OK, I got your attention. Yes, I was sued as a third-year pediatric resident related to an infant in the NICU getting too high a dose of potassium. The incident occurred six months before I did my NICU rotation. In fact, I only wrote one note in the chart, stating that the infant was stable. Everyone who had ever had any contact with the infant – the NICU nurses, all residents, NICU fellows, staff, the NICU, the University of Tennessee, and the United States was named in the suit. After two years and a deposition, I was removed from the case. That remains my only personal encounter with malpractice, thank goodness.
In general, it is not a big issue for most allergists. We tend to be sued less often than physicians in other specialties. As far as cost for malpractice insurance, it is not usually a major expense for the average allergist.
I really wrote this column because a report got my attention from the American Medical Association on April 2, entitled “New Data Show the Highest Prevalence of Medical Liability Premium Increases in 15 Years.” The data came from Medical Liability Monitor’s (MLM) annual survey on malpractice insurance costs, which provided the data for the AMA study. The research examined premium levels in select geographic areas of the United States from 2011 to 2020 for the following three specialties: OB/GYN, general surgery and internal medicine. The main and most significant finding in this year’s report is that more premiums increased than in any year since 2005. The proportion of premiums that went up in 2018 almost doubled in 2019 – from 13.7% to 26.5%. Then in 2020, this share grew again, as 31.1% of premiums increased from the previous year. This appears to be the beginning of an upward trend in rises in premiums – a trend not seen in over 20 years.
Premium increases of 10% or more were reported in 11 states. Those states and their percentage of rate hikes that were greater than 10% were Kentucky (29.6%), South Carolina (27.8%), Maryland (18.8%), Nebraska (16.7%), Oregon (16.7%), Montana (16.7%), Georgia (14.8%), Missouri (14.8%), New Hampshire (13.3%), Illinois (11.9%) and Michigan (11.6%).
In an article by Medscape Medical News, Sue Bailey, MD, FACAAI, president of the AMA, voiced her concern on the hike in malpractice rates for physicians. “It’s important to keep liability premium growth in check, because physician practices have been incredibly stressed during the pandemic: Their patient numbers are down, their reimbursements are down, their burnout is up,” she said. “To add an increased liability premium on top of all those negative impacts of COVID-19 – there are some practices that won’t be able to pay the premiums. Some practices will be forced to close or to change in some way, and that would be a terrible outcome of the pandemic.” Watch your malpractice rates. They may be going up dramatically.
Do we know how often allergists are sued for malpractice? The latest Medscape Malpractice Report, from 2019, which was an online survey of 4,360 physicians (63% male) across over 29 specialties weighed to the AMA’s physician distribution by specialty. Allergy/Immunology was included but the exact numbers were not shown. The survey was performed from Aug. 6 to Sept. 26, 2019. They point out that more than half of physicians will be named in a lawsuit at some point in their careers. That’s a disturbing statistic, though the good news is that only a tiny percentage go to trial and have the case decided against the doctor. In this survey, 59% had been sued either individually, with others, or both. Specialists (62%) were sued more often than primary care physicians (52%). The top 10 specialities for lawsuits are what you would generally expect. Here is the list from highest to lowest:
- General Surgery
- Urology
- Otolaryngology
- OB/GYN
- Specialized Surgery
- Radiology
- Emergency Medicine
- Cardiology
- Gastroenterology
- Anesthesiology
It isn’t surprising that Allergy/Immunology is not in the top ten. The survey does not show where the other specialties ranked, but I guess we are near the bottom. Personally, I always thought OB/GYN was the highest, although the top five were within 5% of each other. They did quote an allergist in the survey who was asked about the reason for his/her malpractice suit. “There was a broken needle left in the patient, which I removed four weeks later, and I was sued.” Yikes!
Hopefully you will never get named in a malpractice lawsuit. I caution all of us to take steps to prevent malpractice. I especially like the following ten steps from Adam Rapp on prevention of malpractice:
- Communicate, communicate, communicate.
- Get it in writing (documentation).
- Stay up to date on current standards.
- Always obtain informed consent.
- Be sure to follow up.
- Manage your patient’s expectations.
- Put yourself in your patient’s shoes.
- Keep an open mind when it comes to your patients.
- Swallow your pride and ask for help.
- Avoid developing bad habits.
