Learning from Medmal Cases Involving Endoscopic Perforation

Medical malpractice data can be used to improve patient safety. It can also be used to understand which factors make malpractice claims more likely to pay. This information can support the work of claims managers to determine how to allocate claims management resources more effectively.

Analyzing large medical malpractice datasets can provide information about who is involved (responsible service), where injuries occurred (ambulatory, ED, in-patient), and what injuries are caused. The Comparative Benchmarking System (Candello) relies on a highly governed taxonomy to code malpractice cases that offers the unique ability or gain insights as to why events occur—or the contributing factors that were aspects in the event.

In the recent report, The Power to Predict, analyst applied predictive modeling to understand which contributing factors are more likely to pay. This is possible because Candello data includes paid and unpaid claims, as well as contributing factors that codify issues that have statistically significant impact on case resolution. While the report looked specifically at contributing factors, this method can also be applied to targeted areas, such as specialty or type of injury.

CONTRIBUTING FACTORS THAT AFFECT LEGAL OUTCOMES AFTER ENDOSCOPIC PERFORATIONS

In a study published in The American Journal of Gastroenterology, researchers analyzed malpractice claims in Candello to determine the association of technical and nontechnical skills of endoscopists with indemnity payments to patients after endoscopic perforations. Researchers analyzed closed medical malpractice cases in Candello from 2004 to 2014 that named gastroenterologists and involved endoscopic perforations.

The researchers observed that inadequate communication and clinical judgment were associated with indemnity payment, independent of the severity of the clinical outcomes. However, when cases alleged poor technical skills without communication breakdown or clinical judgment issues, favorable outcomes were associated for the physician defendant.

This table from the study illustrates the nontechnical skills because of communication or clinical judgment contributing factors identified in this data set. Some cases involved more than one contributing factor.

Communication factors %
Inadequate consent 14%
Lack of communication with the patient/family, language barrier 10%
Poor communication with other providers 5%
Alteration or lack of documentation 5%
Poor patient rapport 5%
Delay in disclosure of perforation to the patient 2%
Clinical judgment factors %
Premature discharge 11%
Failure to appreciate signs and symptoms of perforation 10%
Failure or delay in ordering diagnostic tests 9%
Failure to establish differential diagnosis 5%

“In the cases of poor communication or poor clinical judgment, the odds of indemnity payment were over 3-folds higher than those without. Similarly, if there were no communication or clinical judgment issues and the only allegation was poor technical skill, the odds of indemnity payment were less than half of those cases.”—Lyndon V. Hernandez, MD, MPH, et. al

APPLYING THE INSIGHTS

This study offers insights that can be applied to clinical practice to reduce harm and financial loss. Researchers suggest that the “likelihood of a procedure-related injury evolving into a paid malpractice claim may depend more on what happens before (informed consent) and after (communication and clinical judgment) the precipitating event, rather than the injury itself.”

If an organization analyzes its medical malpractice claims data and learns that communication before and/or after an adverse event is frequently involved, it may propel them to examine its organization’s communication procedures. For example, is the informed consent process being followed and if it is, ensuring that there are not gaps that could contribute to a patient feeling uninformed about a procedure. Or it may look at its policy and support offered to providers and patients following an adverse event.

Malpractice cases involving perforation injuries are rare so assessing exposure may be less straight-forward. Claims managers may look at this information and apply it to similar cases in setting reserves and allocating resources as understanding the technical dimensions of a case can be helpful in this process.

In addition, a clear picture of how these contributing factors intersect with the consent process and a provider’s follow up actions after a complication may impact the strengths and weaknesses of a defense.

Special thanks to Peter McCormack, Reinsurance Manager for CRICO, who provided insights about how claims managers can leverage data insights from Candello.

Download the full-text study

Hernandez LV, Klyve D, Feld L, Nalini G, Feld A. "Do nontechnical skills affect legal outcomes after endoscopic perforations?"The American Journal of Gastroenterology. September 2020 - Volume 115 - Issue 9 - p 1460-1465. doi: 10.14309/ajg.0000000000000671

Written By
Katy_Schuler_web
Katy Schuler, MSc
Katy Schuler was the Marketing Manager for CRICO Strategies.
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