Malpractice: Diagnostic errors top allegation involving children


Diagnostic error is the most common allegation against pediatricians when sued by patients and their families, a study finds.

Ten specialties most often named in pediatric claims

Investigators with The Doctors Company, a national medical liability insurer, examined 1,215 closed claims involving children from the company’s database between 2008 and 2017. Results showed that diagnostic mistakes, including delayed diagnosis, incorrect diagnosis, and failure to diagnose, were the most common accusations among claims that involved children ages 1 through 17. Poor medical treatment was the second most common allegation for claims that involved children aged 1-9, while surgical treatment-related error was the second most frequent accusation for children ages 10-17.

Pediatricians, orthopedic surgeons, and emergency medicine physicians were the most frequently named specialists in claims associated with children older than 1 month. Obstetricians were most frequently defendants in claims involving neonates. For these cases, errors during labor and delivery care were the most common complaints.

Of the 1,215 claims, obstetricians were named in 24% of the cases and pediatricians were named in 15% of the cases. The majority of claims were filed against physicians in the first 3 years following the medical incident alleged, according to the study, published by The Doctors Company.

The average patient payment in each case was $630,456, and the average expense to defend each claim was $157,502, according to the analysis. Claims that involved neonates had the highest average payment ($936,843) and the highest defense costs ($187,117), while claims involving children aged 10-17 years had the lowest average payment ($386,849) and cost the least to defend ($129,816).

For cases involving neonates, the type of therapy selected during labor and delivery and how it was managed were the most common factors contributing to the alleged injury, according to the analysis.

The most frequent factors contributing to patient harm for other age groups involved patient assessment issues and communication problems between the patient/family and the physician. Inadequate patient assessments were closely linked to incorrect diagnoses, while incomplete communication between patients/family members and providers impacted clinicians’ ability to make correct diagnoses, according to the study.

This analysis “shows that pediatric malpractice lawsuits impact nearly every area of medicine,” William F. Getman, MD, a pediatrician in Austin, Tex., said in an interview. “I was surprised to see that the most common age of a patient in a malpractice lawsuit was less than 1 month old. This age group also sustained the most severe injuries and had the highest indemnity paid.”

The study offers several key takeaways, including the importance of identifying system weaknesses in your medical practice and evaluating if improvements are needed, according to Darrell Ranum, vice president for patient safety and risk management for The Doctors Company.

Darrell Ranum, vice president for patient safety and risk management, The Doctors Company

Darrell Ranum

Simple improvements, such as implementing tracking mechanisms for test results and referrals, can reduce the chance that important information falls through the cracks and delays diagnosis or treatment, Mr. Ranum said in an interview.

“When parents raise questions about their child’s complaints, this is the best opportunity to identify illnesses and conditions that represent a serious threat to children,” he said. “Prepare office staff members to know what complaints need to be evaluated by a clinician or require immediate care.”

In addition, the study findings point to the need to improve communication in all areas of the practice spectrum, Dr. Getman said.

“Many of the lawsuits could have been avoided by improvements in communication – doctor to patient, patient to doctor, doctor to nurse, doctor to doctor, nurse to patient, etc.,” he said. “Finding more effective and accurate ways to communicate will avoid mistakes, improve care, and improve outcomes. Examples of ways to improve communication include use of an interpreter when indicated, verbal and written explanations of instructions, and system improvements in tracking messages/labs/data. There are innumerable other ways to improve communication in health care.”

SOURCE: Ranum, D. The Doctor’s Advocate. First Quarter 2019.

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