Closed Claims Studies

Apr 19, 2024, Anesthesia and Analgesia
Anesthesia-Related Closed Claims in Free-Standing Ambulatory Surgery Centers
As higher acuity procedures continue to move from hospital-based operating rooms (HORs) to free-standing ambulatory surgery centers (ASCs), concerns for patient safety remain high. We conducted a contemporary, descriptive analysis of anesthesia-related liability closed claims from The Doctors Company to understand risks to patient safety in the free-standing ASC setting, compared to HORs.

Mar 01, 2024
Burnout and Litigation Against Primary Care Providers: Where Do They Overlap?
Jacqueline Ross, RN, PhD, Coding Director, and Robert Morton, MAS, CPPS, CPHRM, ARM, Assistant Vice President, Department of Patient Safety and Risk Management, The Doctors Company, Part of TDC Group
Certain trends in primary care suggest potential avenues for investigation into malpractice allegations. These include a worsening shortage of primary care physicians, an association between burnout and patient safety concerns, and the rise in both the number of women physicians and the rate of burnout among women physicians.

Feb 24, 2024, Risk Management and Healthcare Policy
Analysis of Closed Claims Among All Medical Specialties: Importance of Communication and Other Non-Clinical Contributing Factors
Evaluation of contributing factors associated with medical malpractice claims provides important information to optimize the patient–provider relationship. This review of closed claims from The Doctors Company highlights common factors contributing to lawsuits and strategies to avoid them, with a particular focus on communication.

Jan 26, 2024
Maternal Health Closed Claim Review: Preparing a Facility for Emergencies
This case study highlights risk reduction strategies facilities can use to prepare for and address maternal health emergencies.

Dec 15, 2023, Inside Medical Liability
MPL Cases: What Are the Primary Drivers of High-Indemnity Medical Malpractice Claims?
Jacqueline Ross, RN, PhD, Coding Director, and Kathrine Soulsby, RN, BSN, Senior Patient Safety Analyst, The Doctors Company, part of TDC Group, investigate high-dollar medical malpractice litigation and explain how reducing diagnostic errors is paramount to enhancing patient safety and mitigating loss costs.

Nov 27, 2023
Diagnosis-Related Medical Malpractice Claims With Indemnities Over $1 Million: Understanding the Primary Drivers
Jacqueline Ross, RN, PhD, Coding Director, and Kathrine Soulsby, RN, BSN, Senior Patient Safety Analyst, Department of Patient Safety and Risk Management, The Doctors Company, Part of TDC Group
Identifying and concentrating on factors related to high-indemnity medical malpractice claims can help to both improve patient outcomes and reduce financial losses. One common thread in high-indemnity claims is diagnostic errors. Therefore, understanding more about how to protect against and prevent diagnostic errors is paramount to patient safety and to mitigating loss costs.

Professional Education
Missed Medical History Leads to Adverse Outcome (Claims Corner)
The Doctors Company has identified patient assessment issues and communication failure between providers as key contributors to malpractice claims. This dental case study describes how inadequate patient history taking and poor communication can lead to an adverse patient outcome. The lessons learned in this course are applicable to all healthcare professionals.
0.5 credit

Aug 22, 2023, KevinMD
For Orthopedic Surgeons, an All-of-the-Above Approach Lowers Liability Risks
Jacqueline Ross, RN, PhD, Coding Director, and Eric E. Cleckler, MSN, RN, Patient Safety Risk Manager II, Department of Patient Safety and Risk Management, The Doctors Company, part of TDC Group, analyze orthopedic medical malpractice insurance claims and translate the findings into patient safety insights to help medical professionals pursue best practices for risk mitigation.

Aug 11, 2023
Physical Medicine and Rehabilitation Malpractice Claims: Lessons Learned
Michelle Swift, JD, RN, Senior Patient Safety Risk Manager, The Doctors Company
We analyzed closed physical medicine and rehabilitation claims to better understand what motivates allegations of injury.

Professional Education
Failure to Diagnose Congenital Asplenia Results in Tragic Patient Outcome (Claims Corner CME)
Referral process system failures can contribute to delayed diagnosis of serious conditions which can lead to severe consequences for patients. Problems can arise when referral is needed but is not initiated properly or timely, when the specialist does not ensure their recommendations are fully and clearly communicated back to the referring clinician, when the referring clinician does not understand or act on the specialist’s recommendations, or when the referring office fails to track their open referrals to ensure they have received all consultation reports. This program will examine a malpractice case involving all the above referral-related deficiencies, leading to a catastrophic result for the patient and significant liability for the involved clinicians. Risk management strategies will be provided for any practice to improve the referral process and to prevent similar tragedies from occurring.
0.8 credit

Professional Education
Prevention of Medical Errors Florida (2023–2025 Edition)
This activity is specific to Florida statutes and reflects regulations effective February 2022. Few medical errors are attributed to faulty medical judgment. More commonly, they are attributed to system failures inherent in healthcare delivery. By drawing on our professional liability closed claims data, we have identified common performance and diagnostic errors that reflect on the most common issues identified by Florida: wrong site surgery, surgery complications, cancer, gastroenterology conditions, cardiology issues, neurological issues, and adverse drug events, which will serve as the focal point of this patient safety and risk management course. We analyzed loss prevention measures in tandem with the elements necessary to conduct a credible and thorough root cause analysis to reduce system failures, respond to sentinel events, prevent medical errors, and improve patient safety. The purpose of this educational activity is to provide physicians with the most current information regarding the prevention of common performance and diagnostic errors.
2.0 credits

Professional Education
Risk Management 101 for Healthcare Professionals: Malpractice, Patient Relations, and Documentation
This is an introductory level course about basic risk management for practicing clinicians focusing on malpractice, patient communication, and documentation. Healthcare professionals new to practice and more experienced will learn the legal elements of a malpractice claim that must be proven for a plaintiff to prevail. We share communication strategies to enhance patient understanding, compliance, and satisfaction while reducing the risk of abandonment when ending patient relationships. We address the importance of documentation, share open notes strategies for success, and strategies to demonstrate quality of care and reduce risk. Documentation examples are provided, as are tips for electronic health record (EHR) and telehealth documentation.
1.5 credits

Jun 23, 2023
The Malpractice Experience of Orthopedic Surgeons 2011 to 2021: Patient Selection and Communication May Mitigate Risk of Claims
Jacqueline Ross, RN, PhD, Coding Director, and Eric E. Cleckler, MSN, RN, Patient Safety Risk Manager II, Department of Patient Safety and Risk Management, The Doctors Company, Part of TDC Group
This study analyzed 1559 closed medical malpractice claims and suits (814 ambulatory, 745 inpatient) from the loss years of 2011 to 2021 in which orthopedic surgeons were the major responsible service.

Professional Education
Failure to Rescue a Recurring Post-Surgical Event (Claims Corner CME)
Claims arising from the perioperative experience are frequent, often preventable, and some of the costliest claims for physicians. One study of surgical claims conducted by The Doctors Company noted that about two out of three general surgeons have been involved in a medical malpractice suit.  Malpractice data consistently finds that the most serious and common post-operative complications are unrecognized intestinal puncture or perforation. Diagnostic error by surgeons involving unrecognized intestinal puncture or perforation of an organ can quickly lead to septic shock and death.
0.5 credit

May 11, 2023, Inside Medical Liability Online
Postpartum Malpractice Claims: Can We Understand Preventable Harms and Socioeconomic Factors?
Rates for maternal morbidity and mortality are higher in the U.S. than in any other developed country—and many of the harms suffered by patients are preventable. In a multifactorial study, David L. Feldman, MD, MBA, FACS, Chief Medical Officer, The Doctors Company and TDC Group; Jacqueline Ross, PhD, RN, CPAN, Coding Director, Department of Patient Safety and Risk Management, The Doctors Company, and Shelise Valentine, RNC, MSN, Director of Clinical Education, Healthcare Risk Advisors, part of TDC Group, investigated postpartum claims to develop clinical recommendations to decrease the risks of postpartum morbidity and mortality.

Apr 14, 2023
Postpartum Malpractice Claims: Understanding Preventable Harms and Socioeconomic Factors
Jacqueline Ross, RN, PhD, Coding Director, Department of Patient Safety and Risk Management, The Doctors Company, Part of TDC Group, and Shelise Valentine, RNC, MSN, Director of Clinical Education, Healthcare Risk Advisors, Part of TDC Group
Investigators reviewed 43 closed postpartum medical malpractice claims to develop clinical recommendations to decrease the risks of postpartum morbidity and mortality.

Professional Education
Loss Lessons: Recognition of Wernicke Encephalopathy
Wernicke encephalopathy (WE) is a syndrome commonly seen in patients with alcohol use disorder who do not take adequate thiamine. WE should be suspected in any patient with conditions that may lead to malnutrition in combination with any of the following symptoms: altered mental status ophthalmoplegia, ataxia, delirium, and hypotension. Considered a medical emergency, it must be reversed to prevent permanent deficits. This case illustrates a cascade of errors which led to permanent disability. Some practical interventions to quickly recognize and reverse the condition are offered following the case presentation, which will be helpful for gastroenterology/gastroenterologists, ophthalmology/ophthalmologists, and neurology/neurologists.
0.5 credit

Professional Education
Errors in Anticoagulation Management in the Dermatology Office (Claims Corner CME)
In reviewing closed malpractice claims, The Doctors Company has found an increased risk of claims in patients taking direct acting oral anticoagulants that undergo office-based dermatologic procedures. This case study highlights the factors contributing to the improper management of these patients, including errors in clinical judgment, anticoagulant management, and communication.
0.5 credit

Professional Education
Anesthesia Care: Preventing Dental Injury
Dental injury claims continue to make up almost a quarter of all anesthesiology claims (22 percent) with over 30 percent of tooth damage claims resulting in indemnity payments to the plaintiff. Due to the frequent occurrence of dental injury claims, anesthesia professionals must be aware of dental injury causes, preventive measures, and steps to take if injury occurs.
0.8 credit

Professional Education
Prevention of Medical Errors (2023–2025 Edition)
Few medical errors are attributed to faulty medical judgment. More commonly, they are attributed to system failures inherent in healthcare delivery. By drawing on our professional liability closed claims data, we have identified common performance and diagnostic errors. We analyzed loss prevention measures in tandem with the elements necessary to conduct a credible and thorough root cause analysis to reduce system failures, respond to sentinel events, prevent medical errors, and improve patient safety. The purpose of this program is to provide clinicians with the most current information regarding the prevention of common performance and diagnostic errors.
2.0 credits

Professional Education
Post-Surgical Management of Antiphospholipid Syndrome Leads to Adverse Outcome (Claims Corner CME)
Clinical judgement involves a clinician’s utilization of objective and subjective information to arrive at treatment decisions. The way providers process or interpret information, or cognitive bias, can also impact clinical judgment. This program presents a case study that reveals multiple factors which contributed to the patient’s adverse outcome or injury. After reviewing the case details, we will highlight three of those contributing factors that influenced the case.
0.5 credit

Oct 04, 2022
Mapping the Perioperative Claims Experience of General Surgeons
Jacqueline Ross, RN, PhD; Kim Hathaway, RN, MSN; Melissa Nelson, RN, BSN; Kathrine Soulsby, RN, BSN; Angela Jordan, RN, MHSc
About 63 percent of general surgeons have been involved in a medical malpractice suit. Understanding the most common types of complications and the factors that contribute to errors may provide insights for general surgeons about their practice.

Aug 26, 2022
Hip and Knee Replacements: An Examination of Malpractice Claims Against Orthopedic Surgeons From the Ambulatory and Inpatient Settings
Jacqueline Ross, RN, PhD, Coding Director, Department of Patient Safety and Risk Management
The literature related to malpractice claims comparing inpatient and ambulatory knee and hip replacements has so far been limited. Therefore, the purpose of this novel study was to explore potential differences between the two settings in malpractice claims for surgery.

Jul 13, 2022
Malpractice May Be Negative, but Its Data Can Generate Positive Results
David L. Feldman, MD, MBA, FACS, Chief Medical Officer, The Doctors Company and TDC Group
We can leverage malpractice data to target and drive investment in patient safety efforts. Malpractice data shows us very clearly that good communication and teamwork are vital to preventing adverse events and malpractice claims—while also dramatically improving working conditions and enhancing patient safety.

Professional Education
Cervical Cancer Claims: A Review for Advanced Practice Clinicians
Cervical cancer medical negligence claims are reviewed over a 10-year period to identify the major case types in which the advanced practice clinician (APC) is the responsible party. The factors that contributed to those claims as identified by plaintiff and defense provider experts are discussed through case examples with learner questions. Risk mitigation strategies are identified to guide gynecologists in further providing the safest patient care and thereby improving their risk profile.
1.0 credit

Professional Education
Breast Cancer Claims: A Review for Advanced Practice Clinicians
Breast cancer medical negligence claims are reviewed over a 10-year period to identify the major case types in which the gynecologist is the responsible party. The factors that contributed to those claims as identified by plaintiff and defense physician experts are discussed through case examples with learner questions. Risk mitigation strategies are identified to guide gynecologists in further providing the safest patient care and thereby improving their risk profile.
1.0 credit

Professional Education
Clinical Presentations for Advanced Practice Clinicians: Failure to Diagnose Myocardial Infarctions
In reviewing closed malpractice claims, TDC Group identified missed or delayed diagnosis of myocardial infarction (MI) in the ambulatory internal medicine setting as a reoccurring problem. This course highlights the importance of recognizing the varying clinical presentations of MI and contributing factors associated with failure to diagnose and treat. Assumptions, lack of a thorough history and physical, communication failures, and failure to recognizing atypical signs and symptoms are highlighted in this case study.
0.5 credit

Professional Education
When Personal Relationships Interfere with the Standard of Care for Advanced Practice Clinicians
The Doctors Company rigorously analyzed 988 claims* against internal medicine physicians that closed from 2009–2018. Regardless of the outcome, all cases that closed from 2009–2018 were included in this analysis—an approach that helps better understand what motivates patients to pursue claims and gain a broader overview of the system failures and processes that result in patient harm.
0.5 credit

Apr 01, 2022
Analysis of Cerebrovascular Accidents and Malpractice Claims
Shelley Rizzo, MSN, CPHRM, Senior Patient Safety Risk Manager, The Doctors Company
Because cerebrovascular accidents can happen at any time and in any location, it is imperative that all members of the healthcare team are able to recognize and respond to symptoms in a timely manner.

Professional Education
Clinical Presentations Cause Delays: Failure to Diagnose Myocardial Infarction
In reviewing closed malpractice claims, The Doctors Company identified missed or delayed diagnosis of myocardial infarction (MI) in the ambulatory internal medicine setting as a reoccurring problem. This course highlights the importance of recognizing the varying clinical presentations of MI and contributing factors associated with failure to diagnose and treat. Assumptions, lack of a thorough history and physical, communication failures, and failure to recognizing atypical signs and symptoms are highlighted in this case study.
0.5 credit

Professional Education
Delayed Diagnosis of Stroke
In reviewing closed malpractice claims, The Doctors Company identified diagnostic failure as a reoccurring problem and one of the top three leading allegations that result in malpractice claims. This failure often leads to a delay in treatment and causes significant harm to patients. The following highlights the importance of recognizing the signs and symptoms of a stroke.
0.5 credit

Oct 28, 2021
Plastic Surgery Closed Claims Study Reveals Most Common Case Types
Jacqueline Ross, RN, PhD, Coding Director, Department of Patient Safety and Risk Management, and Susan Shepard, MSN, RN, Senior Director, Patient Safety Staff Education
In this study of plastic surgery closed claims, The Doctors Company looks at the most common case types, most common patient injuries, primary drivers / frequent allegations, and strategies for mitigating risk for both cosmetic and reconstructive surgery.

Professional Education
Cervical Cancer Claims: A Review in Gynecology
Cervical cancer medical negligence claims are reviewed over a ten-year period to identify the major case types in which the gynecologist is the responsible party. The factors that contributed to those claims as identified by plaintiff and defense physician experts are discussed through case examples with learner questions. Risk mitigation strategies are identified to guide gynecologists in further providing the safest patient care and thereby improving their risk profile.
1.0 credit

Oct 20, 2021
Diagnostic Error in General Surgery: Cognitive Bias and Systems Issues in Medical Malpractice Claims (Abstract)
Jacqueline Ross, RN, PhD, Coding Director, Department of Patient Safety and Risk Management
Although claims against general surgeons primarily allege technical surgical-type errors, diagnostic error is the second most frequent allegation against or case type for general surgeons. Analysis of malpractice claims can elucidate the causes of and solutions to diagnostic errors. This study considers differences between diagnostic errors, both cognitive and systemic, committed by general surgeons in the inpatient vs. the outpatient setting.

Sep 23, 2021
The Malpractice Experience of Obstetricians with Shoulder Dystocia: Preparation May Mitigate Risks With This Unpredictable Event
Jacqueline Ross, RN, PhD, Coding Director, Department of Patient Safety and Risk Management, The Doctors Company, Part of TDC Group; Larry Veltman, MD, FACOG, DFASHRM, Director, National Perinatal Information Center; and Peter S. Bernstein, MD, MPH, Professor and Program Director, Department of Obstetrics and Gynecology and Women’s Health, Maternal Fetal Medicine, Albert Einstein College of Medicine
Shoulder dystocia (SD) is a rare complication of vaginal delivery. The purpose of this study was to better understand factors that may contribute to medical malpractice claims with SD and to offer recommendations to practicing obstetricians regarding the management of SD.

Aug 06, 2021
The Malpractice Experience of Neurosurgeons 2014–2019: Patient Selection and Communication May Mitigate Risk of Claims (Abstract)
Jacqueline Ross, RN, PhD, Coding Director, Department of Patient Safety and Risk Management
The Doctors Company conducted an analysis of medical malpractice claims against neurosurgeons that closed between the years of 2014 and 2019. This evaluation included 302 claims and lawsuits, and examined allegations, diagnoses, procedures, and contributing factors, as well as indemnities and expenses paid. The claims experience of neurosurgeon members of The Doctors Company was then benchmarked against a national sample of other neurosurgeons.

Professional Education
The Need for Close Monitoring in Hyponatremia: Osmotic Demyelination Syndrome
In reviewing closed malpractice claims, The Doctors Company identified mismanagement of sodium levels during correction of severe hyponatremia as a serious problem that can result in catastrophic permanent neurological injury due to osmotic demyelination syndrome (also known as central pontine myelinolysis). This article highlights the importance of close monitoring of sodium levels during correction of severe hyponatremia, with a slow and controlled pace of sodium correction. Contributing factors discussed include clinical judgment with regard to rate of rise of sodium levels, patient monitoring, choice of practice setting, and communication between providers, especially at points of transition in care.
0.5 credit

Jun 18, 2021
Study of Emergency Department Diagnosis Case Type Malpractice Claims: Abstract
Jacqueline Ross, RN, PhD, Coding Director, Department of Patient Safety and Risk Management
A study of diagnosis-type closed medical malpractice claims from care that occurred in the ED from 2014 through the second quarter of 2019 using closed coded claims from The Doctors Company.

Jun 09, 2021
Prevent, Communicate, Document: Medical Malpractice Data Help Us Manage Risk
David L. Feldman, MD, MBA, FACS, Chief Medical Officer, The Doctors Company, and for the TDC Group of Companies
Medical malpractice data provide a rich source of information, offering insights into high-risk specialties, medical conditions, and procedures that result in claims.
From The Doctor’s Advocate

Professional Education
Dictation Errors in the Emergency Department
The Doctors Company identified dictation errors as a significant patient safety risk factor. The following case highlights the importance of timely recognition of dictation errors to ensure accuracy of the permanent electronic health record (EHR). This is particularly important when using a voice recognition program to document encounters in the busy emergency department. In this case, the voice recognition system was Dragon Direct Voice Recognition Program.
0.5 credit

Professional Education
Breast Cancer Claims: A Review in Gynecology
Breast cancer medical negligence claims are reviewed over a ten-year period to identify the major case types in which the gynecologist is the responsible party. The factors that contributed to those claims as identified by plaintiff and defense physician experts are discussed through case examples with learner questions. Risk mitigation strategies are identified to guide gynecologists in further providing the safest patient care and thereby improving their risk profile.
1.0 credit

Professional Education
Pain Management: A Closed Claim Analysis Looking at Risks and Lessons Learned
For the first time, The Doctors Company has published an analysis of lawsuits and claims filed against pain management physicians. This study completed in 2020 provides quantitative and qualitative information that a physician who practices pain management, including interventional approaches to treatment would find useful in mitigating the risks of unintended outcomes or harms. This study breaks down where most patient injuries occur, what those injuries are, and the lessons learned from those claims.
1.2 credits

Jan 29, 2021
Pain Management Closed Claims Study
Jacqueline Ross, RN, PhD, Coding Director, and Michelle Swift, RN, JD, Senior Patient Safety Risk Manager
The Doctors Company reviewed medical malpractice claims that closed between 2008 and 2018 and involved pain management physicians as the primary specialty responsible in the claim. That criteria identified 273 claims and lawsuits.

Dec 23, 2020
Podiatry: Lessons from Malpractice Claims
Carol Murray, RHIA, CPHRM, Senior Patient Safety Risk Manager, The Doctors Company
We analyzed 162 podiatric claims to identify top allegations and factors contributing to patient injury.

Nov 12, 2020
Cardiology Closed Claims Study
This review of 210 cardiology malpractice claims identifies the most common patient allegations and the specific factors contributing to patient injury.

Oct 02, 2020
Oncology Closed Claims Study
The Doctors Company conducted a review of medical and surgical oncology claims that closed between 2012 and 2018. This study was based on claims and lawsuits filed against the more than 500 oncologists insured by The Doctors Company.

Sep 14, 2020
Hospitalist Closed Claims Study
This review of 238 closed hospitalist claims identifies top allegations and factors contributing to patient injury.

Jun 15, 2020
Overview of Obesity-Related Malpractice Claims
Paul Nagle, ARM, CPHRM, Director, Department of Patient Safety and Risk Management
The Doctors Company continues to see an increase in lawsuits involving patients with obesity.

Feb 20, 2020
Anesthesiology Closed Claims Study
Darrell Ranum, JD, CPHRM, Vice President, Department of Patient Safety and Risk Management
The Doctors Company studied 640 anesthesia medical malpractice claims that closed from 2007–2012 and 587 claims that closed between 2013–2018. These studies determined whether the number of patient injuries had decreased and to identify any new trends in claims involving anesthesia care.

Video Feb 04, 2020
Interventional Radiology Malpractice Claims Study
The Doctors Company analyzed 54 medical malpractice claims against interventional radiologists that closed from 2013 to 2018. Communication between patient and provider played a role in a quarter of these claims and was most often related to inadequate consent for invasive procedures. There was also a lack of consultation between physicians. The case in this video highlights these key issues.

Video Feb 04, 2020
Diagnostic Radiology Malpractice Claims Study
The Doctors Company analyzed 542 medical malpractice claims against diagnostic radiologists that closed from 2013 to 2018. Diagnosis-related claims were the most common case type, and malignant neoplasm of the breast was the most common missed diagnosis. The case in this video highlights these key issues.

Dec 02, 2019
Diagnostic and Interventional Radiology Closed Claims Study
Darrell Ranum, JD, CPHRM, Vice President, Department of Patient Safety and Risk Management
The Doctors Company analyzed 596 medical malpractice claims against diagnostic and interventional radiologists that closed from 2013 through 2018, identifying the top allegations and factors contributing to patient injury.

Aug 27, 2019
Electronic Health Records Continue to Lead to Medical Malpractice Suits
Darrell Ranum, JD, Vice President of Patient Safety and Risk Management
We analyzed 216 medical malpractice claims that closed from 2010 to 2018 in which EHRs contributed to patient injury. The pace of these claims grew, from a low of seven cases in 2010 to an average of 22.5 cases per year in 2017 and 2018. As EHRs approach near-universal adoption, they may become a more prevalent source of patient safety risk.

Video Apr 09, 2019
Study of Malpractice Claims Involving Children
Patient safety risks when treating children vary depending on the patient’s age—but communication breakdowns between doctors and patients/families occur in malpractice claims for pediatric patients of ALL ages. Watch this important case study to learn more.

Mar 20, 2019
Study of Malpractice Claims Involving Children
Darrell Ranum, JD, CPHRM, Vice President, Patient Safety and Risk Management
The Doctors Company analyzed 1,215 claims filed on behalf of pediatric patients that closed from 2008 through 2017. The study is based on the claims filed against physicians in 52 specialties and subspecialties and includes an overview of the most common types of claims, expert insights into the specific elements that led to patient injury, and risk mitigation strategies.