The following is a compilation of medical malpractice claim data from January 1, 2006 to December 31, 2015, submitted by member companies of the Medical Professional Liability Association (MPL Association), a trade association of liability insurance companies. The MPL Association’s member companies insure more than two-thirds of private practicing physicians in the United States.
The MPL Association was formerly known as PIAA. This name change occurred in May 2018.1
The MPL Association created its Data Sharing Project in 1985 to help identify areas of medical practice most vulnerable to medical liability claims. Participating member companies submit claim data semi-annually to the Data Sharing Project. All data is reported in a codified manner; the names of physicians are not reported.
According to the MPL Association data, the average indemnity payment from 2006 to 2015 was $359,256. The total national indemnity paid in medical liability claims over the same period was $9 billion.2
The following data highlights the three most prevalent chief medical factors and patient outcomes by specialty.
The MPL Association defines “chief medical factor” as an “act, or omission by a health care provider that falls below the accepted standards of medical care, triggering a claim for medical and/or legal damages.” The “outcome” is defined as the patient’s condition that “occurred after a medical encounter and resulted in the chief medical factor.” 2
What follows is not an in-depth analysis, but a short review of claims by specialty meant to educate physicians about the national risk trends.
Anesthesiology3
Top chief medical factors (most prevalent):
- No medical misadventure4
- Improper performance
- Problems with patient monitoring in surgery
Top outcomes (most prevalent):
- Cardiac or cardiorespiratory arrest
- Central nervous system complications of a procedure
- Broken tooth
Number of closed claims: 3,716
Average indemnity: $370,199
Total indemnity: $365,386,376
Cardiovascular and Thoracic Surgery5
Top chief medical factors (most prevalent):
- Improper performance
- No medical misadventure4
- Failure to recognize a complication of treatment
Top outcomes (most prevalent):
- Cardiac or cardiorespiratory arrest
- Surgical foreign body left in patient during a procedure
- Accidental puncture or laceration during a procedure
Number of closed claims: 2,656
Average indemnity: $340,386
Total indemnity: $231,802,947
Cardiovascular Diseases – nonsurgical6
Top chief medical factors (most prevalent):
- Improper performance
- Errors in diagnosis
- Performed when not indicated or contraindicated
Top outcomes (most prevalent):
- Cardiac or cardiorespiratory arrest
- Long term use of drugs
- Acute myocardial infarction
Number of closed claims: 2,179
Average indemnity: $248,590
Total indemnity: $143,436,504
Dermatology7
Top chief medical factors (most prevalent):
- Improper performance
- No medical misadventure4
- Errors in diagnosis
Top outcomes (most prevalent):
- Dyschromia (alteration of skin or nail color)
- Malignant neoplasms of the skin
- Malignant melanoma
Number of closed claims: 1,084
Average indemnity: $238,145
Total indemnity: $66,918,689
Emergency Medicine8
Top chief medical factors (most prevalent):
- Errors in diagnosis
- No medical misadventure4
- Improper performance
Top outcomes (most prevalent):
- Cardiac or cardiorespiratory arrest
- Acute myocardial infarction
- Occlusion and stenosis of cerebral arteries
Number of closed claims: 3,546
Average indemnity: $336,413
Total indemnity: $279,222,474
Gastroenterology9
Top chief medical factors (most prevalent):
- Improper performance
- Errors in diagnosis
- No medical misadventure4
Top outcomes (most prevalent):
- Accidental puncture or laceration during a procedure
- Cardiac or cardiorespiratory arrest
- Disorder of intestine
Number of closed claims: 1,879
Average indemnity: $336,182
Total indemnity: $123,378,806
General and Family Practice10
Top chief medical factors (most prevalent):
- Errors in diagnosis
- No medical misadventure4
- Improper performance
Top outcomes (most prevalent):
- Cardiac or cardiorespiratory arrest
- Acute myocardial infarction
- Emotional distress only
Number of closed claims: 8,143
Average indemnity: $295,961
Total indemnity: $664,433,524
General Surgery11
Top chief medical factors (most prevalent):
- Improper performance
- No medical misadventure4
- Errors in diagnosis
Top outcomes (most prevalent):
- Cardiac or cardiorespiratory arrest
- Postoperative infection
- Accidental puncture or laceration during a procedure
Number of closed claims: 8,763
Average indemnity: $330,264
Total indemnity: $853,403,358
Gynecology12
Top chief medical factors (most prevalent):
- Improper performance
- No medical misadventure4
- Errors in diagnosis
Top outcomes (most prevalent):
- Accidental puncture or laceration during a procedure
- Emotional distress only
- Surgical foreign body left in patient during a procedure
Number of closed claims: 989
Average indemnity: $326,530
Total indemnity: $85,877,363
Internal Medicine13
Top chief medical factors (most prevalent):
- No medical misadventure4
- Errors in diagnosis
- Improper performance
Top outcomes (most prevalent):
- Cardiac or cardiorespiratory arrest
- Acute myocardial infarction
- Lung cancer
Number of closed claims: 9,735
Average indemnity: $354,831
Total indemnity: $810,788,957
Neurology - nonsurgical14
Top chief medical factors (most prevalent):
- Errors in diagnosis
- No medical misadventure4
- Improper performance
Top outcomes (most prevalent):
- Occlusion and stenosis of cerebral arteries
- Encephalopathy, not further defined
- Cerebrovascular accident
Number of closed claims: 1,263
Average indemnity: $443,956
Total indemnity: $140,290,112
Neurosurgery15
Top chief medical factors (most prevalent):
- Improper performance
- No medical misadventure4
- Errors in diagnosis
Top outcomes (most prevalent):
- Central nervous system complications of a procedure
- Specified complications of procedures
- Postoperative infection
Number of closed claims: 2,138
Average indemnity: $454,989
Total indemnity: $272,993,363
Obstetric and Gynecologic Surgery16
Top chief medical factors (most prevalent):
- Improper performance
- No medical misadventure4
- Errors in diagnosis
Top outcomes (most prevalent):
- Brain damaged infant
- Birth trauma
- Surgical foreign body left in patient during a procedure
Number of closed claims: 10,256
Average indemnity: $437,781
Total indemnity: $1,396,522,114
Ophthalmology17
Top chief medical factors (most prevalent):
- Improper performance
- No medical misadventure4
- Errors in diagnosis
Top outcomes (most prevalent):
- Moderate to severe visual impairment
- Retinal detachments and defects
- Specified visual disturbances, other
Number of closed claims: 2,325
Average indemnity: $280,227
Total indemnity: $158,047,857
Orthopedic Surgery18
Top chief medical factors (most prevalent):
- Improper performance
- No medical misadventure4
- Errors in diagnosis
Top outcomes (most prevalent):
- Postoperative infection
- Specified complications of procedures
- Disorder of joint, not including arthritis
Number of closed claims: 7,643
Average indemnity: $271,913
Total indemnity: $554,701,753
Otorhinolaryngology19
Top chief medical factors (most prevalent):
- Improper performance
- No medical misadventure4
- Errors in diagnosis
Top outcomes (most prevalent):
- Unhappy with results of plastic surgery
- Cardiac or cardiorespiratory arrest
- Hearing impairment or loss
Number of closed claims: 1,474
Average indemnity: $316,683
Total indemnity: $171,008,576
Pathology20
Top chief medical factors (most prevalent):
- Errors in diagnosis
- No medical misadventure4
- Improper performance
Top outcomes (most prevalent):
- Unnecessary procedure performed
- Malignant neoplasm of the female breast
- Emotional distress only
Number of closed claims: 705
Average indemnity: $345,521
Total indemnity: $77,051,095
Pediatrics21
Top chief medical factors (most prevalent):
- Errors in diagnosis
- No medical misadventure4
- Improper performance
Top outcomes (most prevalent):
- Cardiac or cardiorespiratory arrest
- Brain damaged infant
- Emotional distress only
Number of closed claims: 1,977
Average indemnity: $399,929
Total indemnity: $217,961,034
Plastic Surgery22
Top chief medical factors (most prevalent):
- Improper performance
- No medical misadventure4
- Failure to recognize a complication of treatment
Top outcomes (most prevalent):
- Unhappy with the results of plastic surgery
- Postoperative infection
- Dyschromia (alteration of skin or nail color)
Number of closed claims: 3,008
Average indemnity: $185,758
Total indemnity: $141,361,756
Radiology23
Top chief medical factors (most prevalent):
- Errors in diagnosis
- No medical misadventure4
- Improper performance
Top outcomes (most prevalent):
- Malignant neoplasms of the female breast
- Malignant neoplasms of the bronchus and lung
- Cardiac or cardiorespiratory arrest
Number of closed claims: 6,526
Average indemnity: $364,106
Total indemnity: $664,858,230
Urologic Surgery24
Top chief medical factors (most prevalent):
- Improper performance
- No medical misadventure4
- Errors in diagnosis
Top outcomes (most prevalent):
- Malignant neoplasms of the prostate
- Foreign body left in patient during surgical procedure
- Accidental puncture or laceration during a procedure
Number of closed claims: 2,296
Average indemnity: $334,299
Total indemnity: $202,584,978
Claim Payment Analysis by Specialty: Combined Specialties, closed claims between 2006 and 2015*
Specialty Group |
Closed Claims |
Paid Claims |
% Paid to Closed |
Total Indemnity |
Average Indemnity |
Advanced Practice Professionals (CRNA, NP, PA, SA) |
753 |
199 |
26.4 |
$45,480,914 |
$228,547 |
Anesthesiology |
3,716 |
987 |
26.6 |
$365,386,376 |
$370,199 |
Cardiovascular & Thoracic Surgery |
2,656 |
681 |
25.6 |
$231,802,947 |
$340,386 |
Cardiovascular Diseases - Nonsurgical |
2,179 |
577 |
26.5 |
$143,436,504 |
$248,590 |
Dentists |
517 |
223 |
43.1 |
$15,731,701 |
$70,546 |
Dermatology |
1,084 |
281 |
25.9 |
$66,918,689 |
$238,145 |
Emergency Medicine |
3,546 |
830 |
23.4 |
$279,222,474 |
$336,413 |
Family Practice |
8,143 |
2,245 |
27.6 |
$664,433,524 |
$295,961 |
Gastroenterology |
1,879 |
367 |
19.5 |
$123,378,806 |
$336,182 |
General Surgery |
8,763 |
2,584 |
29.5 |
$853,403,358 |
$330,264 |
Gynecology |
989 |
263 |
26.6 |
$85,877,363 |
$326,530 |
Hospitalist |
1,008 |
175 |
17.4 |
$50,442,750 |
$288,244 |
Internal Medicine |
9,735 |
2,285 |
23.5 |
$810,788,957 |
$354,831 |
Internal Medicine Subspecialties** |
3,155 |
513 |
16.3 |
$157,056,151 |
$306,152 |
Neurology - Nonsurgical |
1,263 |
316 |
25.0 |
$140,290,112 |
$443,956 |
Neurosurgery |
2,138 |
600 |
28.1 |
$272,993,363 |
$454,989 |
Obstetric & Gynecologic Surgery |
10,256 |
3,190 |
31.1 |
$1,396,522,114 |
$437,781 |
Ophthalmology |
2,325 |
564 |
24.3 |
$158,047,857 |
$280,227 |
Oral Surgery |
113 |
51 |
45.1 |
$5,201,649 |
$101,993 |
Orthopedic Surgery |
7,643 |
2,040 |
26.7 |
$554,701,753 |
$271,913 |
Other Nonsurgical Specialties |
1,875 |
444 |
23.7 |
$147,800,555 |
$332,884 |
Otorhinolaryngology |
1,474 |
540 |
36.6 |
$171,008,576 |
$316,683 |
Pathology |
705 |
223 |
31.6 |
$77,051,095 |
$345,521 |
Pediatrics |
1,977 |
545 |
27.6 |
$217,961,034 |
$399,929 |
Plastic Surgery |
3,008 |
761 |
25.3 |
$141,361,756 |
$185,758 |
Psychiatry |
814 |
143 |
17.6 |
$29,415,190 |
$205,701 |
Radiation Therapy |
199 |
45 |
22.6 |
$16,097,915 |
$357,731 |
Radiology |
6,526 |
1,826 |
28.0 |
$664,858,230 |
$364,106 |
Resident/Intern |
8 |
2 |
25.0 |
$175,000 |
$87,500 |
Urologic Surgery |
2,296 |
606 |
26.4 |
$202,584,978 |
$334,299 |
All Specialties |
90,743 |
24,106 |
26.6 |
$8,089,431,691 |
$335,578 |
*Reprinted with permission from the MPL Association, formerly PIAA. MPL Closed Claim Comparative, 2016 Edition, PIAA. Copyright, 2016
**Adolescent Medicine; Allergy & Immunology; Critical Care Medicine; Endocrinology; Diabetes & Metabolism; Geriatric Medicine: Hematology; Hospice & Palliative Medicine; Infectious Disease: Interventional Cardiology; Medical Oncology; Pulmonary Disease: Rheumatology: and Sports Medicine
Sources
- News release: PIAA changes name to the Medical Professional Liability Association. MPL Association website. Available at https://www.mplassociation.org/docs/News_Releases/2018_Press_Release_Name_Change.pdf. Accessed September 26, 2018.
- PIAA Data Sharing Project. Comparative claim payment summary by close year: Claims closed between 2006 and 2015. Exhibit 1. Closed Claim Comparative. PIAA. 2016 Edition. January 1, 2006 to December 31, 2015. Rockville, MD.
- PIAA Data Sharing Project. Specialty Specific Series: Anesthesiology. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association, 2016.
- According to the MPL Association website, “no medical misadventure” is a “code used in the absence of a medical mishap. If a claim has no medical misadventure, but is felt to have legal merit, there is an appropriate associated issue designated in the database. These can be problems with records, consent issues, laboratory issues or even assault/battery, abandonment, etc..” This definition is found at https://www.mplassociation.org/wcm/About_MPL_Association/wcm/_About/FAQs.aspx. Accessed September 26, 2018.
- PIAA Data Sharing Project. Specialty Specific Series: Cardiovascular and Thoracic Surgery. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
- PIAA Data Sharing Project. Specialty Specific Series: Cardiovascular Diseases - nonsurgical. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
- PIAA Data Sharing Project. Specialty Specific Series: Dermatology. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
- PIAA Data Sharing Project. Specialty Specific Series: Emergency Medicine. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
- PIAA Data Sharing Project. Specialty Specific Series: Gastroenterology. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
- PIAA Data Sharing Project. Specialty Specific Series: General and Family Practice. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
- PIAA Data Sharing Project. Specialty Specific Series: General Surgery. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
- PIAA Data Sharing Project. Specialty Specific Series: Gynecology. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
- PIAA Data Sharing Project. Specialty Specific Series: Internal Medicine. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
- PIAA Data Sharing Project. Specialty Specific Series: Neurology - nonsurgical. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
- PIAA Data Sharing Project. Specialty Specific Series: Neurosurgery. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
- PIAA Data Sharing Project. Specialty Specific Series: Ob/Gyn Surgery. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
- PIAA Data Sharing Project. Specialty Specific Series: Ophthalmology. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
- PIAA Data Sharing Project. Specialty Specific Series: Orthopedic Surgery. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
- PIAA Data Sharing Project. Specialty Specific Series: Otorhinolaryngology. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
- PIAA Data Sharing Project. Specialty Specific Series: Pathology. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
- PIAA Data Sharing Project. Specialty Specific Series: Pediatrics. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
- PIAA Data Sharing Project. Specialty Specific Series: Plastic Surgery. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
- PIAA Data Sharing Project. Specialty Specific Series: Radiology. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
- PIAA Data Sharing Project. Specialty Specific Series: Urologic Surgery. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
This article is included in the Reporter Q4 2018.
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