Emergency Department and Urgent Care Medical Malpractice Claims 2001–15

Kelly E. Wong, MD; P. Divya Parikh, MPH; Kwon C. Miller; Mark R. Zonfrillo, MD, MSCE


Western J Emerg Med. 2021;22(2):333-338. 

In This Article

Abstract and Introduction


Introduction: This study reviews malpractice, also called medical professional liability (MPL), claims involving adult patients cared for in emergency departments (ED) and urgent care settings.

Methods: We conducted a retrospective review of closed MPL claims of adults over 18 years, from the Medical Professional Liability Association's Data Sharing Project database from 2001–2015, identifying 6,779 closed claims. Data included the total amount, origin, top medical specialties named, chief medical factors, top medical conditions, severity of injury, resolution, average indemnity, and defense costs of closed claims.

Results: Of 6,779 closed claims, 65.9% were dropped, withdrawn, or dismissed. Another 22.8% of claims settled for an average indemnity of $297,709. Of the 515 (7.6%) cases that went to trial, juries returned verdicts for the defendant in 92.6% of cases (477/515). The remaining 7.4% of cases (38/515) were jury verdicts for the plaintiff, with an average indemnity of $816,909. The most common resulting medical condition cited in paid claims was cardiac or cardiorespiratory arrest (10.4%). Error in diagnosis was the most common chief medical error cited in closed claims. Death was the most common level of severity listed in closed (38.5%) and paid (42.8%) claims. Claims reporting major permanent injury had the highest paid-to-closed ratio, and those reporting grave injury had the highest average indemnity of $686,239.

Conclusion: This retrospective review updates the body of knowledge surrounding medical professional liability and represents the most recent analysis of claims in emergency medicine. As the majority of emergency providers will be named in a MPL claim during their career, it is essential to have a better understanding of the most common factors resulting in MPL claims.


Among the challenges in emergency departments (ED) is providing quality care to patients with high-risk diagnoses under the pressures of limited information and increasing demands on time. This complex environment inherently lends itself to potential medical errors and possible resulting litigation. The threat of a malpractice lawsuit partially drives physicians' clinical decision-making in such environments. A survey performed by the Harvard School of Public Health and Columbia Law School found that 93% of physicians in high-risk specialties change their clinical decision-making due to concern of a malpractice suit, a behavior commonly referred to as "defensive medicine."[1]

A prior study by Brown et al. in 2010 examined 11,529 closed medical professional liability (MPL) claims originating from EDs for adult patients between 1987–2007 using a database from the Physician Insurers Association of America (the former name of the MPL Association).[2] The changing landscape of MPL due to tort reform, fluctuations in malpractice insurance premiums, and regulatory interference underscores the need for a more contemporary analysis of the MPL data. This study reviewed MPL claims involving adult patients (over 18 years old) cared for in ED and urgent care settings and provides an update of characteristics in closed MPL claims from 2001–2015.