Medical malpractice claims are legal actions brought against healthcare providers alleging negligence or failure to meet the accepted standard of care, resulting in patient harm. These claims can be significant in healthcare, impacting patient safety, healthcare costs, and provider practices.
For physicians, medical malpractice claims and lawsuits can have serious professional and legal implications. Professionally, claims can damage reputation, lead to loss of hospital or health system privileges, lost wages, and increased insurance premiums. Multiple claims may result in license restrictions or revocation. Legally, health care professionals face potential financial liability and the stress of litigation.
Approximately one in three medical providers will be sued for medical malpractice during their career. The United States paid out approximately $151.7 billion in medical malpractice claim awards between 1990 to 2020. Even if not found liable, the process is time-consuming and emotionally draining.
For physicians, medical professionals, and other healthcare providers, it’s important to understand the common causes to mitigate risk, to say nothing of patient and family member pain and suffering. This guide highlights the six top causes of medical malpractice claims, along with risk factors and prevention strategies.
Misdiagnosis occurs when a healthcare provider incorrectly identifies a patient's condition, while delayed diagnosis happens when making a correct diagnosis, but after too much time has already passed.
For example, misdiagnosis may involve diagnosing heartburn when a patient is actually having a heart attack, while delayed diagnosis could be failing to identify cancer until it has significantly progressed.
These errors often stem from cognitive biases like anchoring (fixating on initial impressions) or availability bias (relying on recent or memorable cases). Lack of information, poor communication, and system failures also contribute.
A real-world example is the case of a Framingham, Massachusetts, girl and her family awarded $11.5 million in a medical malpractice lawsuit against a radiologist. The radiologist diagnosed the child with bronchiolitis and atypical pneumonia but failed to note the child’s enlarged heart, which appeared on the X-ray. The enlarged heart was actually a symptom of myocarditis which went undiagnosed. The misdiagnosis led to delayed treatment of the myocarditis and the child went into cardiac arrest, resulting in brain damage.
This case highlights the severe consequences of misdiagnosis and the importance of thorough evaluation, especially when symptoms persist or worsen despite initial treatment.
A surgical error is an unintended, preventable mistake occurring during a surgical procedure that deviates from standard medical care. These errors are not an accepted risk of the surgery and can cause the patient severe harm, extended hospital stays, additional surgeries, and even death.
Several types of surgical errors can commonly lead to malpractice claims, including:
A medication error is any preventable event that may lead to inappropriate medication use or patient harm while the medication is controlled by a healthcare professional or patient.
Common types of medication errors that may lead to malpractice claims include:
Electronic Health Records (EHRs) are digital versions of a patient's medical history. EHRs play a crucial role in helping to prevent medication errors by providing legible, standardized prescriptions. They provide clinicians with critical alerts for drug interactions and allergies, enable computerized provider order entry (CPOE) to reduce transcription errors, and help with medication reconciliation across care settings.
Childbirth injuries are physical traumas that occur to the baby or mother during labor and delivery. These injuries can occur because of a medically negligent act, such as improper use of forceps or vacuum extractors, failure to perform timely C-sections, or mismanagement of high-risk pregnancies.
Two common types of childbirth injuries that often lead to malpractice claims are cerebral palsy and Erb’s palsy.
Cerebral palsy is a neurological disorder caused by brain damage during birth, often because of oxygen deprivation. This can result from delayed C-sections, improper use of delivery tools, or failure to monitor fetal distress.
Erb's palsy is a nerve injury affecting arm movement, typically caused by excessive pulling or stretching of the baby's head and shoulders during delivery. The condition is often associated with shoulder dystocia, where the baby's shoulders get stuck in the birth canal.
Anesthesia errors are preventable mistakes that occur during the administration or management of anesthesia, potentially causing harm to patients. These errors can lead to serious complications such as brain damage, organ failure, or even death.
These errors can happen for a variety of factors:
Failure to treat is when a healthcare provider negligently fails to provide necessary medical care or intervention for a diagnosed condition, potentially leading to the worsening of the patient's health or complications that could have been prevented.
Physicians need to provide patients with timely and appropriate care because delays or omissions in treatment can lead to disease progression, complications, or even death. Proper care involves promptly recognizing symptoms, ordering appropriate tests, accurately interpreting results, and beginning treatment without delay.
Here are examples of the kinds of scenarios where failure to treat can lead to medical malpractice claims:
Communication breakdowns between healthcare providers and patients are a significant risk factor contributing to medical malpractice claims. These breakdowns can result in misdiagnosis, medication errors, lack of informed consent, poor treatment adherence, and lack of appropriate follow up care.
Patients may misunderstand instructions, fail to report important symptoms or make uninformed decisions about their care. This can lead to adverse outcomes and an increased likelihood of malpractice claims.
Communication breakdowns occur for several reasons:
Systemic issues in healthcare refer to organizational or institutional problems that can lead to errors and patient harm. These are underlying flaws in the healthcare system itself, rather than individual mistakes.
Addressing these systemic issues is crucial for reducing medical errors and malpractice claims:
Continuing education refers to ongoing learning activities for professionals to maintain or enhance their knowledge and skills after formal education. It includes courses, workshops, seminars, and other educational programs designed to keep professionals updated in their field.
A lack of continuing education puts physicians at an increased risk of medical malpractice claims because practitioners who don't stay current may provide substandard care. Medical practices and guidelines evolve rapidly. A physician who relies on outdated diagnostic techniques or lacks knowledge about new conditions is at risk of providing incorrect or delayed diagnoses.
Failure to learn about and adequately utilize new medical technologies can result in errors or missed opportunities for better patient care.
Implementing best practices is crucial for preventing medical malpractice claims. Incorporating guidelines from professional bodies ensures that care meets current standards and is evidence-based. EHRs effectively improve documentation, reduce medication errors, and enhance provider communication.
Clinical Decision Support Systems (CDSS) play a vital role in reducing diagnostic errors by:
CDSS can help overcome cognitive biases and knowledge gaps by presenting relevant information at the point of care. By integrating CDSS with EHRs, healthcare providers can make more informed decisions, leading to improved patient outcomes and reduced malpractice risk.
Healthcare providers can do a lot to improve patient-provider communication and reduce malpractice risk. One of the simplest things a provider can do is use clear, jargon-free language when explaining diagnoses, treatments, and procedures to patients.
Providers should practice active listening and encourage patients to ask questions. Allow adequate time for discussions and avoid rushing conversations. Many patients benefit from written materials to supplement verbal explanations.
Informed consent is crucial for protecting patient autonomy and reducing legal risk. It involves explaining the nature, risks, benefits, and alternatives of proposed treatments. Managing patient expectations is equally important. Providers should:
Utilizing new technology is becoming increasingly important in preventing medical malpractice claims. AI and data analytics play a crucial role by analyzing large datasets to identify patterns and predict potential errors. These new tools can provide support to clinical decisions, reducing diagnostic errors and flag high-risk patients or situations for extra attention.
While using technology provides many benefits in the healthcare setting, it also requires providers to adapt their risk management strategies to address new challenges.
The increased use of telemedicine, for example, is changing the malpractice risk landscape by:
Proper training, clear protocols, and robust technological infrastructure are essential to mitigate these risks.
To create a culture of safety and prevent medical malpractice claims, medical providers can implement several strategies.
One of the most effective strategies is establishing non-punitive reporting systems that encourage staff to report errors without fear of punishment or retaliation. Non-punitive reporting systems are crucial as they encourage transparency and allow for learning from mistakes.
Healthcare providers should promote open communication by regularly discussing errors and near-misses in team meetings. They can implement an approach that focuses on system improvements rather than individual blame.
Educating and training healthcare staff to recognize and report errors in a timely manner is key. Managers may consider offering confidential reporting options to overcome hesitancy in reporting. Equally important is recognizing and rewarding staff who report errors or suggest safety improvements.
In this guide, we’ve highlighted how medical malpractice claims commonly arise from diagnostic errors, surgical mistakes, medication errors, childbirth injuries, anesthesia errors, and failure to treat them.
Key risk factors include poor communication between healthcare providers and patients, inadequate documentation, systemic issues like understaffing or faulty processes, and lack of continuing education leading to outdated knowledge and skills. Addressing these issues through improved communication, robust safety protocols, and ongoing education can significantly reduce malpractice risks.
But even after implementing risk management and prevention strategies, medical malpractice claims remain a reality for healthcare providers. As a physician, you’ll want to ensure your malpractice insurance policy helps you manage the risks of your profession.
Using its proprietary underwriting model, Indigo leverages robust data sets and artificial intelligence to quickly analyze thousands of data points. This enables us to provide individualized pricing to physicians in all medical specialties. Indigo rewards physicians that practice good medicine with bigger potential savings. Finally, Indigo partners with Omnisure, a clinical risk services firm, to provide a variety of risk management services, many free of charge to Indigo policyholders, designed to help manage risk and improve outcomes for you and your practice.
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