MEDICAL MALPRACTICE

A recent summary of the now considerable discussion of medical malpractice is:

David M. Studdert, Michelle M. Mello, and Troyen A Brennan. "Medical Malpractice." New England Journal of Medicine (NEJM) 350;3: 283-92.

Following are quotes from this article:

"Malpractice law is part of (for further information) tort, or personal-injury, law. To prevail in a tort lawsuit, the plaintiff must prove that the defendant owed a duty of care to the plaintiff, that the defendant breached this duty by failing to adhere to the standard of care expected, and that this breach of duty caused an injury to the plaintiff."

"There are three social goals of malpractice litigation: to deter unsafe practices, to compensate persons injured through negligence, and to exact corrective justice."

"Until 30 years ago, little was known about the epidemiology of medical malpractice or how well the system carried out its theoretical functions. In 1973, an influential government inquiry into medical malpractice led to the first efforts to evaluate the system's efficacy from an epidemiologic perspective."

This was DHEW's publication no. (OS) 73-88.

In 1977 the California medical and hospital associations published the report on their "Medical Insurance Feasibility Study." The NEJM article goes on to say:

"The Medical Insurance Feasibility Study reviewed nearly 21,000 medical records from 23 California hospitals. The study showed that 4.6 percent of hospitalizations involved iatrogenic injury, and 0.8 percent (1 in 126 admissions) involved injuries that medicolegal experts thought would probably give rise to a finding of negligence in court. A comparison of the negligent injuries with the frequency of malpractice claims in California showed a wide gulf: the former outstripped the latter by a factor of 10. This key finding provided an explanation for episodic increases in claims rates. The existence of a huge reservoir of injuries meant that plaintiffs' attorneys could raise or lower the rate of claims at any given time, depending on their business decisions and the permissiveness of the legal environment."

The article goes on to report on a larger Harvard study in New York published in 1990:

"The reviewers found rates of adverse events and negligent adverse events (3.7 percent and 1.0 percent, respectively) that were remarkably close to those in California. Extrapolations from these rates produced alarming estimates . . .that negligent care caused approximately 20,000 disabling injuries and 7,000 deaths in New York hospitals in 1984. Overall, there were 7.6 times as many negligent injuries as there were claims."

"(I)t was the matching of specific claims to specific injuries in New York that threw the troubling relationship between malpractice claims and injuries into sharp relief. Only 2 percent of negligent injuries resulted in claims, and only 17 percent of claims appeared to involve a negligent injury. . . . In a third study conducted in Utah and Colorado in the late 1990s the injury rates detected were similar to those in New York."

For further information, note that the Institute of Medicine's (IOM) reports on patient safety, build upon the New York and Colorado/Utah studies referred to here and were the basis for the IOM's estimates of 44,000 (based upon the Colorado/Utah study) to 98,000 (based upon the New York study) deaths per year because of medical errors in hospitals.