Medical malpractice

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Medical malpractice is the "failure of a professional person, a physician or lawyer, to render proper services through reprehensible ignorance or negligence or through criminal intent, especially when injury or loss follows".[1]

Medical care in federal versus private sector

Malpractice occurring in the United States Veterans Health Administration is regulated by the Federal Tort Claims Act (28 U.S.C. SS 2671-2680).[2]


Medical malpractice is common[3] and can occur in the inpatient setting, outpatient setting[4], and with telephone medicine.[5] Among inpatients, surgery is the most common cause while among outpatients, diagnostic error is the most common cause.[6]

In the United States, the number of cases is dropping.[6]

Relationship to medical error

For more information, see: medical error.

According to the Harvard Medical Practice Study, "medical-malpractice litigation infrequently compensates patients injured by medical negligence and rarely identifies, and holds providers accountable for, substandard care."[7] In one study, one third of claims did not involve medical error.[8]

Relationship to physician communication style

Among non-surgeons, physicians are more likely to have claims of malpractice is:[9]

  • "used more statements of orientation (educating patients about what to expect and the flow of a visit)"
  • "laughed and used humor more"
  • "tended to use more facilitation (soliciting patients' opinions, checking understanding, and encouraging patients to talk)"
  • "spent more time with their patients (mean, 18.3 vs 15.0 minutes)"

Expert testimony and standard of care

In the United States of America, most states now try to determine what is the best medical practice. Originally, efforts focused on assessing the quality of the expert who interprets evidence for the court rather than the quality of the evidence itself. The Frye test helped determine who was expert. More recently, the Daubert standard is used to assess the quality of evidence.[10][11] Occasionally, courts have used "Daubert panels" to assess evidence in large tort claims.[12]

Some states also use a locality rule, or local standards of care despite ethical problems with this standard.[13] The locality rule "may inhibit the incorporation of scientific progress into practice standards."[13] A well-publicized malpractice case of screening for prostate cancer was determined in this way.[14] This specific case has been associated with an increase in screening for prostate cancer.[15]

Decision analysis has been proposed to improve the reliability of expert testimony.[16]

States vary in their implementation of apology laws.[17] Some states have laws that protect voluntary expressions of "sympathy, regret, and condolence" whereas other states protect "admissions of fault as well as expressions of sympathy."[17]


One study found that "For every dollar spent on compensation, 54 cents went to administrative expenses (including those involving lawyers, experts, and courts)."[8]

The relationship between quality of care and rate of malpractice claims is not strong.[18]

Malpractice reform

Malpractice reform is proposed to:

  • decrease health care costs via reduction in defensive medicine[19]
  • increase physician supply[20]

Various reforms have been proposed including:[19]

The Institute of Medicine has encouraged the use of demonstration projects to test specific ideas for reform.[26]

Enterprise liability

The Clinton reforms of 1993 included a proposal for demonstration projects of enterprise liability.[27][28] The American College of Physicians has suggested demonstration projects test the feasibility of enterprise liability.[29][30] Enterprise liability that shifts liability to health care providers such as hospitals maybe preferable to shifting to health care payers such as insurance companies.[31]

Disclosure and offer

One type of reform is disclosure and offer compensation.[19][21]

This can be designed with or without admission of fault and with or without relinquishing the right to sue.

Safe harbors for adherence to evidence-based practices

One type of reform is to provide safe harbors for adherence to evidence-based practices.[19]


One type of reform is the use of tribunals rather than courts to determine liability.[19]


  1. Anonymous (2023), term (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. Weeks WB, Foster T, Wallace AE, Stalhandske E. Tort claims analysis in the Veterans Health Administration for quality improvement. J Law Med Ethics. 2001 Fall-Winter;29(3-4):335-45. PMID 12056372
  3. Jena AB, Seabury S, Lakdawalla D, Chandra A (2011). "Malpractice risk according to physician specialty.". N Engl J Med 365 (7): 629-36. DOI:10.1056/NEJMsa1012370. PMID 21848463. Research Blogging.
  4. Gandhi TK, Kachalia A, Thomas EJ, et al (2006). "Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims". Ann. Intern. Med. 145 (7): 488–96. PMID 17015866[e]
  5. Katz HP, Kaltsounis D, Halloran L, Mondor M (2008). "Patient Safety and Telephone Medicine : Some Lessons from Closed Claim Case Review". J Gen Intern Med. DOI:10.1007/s11606-007-0491-y. PMID 18228110. Research Blogging.
  6. 6.0 6.1 Bishop TF, Ryan AK, Casalino LP (2011). "Paid malpractice claims for adverse events in inpatient and outpatient settings.". JAMA 305 (23): 2427-31. DOI:10.1001/jama.2011.813. PMID 21673294. Research Blogging.
  7. Localio AR, Lawthers AG, Brennan TA, et al (1991). "Relation between malpractice claims and adverse events due to negligence. Results of the Harvard Medical Practice Study III". N. Engl. J. Med. 325 (4): 245–51. PMID 2057025[e]
  8. 8.0 8.1 Studdert DM, Mello MM, Gawande AA, et al (2006). "Claims, errors, and compensation payments in medical malpractice litigation". N. Engl. J. Med. 354 (19): 2024–33. DOI:10.1056/NEJMsa054479. PMID 16687715. Research Blogging. Cite error: Invalid <ref> tag; name "pmid16687715" defined multiple times with different content
  9. Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM (1997). "Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons.". JAMA 277 (7): 553-9. PMID 9032162.
  10. Anonymous. Expertise in Law, Medicine, and Health Care. U.S. Agency for Healthcare Research and Quality. Retrieved on 2009-01-15.
  11. Anonymous. From the Clinics to the Courts: The Role Evidence Should Play in Litigating Medical Care. U.S. Agency for Healthcare Research and Quality. Retrieved on 2009-01-15.
  12. Hulka BS et al. (March 2000). "Experience of a scientific panel formed to advise the federal judiciary on silicone breast implants". N Engl J Med 342: 812–5. PMID 10717019[e]
  13. 13.0 13.1 Lewis MH, Gohagan JK, Merenstein DJ (June 2007). "The locality rule and the physician's dilemma: local medical practices vs the national standard of care". JAMA 297 (23): 2633–7. DOI:10.1001/jama.297.23.2633. PMID 17579232. Research Blogging.
  14. Merenstein D (January 2004). "A piece of my mind. Winners and losers". JAMA 291 (1): 15–6. DOI:10.1001/jama.291.1.15. PMID 14709561. Research Blogging.
  15. Krist AH, Woolf SH, Johnson RE (2007). "How physicians approach prostate cancer screening before and after losing a lawsuit". Ann Fam Med 5 (2): 120–5. PMID 17389535. PMC 1838685[e]
  16. Weir SS, Curtis P, McNutt RA (1990). "Expert testimony based on decision analysis: a malpractice case report". J Gen Intern Med 5 (5): 406–9. PMID 2231036[e]
  17. 17.0 17.1 McDonnell WM, Guenther E (December 2008). "Narrative review: do state laws make it easier to say "I'm sorry?"". Ann. Intern. Med. 149 (11): 811–6. PMID 19047028[e]
  18. Studdert DM, Spittal MJ, Mello MM, O'Malley AJ, Stevenson DG (2011). "Relationship between quality of care and negligence litigation in nursing homes.". N Engl J Med 364 (13): 1243-50. DOI:10.1056/NEJMsa1009336. PMID 21449787. Research Blogging.
  19. 19.0 19.1 19.2 19.3 19.4 Mello MM, Brennan TA. The role of medical liability reform in federal health care reform. N Engl J Med. 2009 Jul 2;361(1):1-3. Epub 2009 Jun 15. DOI:10.1056/NEJMp0903765 PMID 19528190 Cite error: Invalid <ref> tag; name "pmid19528190" defined multiple times with different content Cite error: Invalid <ref> tag; name "pmid19528190" defined multiple times with different content Cite error: Invalid <ref> tag; name "pmid19528190" defined multiple times with different content Cite error: Invalid <ref> tag; name "pmid19528190" defined multiple times with different content
  20. Kessler DP, Sage WM, Becker DJ. Impact of malpractice reforms on the supply of physician services. JAMA. 2005 Jun 1;293(21):2618-25. PMID 15928283
  21. 21.0 21.1 Clinton HR, Obama B. (2006) Making patient safety the centerpiece of medical liability reform. N Engl J Med. 2006 May 25;354(21):2205-8. PMID 16723612
  22. Annas GJ. The patient's right to safety--improving the quality of care through litigation against hospitals. N Engl J Med. 2006 May 11;354(19):2063-6. DOI:10.1056/NEJMsb053756 PMID 16687721
  23. Sage WM. (2003) Medical liability and patient safety. Health Aff (Millwood). 2003 Jul-Aug;22(4):26-36. DOI:10.1377/hlthaff.22.4.26 10.1377/hlthaff.22.4.26 PMID 12889746
  24. Weiler, Paul C. (1991) Medical malpractice on trial. Harvard University Press, Cambridge, Mass. 1991. ISBN 0674561201
  25. K.S.Abraham and P.C. Weiler, "Enterprise Medical Liability and the Evolution of the American Health Care System," Harvard Law Review 108, no. 2 (1994): 381–436 DOI:10.2307/1341896
  26. (2008) “Liability: Patient-Centered and Safety-Focused, Nonjudicial Compensation”, Corrigan JM, Greiner A, Erickson SM: Fostering rapid advances in health care: learning from system demonstrations. Washington, DC: National Academies Press, 81. LCC RA411. ISBN 0309087074. 
  27. Pear, Robert (May 21, 1993) Changing Health Care; Clinton Advisers Outline Big Shift for Malpractice. New York Times
  28. Sage WM, Hastings KE, Berenson RA. Enterprise liability for medical malpractice and health care quality improvement. Am J Law Med. 1994;20(1-2):1-28. PMID 7801972
  29. (March 1995) "Beyond MICRA: new ideas for liability reform. American College of Physicians". Ann. Intern. Med. 122 (6): 466–73. PMID 7856998[e]
  30. Petersen SK (March 1995). "No-fault and enterprise liability: the view from Utah". Ann. Intern. Med. 122 (6): 462–3. PMID 7856996[e]
  31. K.S.Abraham and P.C. Weiler, "Enterprise Medical Liability and the Evolution of the American Health Care System," Harvard Law Review 108, no. 2 (1994): 381–436 DOI:10.2307/1341896