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


Of 135,490 MPL claims and lawsuits closed between 2001–2015, 6,779 (5%) involved adult patients over 18 years old in a US hospital-based ED or ambulatory urgent care setting (Figure) (Table 1). The ED represented 5.2% of adult claims from all facilities, and urgent cares represented 0.9% of claims. Of hospital-based origins, the ED was the third most common origin (9.1%) for a claim, following operating rooms (40.7%) and inpatient rooms (15.8%).

Figure 1.

Claim resolution of closed claims in adult emergency departments or urgent care settings.

Of the 6,779 total claims, 65.9% were dropped, withdrawn or dismissed. Another 22.8% were settled for an average indemnity of $297,709 and an average defense expense of $55,260. Of the 515 (7.6%) cases that went to trial, juries returned verdicts finding for the defendant in 92.6% of cases (477/515). The average defense cost for a verdict in favor of the defendant was $111,446. The remaining 7.4% of cases (38/515) where juries returned verdicts for the plaintiff had an average indemnity of $816,909 and an average defense expense of $159,716. There were 222 claims (3.3%) that resulted in alternative dispute resolution (ADR) or private contract. There were 30 claims (0.4%) with an unknown outcome (Table 2).

Emergency physicians were the primary specialty named in 33.5% of the 6,779 closed claims, followed by internal medicine (12.4%), family practice (9.6%), radiology (7.3%), and general surgery (7.1%).

For the 27.1% of closed MPL claims culminating in an indemnity payment (trial verdicts, verdicts for the plaintiff, ADR/contracts, and unknown), the resulting medical conditions most commonly cited were cardiac or cardiorespiratory arrest (9.1%), acute myocardial infarction (4.0%), aortic aneurysm (2.3%), pulmonary embolism (2.2%), and appendicitis (2.0%). Of these, acute myocardial infarction had the highest paid-to-closed ratio with 39% resulting in a payment. Claims for aortic aneurysms generated the highest average indemnity of $369,872 per claim (Table 3).

The chief medical errors cited in MPL closed claims, seen in Table 4, were errors in diagnosis (36.4%); no medical misadventure (19.2%); improper performance (17.7%); failure to supervise or monitor case (5.2%); and medication errors (3.4%).

As seen in Table 5, death was the most common severity of injury cited in closed adult MPL claims, listed in 38.5% of closed claims and 42.8% of paid claims. Claims reporting major permanent injury had the highest percent of paid-to-closed claims (38.3%), and grave injury had the highest average indemnity of $686,239. Emotional injury was the least likely severity of injury to be listed, comprising 0.9% of total claims, in addition to having the lowest paid-to-closed ratio at 11.7%.