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Medical Malpractice: A Physician’s Perspective. Kevin Biese, MD March 5 th , 2007. The Effect of CAPSTONE. 2 Requirements to be Good Intern. Try Hard Be Honest. Simple Phrase. “I Don’t Know” So Use Your Resources. Bad News. You Will get Sued 1 case per 10 physician years - PowerPoint PPT Presentation
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Medical Malpractice: A Medical Malpractice: A Physician’s PerspectivePhysician’s Perspective
Kevin Biese, MDKevin Biese, MDMarch 5March 5thth, 2007, 2007
The Effect of CAPSTONEThe Effect of CAPSTONE
2 Requirements to be Good 2 Requirements to be Good Intern Intern
Try HardTry Hard Be HonestBe Honest
Simple PhraseSimple Phrase““I Don’t Know”I Don’t Know”
SoSoUse Your ResourcesUse Your Resources
Bad NewsBad News You Will get Sued You Will get Sued
1 case per 10 physician years1 case per 10 physician years Some of you during residencySome of you during residency
Over 20% of cases from academic Over 20% of cases from academic centers involve residentscenters involve residents
It happened to meIt happened to me But I still have a jobBut I still have a job
You Are a DoctorYou Are a Doctor Unfortunately, (usually) the law does not Unfortunately, (usually) the law does not
differentiate resident from attendingdifferentiate resident from attending So you are responsible So you are responsible However, you have lots of helpHowever, you have lots of help
AttendingsAttendings ResidentResident NursesNurses BooksBooks UptoDate ……..UptoDate ……..
Communication is KeyCommunication is Key
Does the System Work: Does the System Work: Medical Malpractice GoalsMedical Malpractice Goals
Deter bad careDeter bad care Compensate the victimsCompensate the victims
The Data: Harvard Medical The Data: Harvard Medical Practice StudyPractice Study
Review of 31,429 random patient charts Review of 31,429 random patient charts from 52 NY hospitals from 1984from 52 NY hospitals from 1984
Looked for adverse events (injury caused Looked for adverse events (injury caused by medical management)by medical management) First screen by NP for specific criteria (hospital First screen by NP for specific criteria (hospital
trauma, drug reactions, readmission)trauma, drug reactions, readmission) Next 2 physicians determined if adverse eventNext 2 physicians determined if adverse event Finally physicians determined if negligence had Finally physicians determined if negligence had
caused the adverse eventcaused the adverse event
Harvard Medical Practice Harvard Medical Practice StudyStudy
31,429 insample
7817 positivescreen
1278 adverseevents
306 withnegligence
Harvard Medical Practice Harvard Medical Practice StudyStudy
3.7% hospitalized patients with 3.7% hospitalized patients with adverse eventsadverse events
1% hospitalized patients adverse 1% hospitalized patients adverse events secondary to negligenceevents secondary to negligence
Extrapolation -In NY State in 1984Extrapolation -In NY State in 1984 27,129 Injuries secondary to negligence27,129 Injuries secondary to negligence 6895 Deaths secondary to negligence6895 Deaths secondary to negligence
Part II - Harvard Medical Part II - Harvard Medical Practice Study Practice Study
Examined types of errors and their Examined types of errors and their association with negligenceassociation with negligence Operative (53% of total / 17% negligent)Operative (53% of total / 17% negligent) Drug-related (16% of total / 17% negligent)Drug-related (16% of total / 17% negligent) Diagnostic (7% of total/ 75% negligent) Diagnostic (7% of total/ 75% negligent)
70% of errors in ED associated with 70% of errors in ED associated with negligence (many diagnostic decisions)negligence (many diagnostic decisions)
Part III - Harvard Medical Part III - Harvard Medical Practice StudyPractice Study
Association of adverse events to Association of adverse events to malpractice claimsmalpractice claims
47 cases from 47 cases from original 31,429 patients original 31,429 patients
Part III - Harvard Medical Part III - Harvard Medical Practice StudyPractice Study
GroupGroup Number Number in Samplein Sample
Number Number of Claimsof Claims
No No adverse adverse eventevent
28,63528,635 2626
Unlikely Unlikely Adverse EventAdverse Event 335335 33
Adverse Adverse event; no event; no
negligencenegligence853853 1010
Adverse Adverse event; yes event; yes negligencenegligence
280280 88
Part III - Harvard Medical Part III - Harvard Medical Practice Study: ConclusionsPractice Study: Conclusions
ManyMany more negligent injuries than claims more negligent injuries than claims 98% of negligent injuries do not result in claim98% of negligent injuries do not result in claim Ratio negligence to claims = 7.6 to 1Ratio negligence to claims = 7.6 to 1
Poor correlation between negligent injuries Poor correlation between negligent injuries and claimsand claims
Malpractice GoalsMalpractice Goals Deter bad careDeter bad care Compensate victims Compensate victims
Part IV - Harvard Medical Part IV - Harvard Medical Practice StudyPractice Study
10 yr follow up of malpractice cases10 yr follow up of malpractice cases No adverse events: 10/24 plaintiffNo adverse events: 10/24 plaintiff Adverse event, no negligence: 6/13 plaintiffAdverse event, no negligence: 6/13 plaintiff Adverse event, negligence: 5/9 plaintiffAdverse event, negligence: 5/9 plaintiff Only independent predictor of payment Only independent predictor of payment
was permanent disabilitywas permanent disability No association between adverse event No association between adverse event
(p=0.79) or negligence (p=0.32) and (p=0.79) or negligence (p=0.32) and paymentpayment
ConclusionConclusion We are playing football on the freeway – We are playing football on the freeway –
we get pretty good at it, but you are we get pretty good at it, but you are gonna get hitgonna get hit
It is often not about you – we usually get It is often not about you – we usually get sued for bad outcomes not bad practicesued for bad outcomes not bad practice
But, there are But, there are a lota lot of errors of errors And harm done …And harm done …
What to doWhat to do CommunicateCommunicate Say when you do not knowSay when you do not know Contact hospital legal as situations Contact hospital legal as situations
arisearise Be kindBe kind
What Not to DoWhat Not to Do DO NOTDO NOT
Pass judgment in the chartPass judgment in the chart You will become a plaintiff witnessYou will become a plaintiff witness
Advise a patient to sueAdvise a patient to sue Carelessly EmailCarelessly Email Abandon your patient when something Abandon your patient when something
goes wronggoes wrong Modify the chartModify the chart
Final ThoughtsFinal Thoughts Most of us will get suedMost of us will get sued We get sued for bad outcomes rather We get sued for bad outcomes rather
than bad practicethan bad practice Be honest and willing to Be honest and willing to
acknowledge what you do not knowacknowledge what you do not know Ask for helpAsk for help Be Kind Be Kind