Pediatric Malpractice Claims Decreased While Median Payout Remained the Same

By Carolyn Crist

March 27, 2020

(Reuters Health) - During a 30-year period, the proportion of U.S. pediatricians who faced malpractice claims fell but the median indemnity stayed about the same, according to a new study based on survey data.

Male pediatricians and hospital-based subspecialists were more likely than others to have been sued during the study period, the authors report in Pediatrics.

"Based on conversations about malpractice, we get the feeling that claims are worse than they used to be," said coauthor Dr. Steven Bondi of the University of Rochester Medical Center in New York.

"We found that's not the case, which was surprising, but it also raises other questions," he told Reuters Health by phone. "What makes the difference between being sued and not sued? We think it has to do with the relationships and interactions with patients."

Dr. Bondi and colleagues analyzed data from seven American Academy of Pediatrics Periodic Surveys between 1987 and 2015. They looked at answers from nearly 6,000 pediatricians to questions about malpractice, and examined the trends over time as well as factors associated with risk and outcomes for malpractice claims and lawsuits.

In 2015, 21% of pediatricians reported ever having been a subject of a claim or lawsuit, as compared to 33% in 1990. Successful outcomes in the most-recent lawsuit increased over time, with the highest proportion, 58%, seen in 2015. Across the years, most payments averaged around $128,000 in 2018 dollars, with the highest amounts around $450,000.

In additional analyses, the research team found that male pediatricians and those in hospital-based subspecialties such as neonatology, pediatric critical care, pediatric emergency medicine, and hospital medicine were more likely to face a malpractice claim. Pediatricians with a longer career and more work hours also had a higher risk of a claim.

"The three specialties that are sued least often are psychiatry, family medicine and pediatrics, which is likely due to the long-term relationships with patients," Dr. Bondi said. "The advice I give to trainees and colleagues, in addition to being up-to-date and scrupulous with documentation, is focusing on the relationship with the patient."

Dr. Bondi added that he would also like to study insurance company data from the past decade to see if it could point to other trends.

"We'd like to repeat this with other data pools, simply because so much has changed," he said. "The impact of tort reform hasn't been captured, especially in regard to pediatrics."

"No matter what you do, there will always be medical errors or adverse events, but the way you deal with it afterward may have something to do with whether it turns into a malpractice claim," said Dr. Daniel Shouhed of Cedars Sinai Medical Center in Los Angeles, California.

Dr. Shouhed, who wasn't involved in the current study, has studied links between malpractice claims and emotional intelligence, especially as it relates to doctor-patient relationships. Although the direct correlation is difficult to show, previous research has noted that physicians with a high number of claims tend to receive more complaints, he said. In addition, those with more complaints tend to have a lower emotional intelligence score.

"Communication is paramount," Dr. Shouhed told Reuters Health by phone. "Whether you have a complication or error or not, the more communication you can provide to patients and families, the stronger the bond and rapport you will develop."

This Pediatrics study confirms what other specialties have seen as well: the rates of claims have dropped, and when claims occur, physicians tend to fare well in the majority of cases, said David Studdert of Stanford University in California.

"Often, there is an exaggerated sense of liability risk," said Studdert, a professor of law and of medicine, who wasn't involved in the current study.

Studdert and colleagues are researching the differences between physicians' experiences of malpractice claims and what improvements can be made at a system level.

"These trends are useful for physicians and policymakers to know, particularly as it relates to liability insurance," Studdert told Reuters Health by phone. "As we've seen across specialties, the volume has dropped in the last 15 years or so, and payments remain flat as well."

SOURCE: Pediatrics, online March 25, 2020.