The National Practitioner Data Bank and Anesthesia Malpractice Payments

Medico-legal liability of injuries arising from laryngoscopy

OBJECTIVE

Dental and mucosal injuries from laryngoscopy in the peri-operative period are common medico-legal complaints. This study investigated lawsuits arising from laryngoscopy.

METHODS

Westlaw, a legal database containing trial records from across the USA, was retrospectively reviewed. Plaintiff and/or defendant characteristics, claimed injuries, legal outcomes and awards were extracted.

RESULTS

Of all laryngoscopy-related dental or mucosal injuries brought before a state or federal court, none (0 per cent) resulted in a defence verdict against the provider or monetary gain for the patient. Rulings in the patient's favour were observed only when laryngoscopy was found to be the proximate cause of multiple compounding complications that culminated in severe medical outcomes such as exsanguination, septic shock or cardiopulmonary arrest.

CONCLUSION

Proper laryngoscopy technique and a robust informed-consent process that accurately sets patients' expectations reduces litigation risk. Future litigation pursuits should consider the low likelihood of malpractice allegation success at trial.

Catastrophic Medical Malpractice Payouts in Spain

Patient safety and professional liability are major concerns worldwide. Despite the pervasive influence of catastrophic malpractice payouts, little is known about the specific characteristics and the overall relevance and characteristics of these payouts, especially outside U.S. borders. Five hundred fifty claims led to a payout among 2,236 claims from January 1, 2004 to December 31, 2010, in Catalonia (Spain). We analyzed data on patient, provider, and claim characteristics. Accordingly to our sample, Spanish catastrophic payouts (SCP) were defined as payouts over &OV0556;200,000, which was found in 32 cases (5.8%). Diagnostic errors and patient death were not as relevant as previously reported. However, it is remarkable that the literature emanating from different countries shows similar trends besides contextual differences: patients suffering minor injuries are not likely to receive a catastrophic payout, catastrophic payouts are associated with patient age less than one; SCP are most associated with anesthesiology and resuscitation, general surgery, and obstetrics and gynecology; and SCP were more likely to occur when a case went to trial compared to when a case was settled out of court. Studies, such as this, provide a wider picture of the medical liability worldwide reality and helps avoiding isolated discourses.

25-Year summary of US malpractice claims for diagnostic errors 1986-2010: an analysis from the National Practitioner Data Bank

BACKGROUND

We sought to characterise the frequency, health outcomes and economic consequences of diagnostic errors in the USA through analysis of closed, paid malpractice claims.

METHODS

We analysed diagnosis-related claims from the National Practitioner Data Bank (1986-2010). We describe error type, outcome severity and payments (in 2011 US dollars), comparing diagnostic errors to other malpractice allegation groups and inpatient to outpatient within diagnostic errors.

RESULTS

We analysed 350 706 paid claims. Diagnostic errors (n=100 249) were the leading type (28.6%) and accounted for the highest proportion of total payments (35.2%). The most frequent outcomes were death, significant permanent injury, major permanent injury and minor permanent injury. Diagnostic errors more often resulted in death than other allegation groups (40.9% vs 23.9%, p<0.001) and were the leading cause of claims-associated death and disability. More diagnostic error claims were outpatient than inpatient (68.8% vs 31.2%, p<0.001), but inpatient diagnostic errors were more likely to be lethal (48.4% vs 36.9%, p<0.001). The inflation-adjusted, 25-year sum of diagnosis-related payments was US$38.8 billion (mean per-claim payout US$386 849; median US$213 250; IQR US$74 545-484 500). Per-claim payments for permanent, serious morbidity that was 'quadriplegic, brain damage, lifelong care' (4.5%; mean US$808 591; median US$564 300), 'major' (13.3%; mean US$568 599; median US$355 350), or 'significant' (16.9%; mean US$419 711; median US$269 255) exceeded those where the outcome was death (40.9%; mean US$390 186; median US$251 745).

CONCLUSIONS

Among malpractice claims, diagnostic errors appear to be the most common, most costly and most dangerous of medical mistakes. We found roughly equal numbers of lethal and non-lethal errors in our analysis, suggesting that the public health burden of diagnostic errors could be twice that previously estimated. Healthcare stakeholders should consider diagnostic safety a critical health policy issue.

An analysis of risk factors for patient complaints about ambulatory anesthesiology care

BACKGROUND

Anesthesiology groups continually seek data sources and evaluation metrics for ongoing professional practice evaluation, credentialing, and other quality initiatives. The analysis of patient complaints associated with physicians has been previously shown to be a marker for patient dissatisfaction and a predictor of malpractice claims. Additionally, previous studies in other specialties have revealed a nonuniform distribution of complaints among professionals. In this study, we describe the distribution of complaints among anesthesia providers and identify factors associated with complaint risk in pediatric and adult populations.

METHODS

We performed an analysis of a complaint database for an academic medical center. Complaints were recorded as comments during postoperative telephone calls to ambulatory surgery patients regarding the quality of their anesthesiology care. Calls between July 1, 2006 and June 30, 2010 were included. Risk factors were grouped into 3 categories: patient demographics, procedural, and provider characteristics.

RESULTS

A total of 22,871 calls placed on behalf of 120 anesthesiologists were evaluated, of which 307 yielded a complaint. There was no evidence of provider-to-provider heterogeneity in complaint risk in the pediatric population. In the adult population, an unadjusted test for the random intercept variance component in the mixed effects model pointed toward significant heterogeneity (P = 0.01); however, after adjusting for a prespecified set of risk factors, provider-to-provider heterogeneity was no longer observed (P = 0.20). Several risk factors exhibited evidence for complaint risk. In the pediatric patient model, risk factors associated with complaint risk included a 10-year change in age, the use of general anesthesia (versus not), and a 1-hour change in the actual minus scheduled start times. Odds ratios were 1.47 (95% confidence interval (CI), 1.04-2.08), 0.22 (95% CI, 0.07-0.62), and 1.27 (95% CI, 1.10-1.47), respectively. In the adult patient model, risk factors associated with complaint risk included male gender, general anesthesia, a 10-year change in provider experience, and speaking with the patient (rather than a family member). Odd ratios were 0.66 (95% CI, 0.47-0.92), 0.67 (95% CI, 0.47-0.95), 1.18 (95% CI, 1.01-1.38), and 1.96 (95% CI, 1.17-3.29), respectively.

CONCLUSIONS

There was apparent evidence in adult patients to suggest heterogeneity in provider risk for a patient complaint. However, once patient, procedural, and provider factors were acknowledged in analyses, such evidence for heterogeneity is diminished substantially. Further study into how and why these factors are associated with greater complaint risk may reveal potential interventions to decrease complaints.

[Dental trauma and anaesthesiology: epidemiology and insurance-related impact over 4 years in Rouen teaching hospital]

OBJECTIVES

Dental injuries are the first cause of sinistrality in anaesthesiology. However, few insurance-related data are available concerning the publicly-owned establishments, in particular on the cost of the complaints deposited. We studied the epidemiology of dental trauma in a teaching hospital and brought it closer to the induced insurance-related costs.

PATIENTS AND METHODS

We conducted a retrospective study, examining the files of declaration of dental trauma, from January 2005 to December 2008. The litigations for dental injuries treated by Quality and Services Department were also analysed.

RESULTS

Seventy-two cases of dental lesions were declared, i.e. 1/1528 general anaesthesias. Concerning the risk factors of lesion, 47 patients (65%) presented bad dental conditions identified during the pre-anaesthetic consultation; 27 patients (37%) had criteria for difficult intubation listed on the sheet of anaesthesia. The association of the 2 factors was found among 20 patients. The indication of information to the patient on the dental risk was registered on the sheet of anaesthesia in 17% of cases. The Quality and Services Department recorded 23 complaints for dental trauma over the period. In 4 cases the complaint was followed by a compensation for an average amount equal to 608 (256-1002) Euros, i.e., a total cost of 2434 Euros.

CONCLUSIONS

The two main risk factors of dental lesion are well identified with the consultation of anaesthesia and are noted on the file. However, information to the patient on this risk is seldom notified. The incidence of dental lesions is important, but few complaints open right to financial repair for a very low insurance-related total amount.

Adverse action reports against optometrists: perspectives from the National Practitioner Data Bank over 18 years

PURPOSE

The aim of this analysis is to describe characteristics of National Provider Data Bank (NPDB) adverse action reports against optometrists.

METHODS

NPDB public use files were analyzed for details of reported optometrist adverse actions from 1991 through 2008. Types of actions, basis for actions, and reporting source were identified, along with geographic and demographic data.

RESULTS

Between 1991 and 2008, a total of 216 adverse actions against optometrists were recorded nationally. Exclusion from Medicare or another government program accounted for 92% of all reports; the remaining 8% were related to unfavorable privileging decisions. Most cases with identifiable explanations were the result of either defaults on student loans (55%) or charges of fraud and abuse (39%). Over two thirds of all reports originated in just 12 states, and 74% involved younger optometrists (age 30 to 49). Repeat offenses were reported for 38% of sanctioned optometrists.

CONCLUSION

NPDB reported adverse actions against optometrists are infrequent but most commonly involve exclusion from Medicare or similar government programs. Student loan default, particularly by younger optometrists, is the single most common cause, followed by allegations of fraud and abuse. Because this national database is permanently archived and widely used by licensing and credentialing bodies, optometrists should endeavor to be ethically responsible and strive to avoid behaviors that mandate such action reports.

Stability and infrequency of radiologic technologist malpractice payments: an analysis of the National Practitioner Data Bank

PURPOSE

The aim of this study was to describe characteristics and trends of radiologic technologist (RT) malpractice payments.

METHODS

National Practitioner Data Bank data files were analyzed for details of RT malpractice payments from 1991 through 2008. Payment amounts, sources, and allegations were all identified and summarized, along with geographic and demographic data.

RESULTS

Between 1991 and 2008, a total of 155 RT malpractice payments were reported nationally, ranging from $750 to $11.5 million (median, $57,500; mean, $293,655 +/- $1,305,091), with 153 (99%) <$1 million. Adjusting for outliers and inflation, payments changed little over the 18-year interval. More than half of all cases originated in 8 states, with per capita payments most common in Louisiana and New Jersey. Alleged errors in diagnosis accounted for one third of all cases.

CONCLUSION

Malpractice payments on behalf of RTs are very infrequent (on average, <9 nationally each year) and usually relatively small (almost half <$50,000). Frequency and mean adjusted payment have remained stable over nearly two decades, likely related in part to "deep pocket" shielding by hospitals and radiologists.

Medical malpractice in gastroenterology

BACKGROUND & AIMS

Gastroenterologists commonly perceive themselves to be at increased legal risk because they perform invasive procedures. However, there is little published information about gastroenterology (GI) malpractice claims. The goal of this study was to evaluate available malpractice claim data within GI.

METHODS

This study was a database analysis of GI claims submitted by insurance companies to the Physician Insurers Association of America Data Sharing Project from January 1, 1985, to December 31, 2005. Another analysis from 2005 compared GI claims with other subspecialties.

RESULTS

Sixty-six percent of physicians involved in claims had previous claims experience. The most common reasons for claims were errors in diagnosis (28%) and improper performance of a procedure (25%). Seventy-two percent of reported closed claims were settled out of court. Of 12,367 total claims in 2005, only 233 (1.8%) were within GI. GI ranked below other procedurally based subspecialties in numbers of claims per physician.

CONCLUSIONS

GI does not rank highly among subspecialties in malpractice claims and only a minority of claims are procedure-related. Physicians with claims experience are likely to have further claims against them and should consider evaluating their practices.

Malpractice issues in modern anaesthesiology

Medical malpractice has been raised as an important problem in daily practice, while the media and public remain unforgiving to those perceived to have harmed the patients' life. This article highlights important legal issues related to medical malpractice and summarizes the sources and the nature of potential errors in anaesthesiology practice.