Patterns and predictors of settlement amounts from surgical malpractice claims in the United States, 1990-2006

Introduction: Medical malpractice litigation continues to be hotly debated, particularly given recent healthcare reform legislation. In this study the National Practitioner Data Bank (NPDB) data was scrutinized to evaluate predictors of malpractice claims ending in large payments. Methods: Retrospective analysis of the NPDB from 1990-2006 involving physicians and/or residents. Payments were adjusted to 2006 dollars. Large payments defined as those exceeding one million dollars. Multivariate regression evaluated predictors of large payments. Statutory law in the states demonstrating significant predictive values was analyzed. Results: A total of 58,518 claims were included. Patients were predominantly female (62%) and inpatient (63%) with mean age of 42 years. Claims per year decreased and payment sums increased over the study period. Median payment was $132,915 (95th percentile $983,263). Claims most frequently cited improper performance (42%). Adjusted analysis explored predictors of large settlements. Patient outcomes of quadriplegia/brain damage/life-long care (OR 142), major permanent injury (OR 66), and death (OR 28) increased the likelihood of large settlements. Compared to 20-69 year-olds, claims involving children less than 10 years-old were 1.7 times more likely to receive large payments (p=0.005); and patients over 70 years were 80% less likely (p<0.0005). Other positive predictors included claims in Illinois, Connecticut, Wisconsin, Rhode Island, New York, Massachusetts, and Georgia. Conclusions: Nationwide, surgical malpractice claims are decreasing in number with rising payment amounts. Patient outcome is the strongest predictor of payment size although significant variation in payments between states exists. Heterogeneity of payment sizes among states suggests a profound impact from the local legal environments. [Copyright &y& Elsevier]