Pediatricians share liability risks with other specialists

by DEBRA FLEISCHMAN
Staff Writer

Pediatricians who believe their specialty is less prone to medical liability risks better think again, new studies indicate.

Two recent reports -- an AAP Periodic Survey and the Physician Insurers Association of America’s (PIAA) Data Sharing Reports -- indicate that pediatricians share a fair amount of liability problems with physicians in other specialties.

In the AAP Periodic Survey, researchers compared the results of a 1990 survey on medical liability with an identical survey conducted in 1987. They found that a fair share of the 1990 respondents -- about 29 percent -- reported having had a liability claim or suit filed against them, two percent higher than in 1987.

Meanwhile, a July 1990 PIAA Data Sharing Report helps break down the areas in which these pediatric malpractice suits are occurring. According to the report, the most common pediatric malpractice cases involve the alleged delay of the diagnosis of meningitis and meningococcal infection, and allegations associated with a delay in hospitalization and failure to recognize a complication of treatment.

“Claims involving meningitis are both the most frequent and expensive for this specialty and account for over 22 percent of the total indemnity paid,” the report states, “with an average indemnity payment of $399,500 on 44 closed paid files.”

The PIAA is a not-for-profit association of 43 physician-owned medical professional liability insurance companies. These companies protect about 50 percent of U.S. physicians, according to a PIAA spokesman.

The management of newborns account for more than 20 percent of the total indemnity paid, the report states. The average indemnity payment of $170,000 is the second highest off all the specialties, and the average large loss of $376,900 is the highest of any specialty, according to the report.

There was some encouraging news, however, contained in the AAP Periodic Survey. While the amount of reported pediatric malpractice cases slightly increased since 1987, the percentage of pediatricians who reported having won these cases rose to 9 percent in 1990, a nearly 20 percent increase since 1987.

However, other more favorable outcomes for pediatric malpractice claims have decreased since 1987. The number of cases settles out of court decreased from about 37 percent in 1987 to about 31 percent in 1990, and the number of cased dropped by the plaintiff also decreased, dropping to 30 percent in 1990 from 36 percent in 1987, according to the survey.

The AAP survey was conducted from February 1990 to May 1990 and was sent to a randomly selected sample of 1,000 U.S. pediatricians. Among those, 741, or 73 percent, responded. The sample is representative of all U.S. AAP members.

The average number of years in practice among pediatricians who have been sued remained the same in 1990 as in 1987 -- about 18 years.

A new question regarding experiences with liability claims during residency was added to the 1990 survey, AAP researchers said. Included in the 29 percent who reported a liability claim or suit, about 4 percent, or 30 pediatricians, reported being party to a claim or suit, about 4 percent, or 30 pediatricians, reported being party to a claim or suit for malpractice as a result of care rendered while they were residents, according to the survey.

An additional 38 respondents, or about 5 percent, said they were a party to a claim or suit while a resident but did not report having had a malpractice claim or suit filed against the, according to the survey.

The number of uninsured plaintiffs increased to about 20 percent in 1990 from about 15 percent in 1987, the survey states. About 63 percent of the plaintiffs were privately insured, and about 18 percent were Medicaid patients -- about the same as in 1987, the survey states.

Similar to the 1987 survey, the majority of pediatricians, about 53 percent, reported that the plaintiff was a patient not seen regularly by the pediatrician, according to the survey. Among that group, 33 percent said the claim or suit involved a coverage situation, compared to 27 percent in 1987.

In both the 1987 and 1990 surveys, the majority, about 67 percent, said a hospital was the site of the alleged malpractice, compared to 25 percent who said it occurred in an office.

Bradford Cohn, M.D., chairman of the AAP Committee on Medical Liability, said he hopes that news of a higher-than-expected incidence of pediatric liability problems encourages physicians to be more cautious when caring for their patients.

“Many pediatricians believe that their specialty involves a lower exposure to medical liability risks,” Dr. Cohen said. “But the reality is that there is not a great deal of truth in that. We want pediatricians to realize that they are not immune from liability problems. We do this not to create fear, but to point out that risks do exist,” he said.

“There is even more at risk for physicians now that the National Practitioner Data Bank (see accompanying article) is now in operation, because physicians who have had liability problems will be more identifiable in the communities,” Dr. Cohen said.

“We hope this new information about the prevalence of liability risks will encourage them to take precautions in this practices,” he said. “That can only help save them the agonies that liability problems can cause.”

Table:

AAP Periodic Survey: Pediatric Malpractice Claims

		1987		1990
How many had claims filed		27%		29%
Cases won		.5%		9%
Cases settled out of court		37%		31%
Cases dropped by plaintiff		36%		30%