Procedural Errors, Misdiagnoses Main Source of Malpractice Claims in Dermatology

Handling medical malpractice liability claims is a stressful, costly process, and delineating the characteristics of such claims is the first step toward recognizing areas for improvement, thus helping to enhance patient outcomes and minimize patient harm, according to the results of a recent analysis of claims against dermatologists from the Physician Insurers Association of America Data Sharing Project published in JAMA Dermatology.

The objective of the current study was to determine the characteristics of medical professional liability claims in the field of dermatology and to compare them with claims against physicians in other specialties. The investigators reviewed data compiled on dermatologists and other physicians who are insured by companies that report their findings to the Physician Insurers Association of America Data Sharing Project — a nationally representative liability claims registry. 

The data analyzed spanned the years from 1991 through 2015. The main outcome measures of the analysis included demographic characteristics of dermatologists with claims against them, features of closed claims, medical errors linked to closed claims, and patient outcomes leading to closed claims. 

Data from 90,743 closed claims were analyzed, with 1.2% (1084 of 90,743) against dermatologists and 98.8% (89,659 of 90,743) against physicians from other specialties. More lawsuits were filed against male (69.5%) than female (24.9%) dermatologists; in 5.6% of claims against dermatologists, the physician’s gender was not listed. Overall, 95% (1035 of 1084) of closed claims were filed against full-time dermatologists — a finding similar to that seen among physicians in all fields (96.2%; 87,271 of 90,743). Regarding practice setting, 55.4% (600 of 1084) of closed claims were brought against solo-practice dermatologists, 39.6% (429 of 1084) against group practices, and 2.9% (31 of 1084) against institutions.

Between 2006 and 2015, the majority (67.8%; 735 of 1084) of claims against dermatologists were abandoned, dismissed, or withdrawn. Trial verdicts in favor of defendants surpassed those in favor of plaintiffs by a factor of 7. The majority of claims were related to errors that occurred during a procedure (n=305), with 102 of these claims actually paid. The second highest number of claims were associated with misdiagnoses (n=192), with 62 of these paid. The average recovery paid by dermatologists was $238,145 — an amount decidedly lower than the $335,578 average recovery for all specialties.

Among dermatologists, the most closed claims involved operative skin procedures (n=420), with 130 of these claims paid. The most common adverse patient outcome associated with a claim was dyschromia, which resulted in 171 closed claims, 40 of which were paid. The second most common adverse patient outcome associated with a claim was malignant skin neoplasms, which resulted in 127 closed claims, of which 43 were paid.

The investigators concluded that future studies are warranted to focus on evidence-based interventions to reduce claims and improve the competency of dermatologists with respect to communication and clinical skills.

Reference

Kornmehl H, Singh S, Adler BL, Wolf AE, Bochner DA, Armstrong AW. Characteristics of medical liability claims against dermatologists from 1991 through 2015 [published online December 6, 2017]. JAMA Dermatol. doi: 10.1001/jamadermatol.2017.3713