Characteristics of Medical Professional Liability Claims Against Internists

Medical professional liability (MPL) claims are a major concern for internists and may influence clinical practice.¹ Greater awareness of the details and outcomes of these lawsuits, including claims paid, may inform clinical decisions and risk management. Accordingly, we examined a unique registry of nearly 250 000 closed cases to better characterize the medical liability landscape.

All data presented in this report were collected by the PIAA (formerly the Physician Insurers Association of America), a trade association that represents domestic and international medical professional liability insurance companies. The Data Sharing Project is a data registry of MPL claim information that is voluntarily submitted to the PIAA by its member companies. The PIAA member companies process an estimated 28 000 closed claims per year, representing 62.2% of the 45 000 estimated annual MPL claims brought yearly.²

Per the PIAA, alleged departures from the appropriate standard of care are defined as medical misadventures and divided into 18 categories.³ These may be errors or omissions of diagnosis, treatment, procedure performance, supervision, or timeliness that cause putative injury to patients. One category, “no medical misadventure,” involves cases in which the primary cause of the lawsuit may include legal or documentation issues such as failure to obtain informed consent or equipment failure. Claims are attributed to the specialty of the primary defendant and limited to internal medicine physicians and their subspecialties; of note, claims attributed to cardiologists and gastroenterologists were not available since procedure-based clinical specialties are placed in different risk groupings within the data registry. Institutional review board approval was not needed for this study.

From 1985 through 2009, of the 247 073 closed lawsuits reported to the PIAA, 33 747 (13.7%) were attributed to internal medicine physicians; 8461 (25.1%) resulted in claims paid. The most common medical misadventure causes for claims appear in the Table, including errors in diagnosis (8925 [26.4%]), which involves alleged errors in diagnosing lung cancer, acute myocardial infarction, colon cancer, and breast cancer; no misadventure (8581 [25.4%]); improper performance of a procedure (3730 [11.1%]); and medication errors (2865 [8.5%]). There was wide variation among MPL claims that resulted in payment. For instance, 40.1% of MPL claims due to failure to refer and 38.1% for failure to perform a procedure resulted in payment, whereas MPL claims with no medical misadventure resulted in payment in only 4.8% of cases. Median payment was at least $100 000 per paid claim across nearly all categories.

These findings, particularly regarding payment probabilities and mean payment amounts, are similar to those seen in the analyses of other primary care⁴ and medical subspecialty physicians.^5,6 The key contribution of the Data Sharing Project is identifying the clinical characteristics of these claims: these data confirm that internists are vulnerable to claims related to what they do commonly—evaluation and management activities (medical histories and physical examinations)—and for the commonly fatal diseases that they are expected to diagnose, such as acute myocardial infarction and lung, colon, and breast cancers. Insight into these MPL claims patterns may help internists craft practice patterns and changes that will result in fewer patient injuries and lower MPL claims.

Corresponding Author: Sandeep S. Mangalmurti, MD, JD, Bassett Heart Care Institute, Bassett Medical Center, One Atwell Road, Cooperstown, NY 13326 (sandeep.mangalmurti@bassett.org).

Published Online: April 28, 2014. doi:10.1001/jamainternmed.2014.1116.

Author Contributions: Drs Mangalmurti and Oetgen had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Mangalmurti, Harold, Flannery, Oetgen.

Acquisition, analysis, or interpretation of data: Harold, Parikh.

Drafting of the manuscript: Mangalmurti, Harold, Oetgen.

Critical revision of the manuscript for important intellectual content: Harold, Parikh, Flannery, Oetgen.

Statistical analysis: Parikh.

Administrative, technical, or material support: Flannery, Oetgen.

Study supervision: Mangalmurti, Harold, Flannery, Oetgen.

Conflict of Interest Disclosures: None reported.

Disclaimer: The views expressed in this report are those of the authors and do not necessarily represent the official position of the military services or the Department of Defense.