Top Reasons Internists Are Sued

More than half of all malpractice lawsuits filed against internists were due to two kinds of errors, according to a study published last year that sought to figure out why internal medicine practitioners were sued, and how successful the plaintiffs were.

The research, published in JAMA Internal Medicine, disclosed that improper diagnoses and medical equipment failure accounted for the lion’s share of claims, as reported by MedPageToday.com.

The research team, led by Dr. Sandeep Mangalmurti, a cardiologist, analyzed nearly 250,000 cases handled by the Physician Insurers Association of America. That’s a trade association of medical liability insurers concerned with more than 6 in 10 claims filed every year, which is estimated to be about 45,000. The cases in the study all were closed between 1985 and 2009, and the researchers limited their review to the ones involving internal medicine physicians; they numbered 33,747.

The data, the study authors wrote, “confirm that internists are vulnerable to claims related to what they do commonly – evaluation and management activities – and for the commonly fatal diseases that they are expected to diagnose, such as acute myocardial infarction [heart attack] and lung, colon, and breast cancers.”

Mangalmurti’s team, by the way, found similar results when they analyzed the top reasons why cardiologists were sued for medical malpractice.

Of all the closed cases, these are the five most common reasons internists were sued were:

1. Harm caused by failure to diagnose correctly primary medical condition (26.4%)

As MedPage Today said, “It seems like a no-brainer that improper diagnosis would top a list of why any doctor would be sued for malpractice, but that is especially the case for specialties whose primary job is to diagnose patients. The exception might be a field such as surgery, where most of the work is procedural and not diagnostic.”

“I wouldn’t be surprised in other primarily procedural-oriented specialties, the problem isn’t diagnosis but actual improper performance,” Mangalmurti told MedPage Today.

About 1 in 3 claims in this category were paid for a median amount of $183,300.

2. Breach of care due to other failures (25.4%)

This category includes events that happen but aren’t actual mistakes according to the administration of medical care. Examples include failure to obtain consent or equipment failure. These are mistakes you wouldn’t necessarily blame on a doctor’s poor judgment. They involve external factors that still can cause injury.

But as Mangalmurti told MedPage Today, physicians must be aware of these issues, because medical care isn’t just about making the right decision; it can be about factors out of their hands.

Almost 5 in 100 claims in this category were paid, for a median amount of $114,150.

3. Harm caused by errors in actual performance of a procedure (11.1%)

Although this category seems to be an obvious cause of malpractice lawsuits against physicians, fewer than 1 in 3 cases resulted in a payment to patients to compensate for damages; the median amount was $103,203.

4. Harm caused by failure to monitor subordinates such as a nurse or resident (10.9%)

Physicians shouldn’t be held responsible for some mistakes committed by a nurse or physician they’re supervising, but, as Mangalmurti told MedPage Today, “there are certainly some situations where the subordinate is acting as a surrogate or an extension of the physician.”

He said this kind of error might be avoided through sheer common sense, monitoring the staff’s work when appropriate and setting expectations for them.

About 31 in 100 claims in this category were paid, for a median amount of $141,875.

5. Harm caused by incorrect prescription or administration of medications (8.5%)

This category includes mistakes such as giving someone medicine without finding about his or her known allergies, giving an incorrect dosage or giving a drug with known side effects and not checking for signs of those adverse events.

Almost 30 in 100 claims in this category were paid, for a median amount of $89,600.

After the top five categories, reasons for being sued for malpractice included harm from unrecognized complications of procedures (3.6% of all closed claims), harm from failure to perform medically indicated procedures (2.7%) and harm from not performing a medically indicated consultation in a timely manner (2.3%).

Although plaintiffs’ success in their lawsuits and their payment amounts were similar to previous findings and work in other subspecialties, the researchers found a wide range of circumstances leading to judgments for patients.

  • More than 4 in 10 claims from failing to refer patients and nearly 4 in 10 from not performing a procedure resulted in a payment.
  • But fewer than 5 in 100 claims because of nonmedical judgment errors such as equipment failure resulted in a payment.

Payment amounts were less extreme, ranging from more than $183,000 for incorrect diagnosis to less than $90,000 for incorrect prescription or medication administration.

The researchers found similar results when they reviewed the top reasons cardiologists were sued for medical malpractice.

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