six percent (36%) of the medical malpractice claims against hospitalists involved diagnosis-related claims. The conditions that most commonly involved incorrect or delayed diagnosis included intestinal disorders (16%), cerebral artery occlusion and acute cerebral vascular accident (7%), acute myocardial infarction and cardiac arrest (6%), sepsis and toxic shock syndrome (5%), pulmonary embolism (5%), spinal epidural abscess (4%), lung cancer (4%), viral and bacterial pneumonia (3%), subacute and acute endocarditis (3%), and aortic dissection or aneurysm (3%).
The study’s reviewers found that 35% of these claims resulted from an inadequate initial assessment, which decreased the chance that the hospitalist would arrive at the correct diagnosis.
Improper Management Of Treatment Claims Against Hospitalists
Improper management of treatment claims relate to decisions regarding patient care after diagnosis. Some of these claims against hospitalists involved allegations that the patient was not assessed or managed for an excessive period of time. Such claims included inadequate assessment of foot and decubitus ulcers that resulted in sepsis and inadequate management of diabetic patients that resulted in ketoacidosis, pyelonephritis, DIC, and loss of lower extremities.
Medication-Related Claims Against Hospitalists
These claims arose in various situations, including sepsis or the loss of a limb from the lack of antibiotics, respiratory failure due to excessive doses of narcotics, venous thrombosis in patients with risk factors for thrombosis that were not addressed, retroperitoneal hematomas and bleeding from various sites from failure to discontinue anticoagulant prior to surgery, and toxicity from a failure to monitor medications.
Factors Contributing To Patient Injury
Thirty-five percent (35%) of the medical negligence claims against hospitalists leading to patient harm involved inadequate patient assessment issues, such as failure to establish a differential diagnosis, failure or delay in ordering diagnostic tests, and failure to consider available clinical information, such as lab values, diagnostic tests, nursing observations, and patient symptoms.
Twenty-three percent (23%) of the medical negligence claims against hospitalists involved communication among providers (when important information regarding a patient was not communicated to other providers, causing harm to the patient), resulting in lack of coordination of care.
Sixteen percent (16%) of the medical negligence claims against hospitalists involved selection and management of treatment and medications, including the failure to order any medication, the failure to order the most appropriate medication, and ordering the wrong medication.
The study found that medical malpractice claims against hospitalists are more likely to have a higher injury severity than claims against other physician specialties because hospitalists manage high-acuity patients, they have limited access to the past medical histories of patients, and their patients often have serious medical conditions. Additionally, hospitalists are often faced with situations that require thorough assessments, comprehensive testing, quick diagnoses, timely referrals, and rapid initiation of treatment.
The study concluded that there are a variety of causes of patient harm: in some cases, hospitalists failed to follow protocols and in other cases, the patient’s presentation was not typical and did not point to a specific diagnosis. The study found that the largest number of medical malpractice claims against hospitalists revealed weaknesses in the systems and processes used by members of the healthcare team.
If you or a loved one may have been injured as a result of the medical negligence of a hospitalist, you should promptly consult with a local medical malpractice attorney in your U.S. state who may investigate your hospitalist negligence claim for you and file a hospitalist medical malpractice claim on your behalf, if appropriate.
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