Association of Past and Future Paid Medical Malpractice Claims

Abstract

ImportanceMany physicians believe that most medical malpractice claims are random events. This study assessed the association of prior paid claims (including a single prior claim) with future paid claims; whether public disclosure of prior paid claims affects future paid claims; and whether the association of prior and future paid claims decayed over time.ObjectiveTo examine the association of 1 or more prior paid medical malpractice claims with future paid claims.Design, Setting, and ParticipantsThis study assessed the association between prior paid claims (including a single prior claim) with future claims; whether public disclosure of prior claims affects future paid claims; and whether the association of prior and future paid claims decayed over time. This retrospective case-control study included all 881 876 licensed physicians in the US. All data analysis took place between July, 2018 and January, 2023.ExposurePaid medical malpractice claims.Main Outcome and MeasuresAssociation between a prior paid medical malpractice claim and likelihood of a paid claim in a future period, compared with simulated results expected if paid claims are random events. Using the same outcomes, we also assessed whether public disclosure of paid claims affects future paid claim rates.ResultsThis study included all 881 876 physicians licensed to practice in the US at the time of the study. Overall, 3.3% of the 841 961 physicians with 0 paid claims in the prior period had 1 or more claims in the future period vs 12.4% of the 34 512 physicians with 1 paid claim in the prior period; 22.4% of the 4189 physicians with 2 paid claims in the prior period; and 37% of the 1214 physicians with 3 paid claims in the prior period. The association between prior claims and future claims was similar for high-medical-malpractice-risk and lower-risk specialties; 1 prior-period claim was associated with a 3.1 times higher likelihood of a future-period claim for high-risk specialties (95% CI, 2.8-3.4) vs a 4.2 times higher likelihood for lower-risk specialties (95% CI, 3.8-4.6). The predictive power of a prior paid claim for future claims declined gradually as the time since the prior claim increased, for prior or future periods up to 10 years. Public disclosure did not affect the association between prior and future paid claims.Conclusions and RelevanceIn this study of paid medical malpractice claims for all US physicians, a single prior paid claim was associated with substantial, long-lived higher future claim risk, independent of whether a physician was practicing in a high- or low-risk specialty, or whether a state publicly disclosed paid claims. Timely, noncoercive intervention, including education, has the potential to reduce future claims.

Paid medical malpractice claims: How strongly does the past predict the future?

“…However, we are able to exclude one possible factor. In other work, we show that the increased risk of a future paid claim is the same in states with and without public disclosure of paid claims-indicating that there is no "blood in the water" effect (Hyman et al, 2023). Further progress on these issues will require more and better data.…”

“…The policy implications of these findings are straightforward (Hyman et al, 2023). Physicians often dismiss paid med mal claims, especially a first paid claim, as idiosyncratic or random -meaning it is unrelated to skill.…”

“…They find that “the risk of recurrence increased with the number of previous paid claims.” For example, compared to physicians with a single‐paid claim, physicians with three paid claims had three times the risk of a future claim. Hyman et al (2023) and Black et al (2019) also use the NPDB and report that having even a single paid claim in an initial 5‐year baseline period roughly quadruples the risk of having a paid claim in the next 5 years.…”

How Do Physicians Respond to Malpractice Allegations? Evidence from Florida Emergency Departments

“…8 Approximately 40% of malpractice claims result in no payment to the claimant (Studdert et al, 2006). Florida has a relatively high rate of paid claims per capita, relative to other states (Hyman et al, 2023). During our study period, noneconomic damages for ER practitioners were relatively low at $150,000 per claimant (Florida Statute 766.118(4)(a)).…”