Friday, July 27, 2012

Why do malpractice claims take so long to be resolved?

Two recent papers have prompted me to ask myself the question, “Why do malpractice suits take so long to be resolved?”

One was by a group from Harvard, USC and the RAND Corporation. They looked at more than 10,000 closed malpractice cases for all specialties and found the average length of time it took to close a case was 19 months, with litigated claims taking a little over twice as long as non-litigated claims, 25.1 vs. 11.6 months respectively. Claims that were resolved at trial took much longer averaging 39.0 months for defendant verdicts and 43.5 months for plaintiff verdicts.

The second study was by a group headed by a surgeon based at a Johns Hopkins affiliated hospital. They reviewed 187 closed surgery claims at four university hospitals in New York. Using a different method of calculating the length of time, they noted a mean time until resolution of all claims of 4.5 years. Cases closed with no payment took 3.9 years, while those won or lost at trial took about 5 years.

I’ll give you a minute to see if you can guess why it takes so long to resolve these claims.

Here’s my theory. I think it might have something to do with the involvement of lawyers. We all know that plaintiffs’ attorneys get a large percentage of the take from any case settled with payment or plaintiff’s verdict with damages.

But defending cases can be expensive too. Since defense lawyers are paid according to their billable hours, it seems to me that it is in their best interest to make a claim last as long as possible. Have you ever been deposed or read a deposition? Lawyers object to every other question, which accomplishes nothing. The question still has to be answered. They also ask the same questions over and over leading to the old “Objection, asked and answered” response. Often the questions seem to have nothing to do with the alleged negligence.

Let’s do some math.

A paper that appeared in the journal Health Affairs in 2005 addressed the legal costs associated with malpractice claims. The study found that “legal costs average $27,000 per claim in the United States, which adds approximately $1.4 billion in costs to the $4.4 billion paid in settlements and judgments. The costs of underwriting insurance against malpractice claims are estimated at an additional 12 percent, or $700 million. The cost of defending U.S. malpractice claims, including awards, legal costs, and underwriting costs, was an estimated $6.5 billion in 2001—0.46 percent of total health spending.”

Yes, it’s less than 1% of total healthcare spending. But as the old and possibly apocryphal saying attributed to the late Senator Everett Dirksen goes “A billion here, a billion there, pretty soon, you're talking real money.” And don’t forget the emotional toll that being the target of a lawsuit takes on the defendent doctor while the case is meandering through the process.

A version of this post appeared on Sermo yesterday. All who commented thought the process took too long.


Robert said...

The length of time it takes to resolve malpractice claims with payments varies greatly from state to state. The National Practitioner Data Bank has data on incident dates leading to all payments. The mean time between incident and payment is between 4 and 5 years nationally. Some states, like New York take longer. If I remember correctly, Massachusetts had the longest average, between 6 and 7 years. By the way, 97 percent of all paid claims result from settlements, not court judgments.

Philip said...

That 1% figure is interesting. I've been on the wards as a medical student for 20 months or so and already I have seen unnecessary scans, tests, antibiotics and other valuable resources used purely "just to be safe." I suspect at least half of these orders are for allaying the medico-legal concerns of the doctors rather than the benefit of the patients. I also suspect that it is easier for a physician dazed from hours of filling out inane forms and checking meaningless boxes to order a head CT than to do a careful neurological exam. It would be nearly impossible to put a hard number on it, but I suspect that malpractice liability is more like 10% or more of all healthcare spending.

Skeptical Scalpel said...

Robert, I agree that the time to resolve a case with payments s longer.

Philip, it is hard the quantify the scope of defensive medicine. I suspect your guess of 10% might be a little low.

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