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PERIODIC SURVEY OF FELLOWS
American Academy of Pediatrics
Division of Health Policy Research
EXECUTIVE SUMMARY
Periodic Survey #48
Experiences With Medical Liability
This report presents finding from Periodic Survey of
Fellows #48 on medical liability. The survey was initiated by the Committee
on Medical Liability (COML) to track trends in pediatricians' experiences
with medical liability claims and suits. This report compares 2001 findings
with data collected on similar surveys conducted in 1987 (PS#2), 1990
(PS#10), 1992 (PS#17) and 1995 (PS#29). Findings across years that are
significantly different at the .05 level or less are noted in the text;
otherwise comparisons are not statistically significant (ns).
PS#48 was an eight-page self-administered questionnaire
sent to a random sample of 1,622 active U.S. members of the AAP. The
original mailing and four follow-up mailings to recontact nonrespondents
were conducted from February to May 2001. After five mailings we received
a total of 1,039 completed questionnaires for a response rate of 64.1%.
The questions regarding medical liability experiences exclude current
residents and all claims that occurred during residency unless otherwise
noted.
Experiences with Liability Claims, 1987 - 2001
Overall there has been little or no change in the frequency
or nature of pediatricians' experiences with medical liability claims/suits
over the past 14 years:
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EVER SUED: The proportion of pediatricians
who have ever had a claim or suit brought against them (excluding
claims during residency) in 2001 is similar to that reported in 1995,
1992 and 1990 (26%, 28%, 30%, 28%, respectively, ns; data not available
for 1987). The proportion of pediatricians who were party to a claim
or suit while a resident has also remained the same during this time:
9% (2001), 10% (1995), 8% (1992), 10% (1990), ns.
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WHO IS SUED: In 2001, the average number of
years in practice among pediatricians who have been sued increased
slightly from 1995 (20.1 v 18.6, p<.05) while from 1987 to 1995, there
were no significant changes (about 18 years for each point in time).
The mean number of times sued remained the same over time: 1.7 in
2001 and 1.6 for each year 1987 - 1995. Male pediatricians are more
likely to report having had a malpractice claim against them than
females: 35% v 16%, 2001; 36% v 17%, 1995; 36% v 18%, 1992; 35% v
16%, 1990; 30% v 18%, 1987, p<.01 for each year).
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DISPOSITION OF LAWSUIT: The proportion of cases
that were settled out of court (36%, 2001; 31%, 1995, 29%, 1992; 31%,
1990; 37%, 1987, ns) and those dropped by the plaintiff (33%, 37%,
35%, 30%, 36%, ns) did not significantly differ over the five time
periods. In 2001, the percentage of pediatricians who reported the
plaintiff lost the case has remained about the same as in 1995 (9%
v 11%, ns); however, in 1995, as in 1992 and 1990, the percentage
increased significantly from that reported in 1987 (11%, 11%, 10%,
0.5%, p<.01). Three percent of pediatricians in 2001 compared to 2%
in 1995 (ns) said the plaintiff won the case; 2% in 1992 compared
to 0% and Executive Summary - PS48 Page 2 0.1% in 1990 and 1987, respectively,
so reported (p<.01%). The remainder of the respondents said their
most recent claim or suit was still in process.
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In 2001 and 1995, pediatricians were asked about
pressures to settle claims. Six out of ten pediatricians with
claims or suits against them (60% and 63%) reported experiencing
little or no pressure by their employer or insurance carrier to
settle out of court; 17% and 25% experienced some pressure, while
only 10% and 12% said there was a great deal of pressure to settle.
Where an out of court settlement was reached, 15% and 10% of those
pediatricians reported using alternative dispute resolution (ADR)
mediation. In 2001, significantly fewer pediatricians than in
1995 (19% v 32%, p<.05) reported claims were filed before the
National Practitioner Data Bank reporting requirement (NPDB) began.
Among those who said their most recent claim was filed after the
NPDB began (September 1990), 59% in both years said the NPDB did
not influence the decision to bring the claim to court or to settle
out of court, 16% in 2001 and 10% in 1995 said it was an influence,
18% and 27% said they didn't know, and 7% and 3% were not aware
of the NPDB reporting requirement.
- PATIENT INSURANCE STATUS: In 2001 and 1995, pediatricians
were asked to identify the source of payment for suits won or settled
out of court: 74% and 77%, respectively, were paid by a commercial insurance
carrier, 18% and 21% were paid by a self-insured institution, the remainder
did not know. In 2001 compared to 1995, significantly fewer pediatricians
said claimants were uninsured (9% v 16%, p<.05). The proportion of uninsured
patients who filed a claim or suit did not significantly differ from
1987-1995 (15%, 20%, 14%, 16%, ns). The majority of pediatricians in
all survey years report the patients filing claims or suits have private
health insurance (64% in 2001, 59% in 1995, 66% in 1992, 63% in 1990,
67% in 1987, ns). In 2001, 53% of pediatricians reported the plaintiff
was not a patient who was seen regularly by them; this was not significantly
different than the proportion of pediatricians so reporting in survey
years 1987-1995 (58%, 53%, 55%, and 52%). At all five points in time,
about one-third of pediatricians said the claim involved a coverage
situation (31%, 32%, 32%, 33%, 27%, ns).
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CHANGES DUE TO SUIT: In 2001, 1995 and 1992,
most pediatricians said, in retrospect, there was nothing they could
have done to lessen the chance of a suit being filed: 78%, 78% and
70%, ns. In 2001 and 1995, an overwhelming majority of pediatricians
who have had a claim or suit brought against them (94% and 92%) said
that being sued did not change the amount of time they spend directly
caring for patients (not asked in other survey years).
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COMMUNITY-BASED ACTIVITIES: In 2001, 1995,
1992 and 1990, few pediatricians who do not participate in community
activities said fear of malpractice was a reason for not participating
(9%, 10%, 11%, 15%, ns), and only 2%, 5%, 3% and 2%, respectively,
of nonparticipating pediatricians reported they were unable to get
malpractice coverage for community-based activities (p<.05, 2001 v
1995 and 1995 v 1990).
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