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The Impact of Incident Disclosure Behaviors on Medical Malpractice Claims

Giraldo, Priscila RN, JD, PhD*†‡§∥¶; Sato, Luke MD***; Castells, Xavier MD, PhD†∥††

doi: 10.1097/PTS.0000000000000342
Original Article: PDF Only

Objectives To provide preliminary estimates of incident disclosure behaviors on medical malpractice claims.

Methods We conducted a descriptive analysis of data on medical malpractice claims obtained from the Controlled Risk Insurance Company and Risk Management Foundation of Harvard Medical Institutions (Cambridge, Massachusetts) between 2012 and 2013 (n = 434). The characteristics of disclosure and apology after medical errors were analyzed.

Results Of 434 medical malpractice claims, 4.6% (n = 20) medical errors had been disclosed to the patient at the time of the error, and 5.9% (n = 26) had been followed by disclosure and apology. The highest number of disclosed injuries occurred in 2011 (23.9%; n = 11) and 2012 (34.8%; n = 16). There was no incremental increase during the financial years studied (2012–2013). The mean age of informed patients was 52.96 years, 58.7 % of the patients were female, and 52.2% were inpatients. Of the disclosed errors, 26.1% led to an adverse reaction, and 17.4% were fatal. The cause of disclosed medical error was improper surgical performance in 17.4% (95% confidence interval, 6.4-28.4). Disclosed medical errors were classified as medium severity in 67.4%. No apology statement was issued in 54.5% of medical errors classified as high severity.

Conclusions At the health-care centers studied, when a claim followed a medical error, providers infrequently disclosed medical errors or apologized to the patient or relatives. Most of the medical errors followed by disclosure and apology were classified as being of high and medium severity. No changes were detected in the volume of lawsuits over time.

From the *Risk Management Foundation of Harvard Medical Institutions, Cambridge, Massachusetts; †IMIM (Hospital del Mar Medical Research Institute); ‡Escuela Superior de Enfermería del Mar, Centro adscrito a la Universitat Pompeu Fabra; §Programa de Doctorado en Metodología de la Investigación Biomédica y Salud Pública, Universitat Autónoma de Barcelona, Barcelona; ∥Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid; ¶Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain; **Harvard Medical School, Boston, Massachusetts; and ††Universitat Autónoma de Barcelona (UAB), Barcelona, Spain.

Correspondence: Priscila Giraldo, JD, RN, PhD, IMIM (Hospital del Mar Medical Research Institute), Passeig Maritim, 25–29, 08003 Barcelona, Spain (e-mail: pgiraldo@parcdesalutmar.cat).

The authors disclose no conflict of interest.

Funding: This project was funded by The Ignacio Larramendi Research Grants 2013 MAPFRE-Foundation, for which P.G. is the principal researcher.

Ethical Approval: The protocol of this study was approved by the ethics committee of the Hospital Mar Medical Research Institute from Barcelona, Spain.

Contributors: P.G. and X.C. conceived the study. L.S., X.C., and P.G. contributed to the design and coordination of the study. P.G. analyzed the data. P.G. and L.S. drafted the first manuscript. All authors contributed substantially to the interpretation of the data and successive revisions of the manuscript. All authors contributed to the manuscript and approved the final version. P.G. is the principal researcher for the project.

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