Outcomes of Medical Malpractice Litigation Against US Physicians

The risk of medical malpractice varies substantially according to physician specialty.^1-3 Despite evidence regarding the frequency with which US physicians in different specialties face malpractice claims,^2,3 there has been little study of the proportion of claims that result in litigation or the outcomes of the litigation process, in particular according to physician specialty.⁴ Malpractice claims that undergo litigation are an important source of concern to physicians,⁵ yet national data are lacking on the frequency of litigation, how litigation is typically resolved, and how long litigation takes to be resolved. Lengthier time to resolution affects physicians through lost practice time and added stress, work, and reputational damage. Patients are affected by anxiety as a result of a lengthy resolution process as well delays in the receipt of benefits. Using malpractice data from a nationwide professional liability insurer, we calculated the proportion of malpractice claims resulting in litigation, analyzed how litigated claims were resolved according to specialty, and calculated the time required to resolve claims of varying types.

We examined all claims closed between 2002 and 2005 that involved some defense cost (N = 10 056). Cases without defense costs were excluded because they often reflected instances in which physicians reported a possible adverse event to the insurer but no allegation of malpractice was made.² Although our data included physicians from all US states, California was overrepresented. We adjusted for oversampling by weighting each physician by the relative number of physicians reported in the Area Resource Files.² Methods and data protection measures were approved by the institutional review board at RAND Corporation, Santa Monica, California.

We computed the proportion of claims that resulted in litigation (defined as the filing and conduct of a lawsuit) and analyzed how these claims were resolved according to physician specialty. Litigated claims were dismissed by the court, were resolved before a verdict was passed, or received a trial verdict in favor of the physician or defendant. Specialties were divided into 9 categories, each with at least 100 claims per specialty. Specialties with fewer than 100 claims that did not fit into 1 of the other categories were grouped into “other specialties.” The mean time required to resolve claims was calculated separately for all claims and for litigated claims according to how claims were resolved. Time to resolution was defined as the length of time in months between when a claim was closed and when it was first filed.

Across all claims, 55.2% resulted in litigation, ranging from 46.7% for claims against anesthesiologists to 62.6% for claims against obstetricians and gynecologists. Among internists and medicine-based subspecialists, 53.5% of claims involved litigation. Outcomes of litigation varied across specialties (Figure). Cases were dismissed by the court 54.1% of the time across specialties. Rates of dismissal were highest among cases against internists and medicine-based subspecialists (61.5%) and lowest among pathologists (36.5%). Among internists and medicine-based subspecialists, 33.3% of litigated claims were resolved before a verdict compared with 49.6% among pathologists. The frequency with which claims underwent a trial verdict was low across specialties (4.5%, ranging from 2.0% among anesthesiologists to 7.4% among pathologists). Cases against internists and medicine-based subspecialists were among the least likely to undergo trial verdict (2.7%). Among cases undergoing verdict, most (79.6%) were judged in favor of the physician.

The mean time required to close a malpractice claim was 19.0 months; 11.6 months and 25.1 months were required for nonlitigated and litigated claims, respectively (eFigure). Each step in the litigation process generated significant delays in the resolution of the claim. Among litigated claims, those dismissed in court required the least time to close (mean, 20.4 months). Claims that were not dismissed but were resolved before a verdict took considerably longer to close (mean, 28.5 months). Claims that were resolved at trial took the longest to resolve (mean, 39.0 and 43.5 months for cases with verdicts in favor of defendants and plaintiffs, respectively).

There are few estimates of the rates and outcomes of malpractice litigation according to physician specialty as well as of the time required to resolve litigated claims of varying types. In our study, approximately 50% of all claims involved litigation, with half of these litigated claims being dismissed in court. A large percentage of litigated claims were resolved before verdict. Outcomes of litigation varied substantially according to specialty. The length of time required to resolve claims was twice as great for litigated than for nonlitigated claims, and time to resolution was considerable even among claims that were dismissed in court. While most claims were ultimately decided in a physician's favor, that resolution came only after months or years. The substantial portion of litigated claims that are not dismissed in court and the length of time required to resolve litigated claims more generally may help explain why malpractice claims undergoing litigation are an important source of concern to physicians.

Correspondence: Dr Jena, Massachusetts General Hospital, Harvard Medical School, Wang Ambulatory Care Center, 15 Parkman St, Boston, MA 02114 (jena.anupam@mgh.harvard.edu).

Published Online: May 14, 2012. doi:10.1001/archinternmed.2012.1416

Author Contributions: Dr Seabury had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Jena, Chandra, Lakdawalla, and Seabury. Acquisition of data: Seabury. Analysis and interpretation of data: Jena, Chandra, and Seabury. Drafting of the manuscript: Jena, Chandra, Lakdawalla, and Seabury. Critical revision of the manuscript for important intellectual content: Jena, Chandra, and Seabury. Statistical analysis: Jena, Chandra, Lakdawalla, and Seabury. Obtained funding: Seabury. Administrative, technical, and material support: Seabury. Study supervision: Jena, Chandra and Seabury.

Funding/Support: Dr Chandra was supported by National Institute on Aging (NIA) grant P01 AG19783-02; Dr Lakdawalla, by NIA grants 7R01AG031544 and 1RC4AG039036-01 and the NIA Roybal Center at the University of Southern California (5P30AG024968); and Dr Seabury, by NIA grant 7R01AG031544.

Role of the Sponsors: The funding agencies had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.