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Claims by Specialty: MPL Association’s 2006-2015 national closed claim data

Wayne Wenske

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):

  1. No medical misadventure4
  2. Improper performance
  3. Problems with patient monitoring in surgery

Top outcomes (most prevalent):

  1. Cardiac or cardiorespiratory arrest
  2. Central nervous system complications of a procedure
  3. 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):

  1. Improper performance
  2. No medical misadventure4
  3. Failure to recognize a complication of treatment

Top outcomes (most prevalent):

  1. Cardiac or cardiorespiratory arrest
  2. Surgical foreign body left in patient during a procedure
  3. 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):

  1. Improper performance
  2. Errors in diagnosis
  3. Performed when not indicated or contraindicated

Top outcomes (most prevalent):

  1. Cardiac or cardiorespiratory arrest
  2. Long term use of drugs
  3. 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):

  1. Improper performance
  2. No medical misadventure4
  3. Errors in diagnosis

Top outcomes (most prevalent):

  1. Dyschromia (alteration of skin or nail color)
  2. Malignant neoplasms of the skin
  3. 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):

  1. Errors in diagnosis
  2. No medical misadventure4
  3. Improper performance

Top outcomes (most prevalent):

  1. Cardiac or cardiorespiratory arrest
  2. Acute myocardial infarction
  3. 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):

  1. Improper performance
  2. Errors in diagnosis
  3. No medical misadventure4

Top outcomes (most prevalent):

  1. Accidental puncture or laceration during a procedure
  2. Cardiac or cardiorespiratory arrest
  3. 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):

  1. Errors in diagnosis
  2. No medical misadventure4
  3. Improper performance

Top outcomes (most prevalent):

  1. Cardiac or cardiorespiratory arrest
  2. Acute myocardial infarction
  3. 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):

  1. Improper performance
  2. No medical misadventure4
  3. Errors in diagnosis

Top outcomes (most prevalent):

  1. Cardiac or cardiorespiratory arrest
  2. Postoperative infection
  3. 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):

  1. Improper performance
  2. No medical misadventure4
  3. Errors in diagnosis

Top outcomes (most prevalent):

  1. Accidental puncture or laceration during a procedure
  2. Emotional distress only
  3. 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):

  1. No medical misadventure4
  2. Errors in diagnosis
  3. Improper performance

Top outcomes (most prevalent):

  1. Cardiac or cardiorespiratory arrest
  2. Acute myocardial infarction
  3. 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):

  1. Errors in diagnosis
  2. No medical misadventure4
  3. Improper performance

Top outcomes (most prevalent):

  1. Occlusion and stenosis of cerebral arteries
  2. Encephalopathy, not further defined
  3. Cerebrovascular accident

Number of closed claims: 1,263

Average indemnity: $443,956

Total indemnity: $140,290,112

 

Neurosurgery15

Top chief medical factors (most prevalent):

  1. Improper performance
  2. No medical misadventure4
  3. Errors in diagnosis

Top outcomes (most prevalent):

  1. Central nervous system complications of a procedure
  2. Specified complications of procedures
  3. 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):

  1. Improper performance
  2. No medical misadventure4
  3. Errors in diagnosis

Top outcomes (most prevalent):

  1. Brain damaged infant
  2. Birth trauma
  3. 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):

  1. Improper performance
  2. No medical misadventure4
  3. Errors in diagnosis

Top outcomes (most prevalent):

  1. Moderate to severe visual impairment
  2. Retinal detachments and defects
  3. 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):

  1. Improper performance
  2. No medical misadventure4
  3. Errors in diagnosis

Top outcomes (most prevalent):

  1. Postoperative infection
  2. Specified complications of procedures
  3. 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):

  1. Improper performance
  2. No medical misadventure4
  3. Errors in diagnosis

Top outcomes (most prevalent):

  1. Unhappy with results of plastic surgery
  2. Cardiac or cardiorespiratory arrest
  3. 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):

  1. Errors in diagnosis
  2. No medical misadventure4
  3. Improper performance

Top outcomes (most prevalent):

  1. Unnecessary procedure performed
  2. Malignant neoplasm of the female breast
  3. Emotional distress only

Number of closed claims: 705

Average indemnity: $345,521

Total indemnity: $77,051,095

 

Pediatrics21

Top chief medical factors (most prevalent):

  1. Errors in diagnosis
  2. No medical misadventure4
  3. Improper performance

Top outcomes (most prevalent):

  1. Cardiac or cardiorespiratory arrest
  2. Brain damaged infant
  3. 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):

  1. Improper performance
  2. No medical misadventure4
  3. Failure to recognize a complication of treatment

Top outcomes (most prevalent):

  1. Unhappy with the results of plastic surgery
  2. Postoperative infection
  3. 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):

  1. Errors in diagnosis
  2. No medical misadventure4
  3. Improper performance

Top outcomes (most prevalent):

  1. Malignant neoplasms of the female breast
  2. Malignant neoplasms of the bronchus and lung
  3. 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):

  1. Improper performance
  2. No medical misadventure4
  3. Errors in diagnosis

Top outcomes (most prevalent):

  1. Malignant neoplasms of the prostate
  2. Foreign body left in patient during surgical procedure
  3. 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

  1. 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.
  2. 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.
  3. PIAA Data Sharing Project. Specialty Specific Series: Anesthesiology. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association, 2016.
  4. 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.
  5. PIAA Data Sharing Project. Specialty Specific Series: Cardiovascular and Thoracic Surgery. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
  6. PIAA Data Sharing Project. Specialty Specific Series: Cardiovascular Diseases - nonsurgical. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
  7. PIAA Data Sharing Project. Specialty Specific Series: Dermatology. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
  8. PIAA Data Sharing Project. Specialty Specific Series: Emergency Medicine. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
  9. PIAA Data Sharing Project. Specialty Specific Series: Gastroenterology. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
  10. PIAA Data Sharing Project. Specialty Specific Series: General and Family Practice. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
  11. PIAA Data Sharing Project. Specialty Specific Series: General Surgery. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
  12. PIAA Data Sharing Project. Specialty Specific Series: Gynecology. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
  13. PIAA Data Sharing Project. Specialty Specific Series: Internal Medicine. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
  14. PIAA Data Sharing Project. Specialty Specific Series: Neurology - nonsurgical. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
  15. PIAA Data Sharing Project. Specialty Specific Series: Neurosurgery. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
  16. PIAA Data Sharing Project. Specialty Specific Series: Ob/Gyn Surgery. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
  17. PIAA Data Sharing Project. Specialty Specific Series: Ophthalmology. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
  18. PIAA Data Sharing Project. Specialty Specific Series: Orthopedic Surgery. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
  19. PIAA Data Sharing Project. Specialty Specific Series: Otorhinolaryngology. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
  20. PIAA Data Sharing Project. Specialty Specific Series: Pathology. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
  21. PIAA Data Sharing Project. Specialty Specific Series: Pediatrics. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
  22. PIAA Data Sharing Project. Specialty Specific Series: Plastic Surgery. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
  23. PIAA Data Sharing Project. Specialty Specific Series: Radiology. 2016 Edition. January 1, 2006 to December 31, 2015. MPL Association 2016.
  24. 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.

About the Author

Wayne Wenske is Senior Marketing Coordinator at Texas Medical Liability Trust. He can be reached at wayne-wenske@tmlt.org.

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