0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Primary Care Closed Claims Experience of Massachusetts Malpractice Insurers

Gordon D. Schiff, MD1,2; Ann Louise Puopolo, RN, BSN3,4; Anne Huben-Kearney, RN, BSN, MPA5,6; Winnie Yu, MA, MBA3; Carol Keohane, RN, BSN3; Peggy McDonough, RN, BSN5; Bonnie R. Ellis, RN, BSN5; David W. Bates, MD1,2; Madeleine Biondolillo, MD7
[+] Author Affiliations
1Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
2Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Department of Medicine, Harvard Medical School, Boston, Massachusetts
3The Risk Management Foundation of the Harvard Medical Institutions (Controlled Risk Insurance Company), Cambridge, Massachusetts
4CVS Caremark Corporation, Woonsocket, Rhode Island
5Coverys Corporation, Boston, Massachusetts
6Signature Healthcare, Brockton, Massachusetts
7Massachusetts Department of Public Health, Boston
JAMA Intern Med. 2013;173(22):2063-2068. doi:10.1001/jamainternmed.2013.11070.
Text Size: A A A
Published online

Importance  Despite prior focus on high-impact inpatient cases, there are increasing data and awareness that malpractice in the outpatient setting, particularly in primary care, is a leading contributor to malpractice risk and claims.

Objective  To study patterns of primary care malpractice types, causes, and outcomes as part of a Massachusetts ambulatory malpractice risk and safety improvement project.

Design, Setting, and Participants  Retrospective review of pooled closed claims data of 2 malpractice carriers covering most Massachusetts physicians during a 5-year period (January 1, 2005, through December 31, 2009). Data were harmonized between the 2 insurers using a standardized taxonomy. Primary care practices in Massachusetts. All malpractice claims that involved primary care practices insured by the 2 largest insurers in the state were screened. A total of 551 claims from primary care practices were identified for the analysis.

Main Outcomes and Measures  Numbers and types of claims, including whether claims involved primary care physicians or practices; classification of alleged malpractice (eg, misdiagnosis or medication error); patient diagnosis; breakdown in care process; and claim outcome (dismissed, settled, verdict for plaintiff, or verdict for defendant).

Results  During a 5-year period there were 7224 malpractice claims of which 551 (7.7%) were from primary care practices. Allegations were related to diagnosis in 397 (72.1%), medications in 68 (12.3%), other medical treatment in 41 (7.4%), communication in 15 (2.7%), patient rights in 11 (2.0%), and patient safety or security in 8 (1.5%). Leading diagnoses were cancer (n = 190), heart diseases (n = 43), blood vessel diseases (n = 27), infections (n = 22), and stroke (n = 16). Primary care cases were significantly more likely to be settled (35.2% vs 20.5%) or result in a verdict for the plaintiff (1.6% vs 0.9%) compared with non–general medical malpractice claims (P < .001).

Conclusions and Relevance  In Massachusetts, most primary care claims filed are related to alleged misdiagnosis. Compared with malpractice allegations in other settings, primary care ambulatory claims appear to be more difficult to defend, with more cases settled or resulting in a verdict for the plaintiff.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Figures

Place holder to copy figure label and caption
Figure.
Disposition of Closed Cases

Comparison of the differences between general medicine and non–general medicine cases and the different outcomes in diagnosis cases vs medication-related cases. There were 551 Risk Management Foundation of the Harvard Medical Institutions (Controlled Risk Insurance Company [CRICO]) and Coverys outpatient malpractice cases closed from 2005 through 2009 that named general medicine staff or fellow physicians (excluding hospitalists) and excluding emergency department locations.

Graphic Jump Location

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 3

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Related Multimedia
Articles Related By Topic
Related Collections
Jobs
brightcove.createExperiences();