To obtain epidemiologic outcome information about pediatric lawsuits that originate in the emergency department and urgent care center.
This was an anonymous retrospective review of all closed pediatric claims in the Physician Insurers Association of America database during a 16-year period (1985-2000). This database, containing data from 20 major malpractice insurance firms, insuring 25% US physicians, was queried for epidemiologic outcome information about pediatric lawsuits originating in US emergency departments and urgent care centers.
There were 2283 closed claims reviewed. Of these, 96% originated in the emergency department, and 4% originated in an urgent care center. Nonteaching hospitals were the sites for 79% of claims. Suits involved emergency department physicians in 29%, pediatricians in 19%, board-certified physicians in 46%, US graduates in 70%, and full-time physicians in 96% of cases. In 66% of cases, doctors had a previous claim. In 65% of cases, more than 1 defendant was involved. Patients were boys in 59% and were younger than 2 years in 47%. The most common diagnoses involved in the lawsuits were meningitis, appendicitis, arm fracture, and testicular torsion. Cases in which the child died were most often from meningitis or pneumonia. The most common misadventures were diagnostic error (39%), and no medical error identified in 18%.
Cases were settled in 93% (indemnity paid in 30%). There was a judgment for the doctor in 5.5% and for the patient in 1.4%. The average indemnity/claim was US$66,000 in 1985 versus US$218,000 (+330%) in 1997. The average indemnity ranged from US$7000 for emotional injury, US$149,000 for death of the patient, US$300,000 for major permanent injury, and US$540,000 for quadriplegic from injury. There was no significant difference between teaching versus nonteaching hospitals, between urgent care center versus emergency department, US graduate physician versus non-US graduate, or physician age. Indemnity paid/claim for full-time physicians was US$161,000 versus US$91,000 for part-time physicians. Total paid to plaintiffs was US$116 million. Legal cost of defending the cases was US$36 million (including defense attorney fees, US$24 million, and expert witness fees, US$3.4 million).
Malpractice suits most often involved fractures, meningitis, and appendicitis. Most suits are settled; many are apparently frivolous. Paid indemnities have dramatically increased in recent years. Verdicts decided by juries favored the doctor in 80% of suits.