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Small number of doctors behind big share of malpractice claims

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Just 1 percent of active U.S. physicians are responsible for nearly a third of the nation's paid malpractice claims, a new study finds.

And, the more paid claims doctors incurred, the higher their risk of future paid claims, the study found.

The results suggest it may be possible to identify "claim-prone" physicians and intervene before they encounter additional claims, said study lead author David Studdert, professor of medicine and law at Stanford University in Palo Alto, Calif.

"I think a lot of liability insurers and health care organizations have not taken that analytical step to really understand who these folks are," he said.

The findings are published in the Jan. 28 issue of the New England Journal of Medicine.

Studdert said there's never been a national study of how malpractice claims are distributed among physicians. Prior studies are decades old and rely on data from a single insurer or state, "so we think this is new information," he said.

Some medical malpractice experts said the findings confirm what they've known for a long time.

"I don't believe that they discovered anything new," said David Sousa, chief operating officer and general counsel of Medical Mutual in Raleigh, N.C., which insures some 13,000 doctors in 22 states.

For the new study, researchers from Stanford and the University of Melbourne in Australia reviewed information culled from the U.S. National Practitioner Data Bank, an electronic repository created by Congress in 1986 to improve health care quality.

The data bank collects information on medical malpractice payments and adverse actions, such as when a physician is barred from participating in Medicare or Medicaid. That information is not available for public scrutiny.

The study included almost 67,000 paid claims against more than 54,000 physicians from 2005 through 2014.

Overall, during the 10-year period, only 6 percent of all active U.S. physicians had a paid claim, the study found.

Those with two of more claims represented just 1 percent of all physicians, but they accounted for 32 percent of all paid claims, the researchers said.

The study didn't break out the amount paid to malpractice victims on behalf of those claim-prone physicians.

Over the decade, a whopping $24.6 billion was paid to satisfy court verdicts and out-of-court settlements of medical malpractice cases, according to Studdert. That doesn't include costs for bringing and defending those claims, he said.

Nearly one-third of the claims involved patients who died, while 54 percent related to "major" or "significant" physical injury. The average payout was more than $371,000, the research revealed.

Twenty-nine states have limits on damages awarded for pain and suffering, according to PIAA, a Rockville, Md.-based trade association representing medical liability insurers.

Physicians at risk of incurring future paid claims share some distinct characteristics, the study found. They are much more likely to be male and much less likely to be younger than 35.

Neurosurgeons, orthopedic surgeons, general surgeons and obstetrician-gynecologists were among those who faced double the risk of future claims, compared with internal medicine physicians, the study showed.

That's partly due to the nature of the work, Sousa explained. "OBs [obstetricians] forever in this country have been the prime target, because if something goes wrong in the delivery of a newborn child, the injuries are devastating," he said.

The most important predictor of a claim appeared to be a physician's past claims history. Compared with doctors with one previous paid claim, those with two paid claims had almost twice the risk of having another. Physicians with three paid claims had three times the risk. Those with six or more had more than 12 times the risk, the study found.

Are they bad doctors or just more likely to attract claims?

"It is a very reasonable question to ask why it's possible to accumulate four or five paid claims in a 10-year period and continue to practice [medicine]," Studdert said. "We don't know the answer to that question."

Dr. Gerald Hickson, senior vice president for quality, safety and risk prevention at Vanderbilt University School of Medicine in Nashville, has studied the relationship between patient and family complaints about a surgeon's behavior and poor outcomes in complex cases.

Patients and families must be sure the hospital where the doctor practices is "committed to a culture of safety," he cautioned. "You want to be sure that the hospital has a mechanism that you can speak up and complain when you're not satisfied with the care you're receiving," he said.