Trends in Pediatric Malpractice Lawsuits, 1987-2015

Steven A. Bondi¹, Suk-fong S. Tang², Robin L. Altman³, Jonathan M. Fanaroff⁴, William M. McDonnell⁵, John W. Rusher⁶.

¹Pediatrics, University of Mississippi Medical Center, Jackson, MS; ²Research, American Academy of Pediatrics, Elk Grove Village, IL; ³Pediatrics, New York Medical College/Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY; ⁴Pediatrics, Case Western Reserve University School of Medicine/Rainbow Babies & Children's Hospital, Cleveland, Ohio, Uganda; ⁵Pediatrics, University of Nebraska Medical Center, Omaha, NE; ⁶Raleigh Pediatric Associates, Raleigh, NC.

Presented at the 2017 Pediatric Academic Societies Annual Meeting.

Background: A possible malpractice suit is a source of anxiety for many pediatricians. While pediatricians are less frequently sued than other physicians, successful suits have a higher average payout. Little is known about how the risk of litigation has changed over time.

Objective: To characterize malpractice lawsuit trends for pediatricians over time.

Methods: The Periodic Survey is a national random sample survey of members of the American Academy of Pediatrics. The AAP Committee on Medical Liability and Risk Management has collaborated on 7 surveys since 1987 to track trends in pediatric malpractice lawsuits. Response rates averaged 57% (see table). Bivariate and multivariable analyses examined trends and factors associated with malpractice lawsuits, including survey year, work experience, gender, practice location (rural (referent), suburban, urban not inner city or urban inner city), work hours and practice type (general pediatrics (referent), procedure-based subspecialty, or other subspecialties).

Results: In 2015, 21% of pediatricians reported ever having been the subject of a lawsuit, a decrease from a peak of 33% in 1990 (p<.005). Females were less likely to be sued than males (p<.001, see table). In logistic regression, the gender difference was significant (Adjusted Odds Ratio(AOR): 1.70, CI: 1.39 – 2.08), along with a decrease in being sued over time (AOR: .96, CI: .95-.98 ), and greater odds of being sued with more experience (AOR: 1.10; , CI: 1.09-1.11), higher work hours (AOR:1.01, CI: 1.01-1.02), procedure-based subspecialties (AOR: 2.01, CI: 1.52-2.66), and urban inner city (AOR:1.46, CI: 1.01-2.12 ) or suburban (AOR:1.39, CI: 1.00-1.93) practice locations. Pediatrician report of a successful outcome in the most recent suit trended upward between 1987 and 2015 (p<.001), culminating at 58% in 2015. Median malpractice indemnity was unchanged from 1995 to 2015, averaging $122,149 (in 2016 dollars). Twenty percent of pediatricians reported receiving malpractice training during residency.

Discussion: From 1987 to 2015, the proportion of pediatricians sued has decreased and the proportion of cases resulting in successful outcomes has increased, while the median indemnity payment has remained unchanged. Female pediatricians are much less likely to have been sued than their male colleagues. Increasing education regarding malpractice is an opportunity for residency programs.