Medical malpractice is a poorly understood and complex phenomenon. Which patients file claims, why these claims are filed, and under what conditions remain vexing questions. In 2014, malpractice lawsuits were filed against 18% of orthopedic surgeons by patients and their families. According to a 2011 study, orthopedics is the fourth most sued specialty, after neurosurgery, cardiothoracic surgery, and general surgery. There are several aspects of orthopedic malpractice claims that intuitively appear to contribute to malpractice losses. Among these factors are the nature and quality of the physician/patient relationship, the amount of time physicians spend communicating with patients, and the presence, or at least the appearance, of physician empathy and compassion.
The Doctors Company recently released a closed claims study examining medical malpractice claims against orthopedists. Covering 1,895 claims against orthopedists that closed between 2007 and 2014, including all claims and lawsuits in which an orthopedist was named a defendant; the study included all cases regardless of the outcome in order to get a broader sense of what motivates a patient to pursue a claim and to gain a better understanding of what led to patient harm and the respective system failures.
According to David B. Troxel, MD, medical director of The Doctors Company in Napa, California, the nation’s largest insurer of physician and surgeon medical liability, “if you practice orthopedic surgery long enough, the odds are good that someone will hit you with some sort of lawsuit.” The good news is that the rate of lawsuits has been declining across all specialties since 2008, added Dr Troxel. However, according to him, far more liability suits could be prevented if orthopedists took the time to maintain good relationships with their patients.
The study analyzed claims against more than 2100 orthopedists, pinpointed the most common types of claims and, based on these findings, developed recommendations for avoiding them.
Given below are some of the important statistics from the study.
- 46% of claims came from patients stating their surgery was performed improperly, making this the largest reason for filing claims. While the allegation was most often made when the outcome of the procedure differed from the patient’s perspective, the findings of expert reviewers showed only a small percentage of injuries were due to substandard care.
- The procedures that brought the maximum and most frequent allegations of improper care were total knee replacement, total hip replacement, knee arthroscopy, vertebroplasty, open reduction internal fixation, discectomy, exploration and decompression of spinal canal, shoulder arthroscopy and rotator cuff repair.
- 16% of all claims stemmed from improper management of surgical patients, with patients claiming improper management if they experienced infections, continued pain or mechanical complications of orthopedic devices or mal-union or nonunion of bones.
- 13% of claims were due to delayed, failed or wrong diagnosis with compartment syndrome, fractures, nonunion of fracture, hematomas, postoperative infections, malignant bone tumors, thromboembolism and dislocations accounting for the most incorrectly diagnosed procedures.
The study also identified several factors that contributed to patient injury.
- 35% of all patient injury was due to technical performance, although that does not necessarily imply negligence. While most claims were related to known risks, a “small” portion was due to substandard care.
- 29% of patient injuries stemmed from patient behavior wherein patients dissatisfied with the care provided sought other providers thus reducing the original physician’s opportunity to address concerns or the unsatisfactory surgical outcomes through follow-up care.
- Harrison, L. (2015, October 7). How Orthopedists Can Get off the List of Most-Sued Doctors. Retrieved from Medscape: http://www.medscape.com/viewarticle/851706_2
- Oliver, E. (2016, August 11). 10 thoughts and statistics on medical malpractice claims against orthopedists. Retrieved from Becker’s Healthcare: http://www.beckersspine.com/sports-medicine/item/32668-10-thoughts-and-statistics-on-medical-malpractice-claims-against-orthopedists.html
- Peckham, C., & Grisham, S. (2016, January 22). Medscape Malpractice Report 2015: Why Orthopedists Get Sued. Retrieved from Medscape: http://www.medscape.com/features/slideshow/malpractice-report-2015/orthopedics
- Sonny Bal, M. M., & Lawrence H. Brenner, J. (2008, April). Surgeon characteristics and medical malpractice: Are orthopedists at risk? Retrieved from Healio Orthopedics Today: http://www.healio.com/orthopedics/business-of-orthopedics/news/print/orthopedics-today/%7Bc033311f-cb7b-4d01-bc35-a69a36c2c5a2%7D/surgeon-characteristics-and-medical-malpractice-are-orthopedists-at-risk