Journal Quotes CAP Member Dr. Troxel on Malpractice Insurance

The Wall Street Journal

Clues to Better Health Care from Old Malpractice Lawsuits

By: Laura Landro 

Doctors are learning valuable new lessons from past malpractice cases about mistakes that could put their patients at risk and expose them to lawsuits. 

Malpractice insurers and medical specialty groups are mining thousands of closed claims from suits that have been tried, dismissed or settled over the past few years. Their goal is to identify common reasons that doctors are sued and the underlying issues that threaten patient safety. They are sharing those insights with doctors and hospitals, which in turn are using them to develop new safety protocols and prevention strategies. 

Changes to medical malpractice laws in recent years, including caps on pain-and-suffering damages in some states, have helped reduce the frequency of malpractice claims. But payouts in cases continue to rise about 4% a year, says Dr. David Troxel, a pathologist and medical director of the Doctors Company, the largest physician-owned malpractice insurer. 

His company has conducted over 40 studies of more than 10,000 closed claims in recent years. It is providing data to doctors and hospitals to perform their own analysis and holding meetings with different specialist groups to highlight emerging concerns and share tips for avoiding common pitfalls. 

Over the past year, Crico, the malpractice insurer for Harvard Medical School-affiliated doctors and hospitals, has analyzed risks associated with primary care. It is now developing a program to help doctors improve diagnostic accuracy and follow up on test results and referrals of patients to other doctors. 

The average doctor spends over 50 months, or almost 11%, of a 40-year career with an unresolved, open malpractice case, according to a 2013 study in the journal Health Affairs. The study, based on data from the Doctors Company, found that even though the majority of cases don’t result in payments to the plaintiff, the time spent resolving claims adds to stress and diverts doctors from making quality and safety improvements. 

And despite efforts to improve patient safety over the past decade, medical errors that can lead to malpractice suits continue to occur at alarming rates. In a study published last week in the journal BMJ, researchers at Johns Hopkins estimated that more than 250,000 deaths a year are due to medical error. The researchers said most are due to systemic problems, including poorly coordinated care. 

There are common themes in claims from almost every medical specialty—including failure to properly diagnose a patient or poor technique in a procedure. But data collections from different specialty groups are also helping to identify issues unique to different types of doctors, including primary-care physicians, anesthesiologists, emergency-room doctors and cardiologists. In obstetrics, for example, one dangerous emergency can arise during vaginal deliveries, especially with larger babies. After the baby’s head emerges, the shoulders can get stuck inside the mother’s body. Known as shoulder dystocia, it can cause damage to the brachial plexus, the nerves around the baby’s shoulder, and was one of the most common injuries alleged in 882 obstetrics claims from 2007 to 2014. Certain women are at higher risk, including overweight mothers, those with diabetes and those who are older during their first birth.

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As the leading organization for board-certified pathologists, the College of American Pathologists (CAP) serves patients, pathologists, and the public by fostering and advocating excellence in the practice of pathology and laboratory medicine worldwide. With more than 18,000 physician members, the CAP has led laboratory accreditation for more than 50 years with more than 7,700 CAP-accredited laboratories in 50 countries.