Pediatricians: Fewer Malpractice Claims, Equivalent Payments

Troy Brown

May 06, 2013

Pediatricians have much lower rates of malpractice claims and indemnity payments than other physicians, but similar rates of payments that exceed $1 million, according to an analysis of the malpractice claims of 40,916 physicians (1630 pediatricians) from 1991 to 2005.

Anupam B. Jena, MD, PhD, an assistant professor of health care policy and medicine at Harvard Medical School and an assistant physician and professor in the Department of Medicine at Massachusetts General Hospital in Boston, and colleagues present their findings in an article published online May 6 in Pediatrics.

The researchers analyzed data from a physician-owned professional liability insurer that covers physicians in all 50 states and the District of Columbia.

The annual percentage of pediatricians (3.1%) with a malpractice claim against them was much lower than for all other physicians (7.4%; P < .001) and for physicians in high-risk specialties (14.5%; P < .001). A total of 404 claims against pediatricians were closed during the study period; of those, 83 (20.5%) led to an indemnity payment and 15 (3.7%) led to a payment of more than $1 million.

Annual indemnity rates were also much lower among pediatricians (0.5%) compared with physicians in other specialties (1.6%; P < .001) and high-risk specialists (3.3%, P < .001), but rates of payments that exceeded $1 million were similar (0.13% among pediatricians and 0.11% among other physicians; P = .57). Rates of indemnity payments that exceeded $750,000 were also similar between pediatricians (0.16%) and other physicians (0.13%; P = .59).

The researchers performed multivariate analyses, adjusting for patient age, injury type, physician age, and state and year fixed effects. In adjusted models, indemnity payment was most likely to result from claims involving children between 1 and 12 months of age (21.2%), followed by children younger than 1 month (18.7%) and those older than 1 year (10.8%).

In adjusted models, indemnity payment resulted from 23.9% of claims involving permanent injury compared with 12.1% of claims involving fatality and 10.8% of claims involving temporary or psychological injury (P = .09).

In adjusted analyses, the time to case resolution was longest for cases that involved children between the ages of 1 and 12 months (27.2 months).

Mean time to resolution was much longer for cases that involved permanent injury (28.0 months) compared with those involving fatality (18.4 months) or temporary or psychological injury (20.4 months). These differences were statistically significant (P < .05) in both the unadjusted and adjusted models.

In unadjusted analyses, mean indemnity payments were highest for cases that involved children younger than 1 month ($925,380) compared with those older than 1 year ($518,887) and those aged between 1 and 12 months ($313,514); these differences were significant (P = .02). The differences narrowed markedly in adjusted analyses (range, from $522,230 for children aged 1 to 12 months to $657,852 for children younger than 1 month). These differences were not jointly significant (P = .71).

Jonathan M. Fanaroff, MD, JD, an associate professor of pediatrics at Case Western Reserve University School of Medicine, director of the Rainbow Center for Pediatric Ethics, and codirector of the Neonatal Intensive Care Unit at Rainbow Babies & Children's Hospital/University Hospitals Case Medical Center in Cleveland, Ohio, commented on the study in a telephone interview with Medscape Medical News.

"It's important for pediatricians to be aware of the high-risk areas within [pediatrics]: What types of patients are more likely to put them at risk for lawsuits, such as brain-damaged newborns, meningitis, and pneumonia, with the ultimate goal of working to improve quality and safety of care," Dr. Fanaroff said. He was not involved in the study.

"Communication is always very important with families," Dr. Fanaroff added.

One coauthor received support from the RAND Institute for Civil Justice and a National Institute on Aging grant. One coauthor was supported by a National Institute on Aging grant. The study was funded by the National Institutes of Health. The other authors and Dr. Fanaroff has disclosed no relevant financial relationships.

Pediatrics. Published online May 6, 2013.