Chapter 4.A.2: Critiquing and Measuring the Malpractice System

Notes: Malpractice in Action

Note 1. The Frequency and Distribution of Malpractice Suits

For more on how malpractice suits are distributed across provider populations, see David A. Hyman, Are We Driven by Data? The Problem of Bad Doctors, 96 Denver L. Rev. 761 (2018); Derek A. Weycker & Gail A. Jensen, Medical Malpractice Among Physicians: Who Will Be Sued and Who Will Pay?, 3 Health Care Mgmt. 269 (2000); Randall R. Bovbjerg & Kenneth R. Petronis, The Relationship Between Physicians’ Malpractice Claims History and Later Claims, 272 JAMA 1421 (1994).

Note 2. Relationship Between Injuries and Paid Claims

For more on the decline in litigation and paid claims over time, see David A. Hyman, Bad doctors: naming and blaming in a world with much less claiming, 68 DePaul L. Rev. 263 (2018); Myungho Paik et al., The Receding Tide of Medical Malpractice Litigation: Part 1 - National Trends, 10(4) J. Empirical Legal Stud. 612 (2013); Cynthia G. Lee & Robert C. LaFountain, Medical Malpractice Litigation in State Courts, 18 Ct. Stat. Proj. 1 (2011); U.S Department of Justice, Civil Bench and Jury Trials in State Courts (2005); Thomas H. Cohen & Steven K. Smith, U.S. Dep't of Justice, Civil Trial Cases and Verdicts in Large Counties, 2001 (2004)

Note 3. Plaintiff’s Lawyers and Case Selection

On medical malpractice attorneys’ case selection and patients’ access to justice, see Joanna Shepherd, Uncovering The Silent Victims of the Medical Liability System, 67 Vand. L. Rev. 151 (2014); Stephen Daniels & Joanne Martin, Plaintiff’s Lawyers, Specialization, and Medical Malpractice, 59 Vand. L. Rev. 1051 (2006); Catherine T. Harris et al., Who Are Those Guys? An Empirical Examination of Medical Malpractice Plaintiffs’ Attorneys, 58 SMU L. Rev. 225 (2005); Kenneth DeVille, Act First and Look Up the Law Afterward? Medical Malpractice and the Ethics of Defensive Medicine, 19 Theoretical Med. & Bioethics 569 (1998) (an excellent overview, both for doctors and lawyers, of the factors that influence patients’ decisions to consult a lawyer, lawyers’ decisions to bring a case, the chances of success, and the likely recovery); L. Laska, Medical Malpractice Cases Not to File, 20 Mem. St. U. L. Rev. 27 (1989). 

An additional short reading you may wish to assign that addresses access to justice issues is a ProPublica online article titled Patient Harm: When An Attorney Won’t Take your Case.

Note 4. Case Resolution and Accuracy of Jury Verdicts

For additional views and research on jury bias, accuracy, and impact on settlement, see Paul Fenn and Neil Rickman, Information and the Disposition of Medical Malpractice Claims: A Competing Risks Analysis, 30(2) J. L. Econ. & Org. 244 (2014); Philip G. Peters Jr., Twenty Years of Evidence on the Outcomes of Malpractice Claims, 467 Clin. Ortho. and Related Research 352 (2009); Thomas M. O'Toole, Bruce A. Boyd and Theodore O. Prosise, The Anatomy of a Medical Malpractice Verdict, 70 Mont. L. Rev. 57 (2009); Frank Sloan & Lindsey M. Chepke, Ill-Suited? Medical Malpractice at a Crossroads (MIT Press 2008); Philip G. Peters, Jr., What We Know About Malpractice Settlements, 92 Iowa L. Rev. 1783 (2007); David M. Studdert and Michelle M. Mello, When Tort Resolutions are “Wrong”: Predictors of Discordant Outcomes in Medical Malpractice Litigation, 36 J. Leg. Stud. 547 (2007); William M. Sage & Rogan Kersh, Medical Malpractice and the U.S. Health Care System (2006); David M. Studdert et al., Claims, Errors, and Compensation Payments in Medical Malpractice Litigation, 354 New Eng. J. Med. 2024 (2006); Philip G. Peters, The Role of the Jury in Modern Malpractice Law, 87 Iowa L. Rev. 911 (2002) (thorough review of the evidence, concluding that juries, on balance, reach defensible results and are not biased against physicians; if anything, juries are biased in doctors’ favor); Jeffrey O’Connell & Christopher Pohl, How Reliable Is Medical Malpractice Law? A Review of “Medical Malpractice and the American Jury,” 12 J. L. & Health 359 (1998) (insightful review of both Neil Vidmar’s research of jury verdicts and the Harvard study findings, concluding that malpractice law is not well designed to produce accurate and fair results, and advocating instead a no-fault compensation system); Thomas B. Metzloff, Resolving Malpractice Disputes: Imaging the Jury’s Shadow, 54 Law & Contemp. Probs. 43 (Winter 1991).

Note 5. Compensation

For more on trends in payouts in malpractice actions, see Adam C. Schaffer et al, Rates and Characteristics of Paid Malpractice Claims Among US Physicians by Specialty, 1992-2014. 177(5) JAMA Intern Med. 710 (2017).

Note 7. Defensive Medicine

For additional discussion of defensive medicine, clinical cascades, and physicians’ perceptions of the legal system, see Michael J. Saks and Stephen Landsman, The Paradoxes of Defensive Medicine, 30 Health Matrix 25-84 (2020); Eric F. Katz, Defensive medicine: a case and review of its status and possible solutions, 3(4) West J Emerg Med 329 (2019); Vera Lúcia Raposo, Defensive medicine and the imposition of a more demanding standard of care, 39(4) J. Leg Med. 401 (2019); James Reschovsky & Cynthia Saiontz-Martinez, Malpractice Claim Fears and the Costs of Treating Medicare Patients, Health Serv. Res. (2017) (estimating that physicians’ liability concerns add $1,000–$2,000 per year to the cost of Medicare patients); Myungho  Paik et al. “Damage Caps and Defensive Medicine, Revisited, 51 Journal of Health Economics 84 (2017); Michael D. Frakes, The Surprising Relevance of Medical Malpractice Law, 82 U. Chicago L. Rev. 317 (2015); , H. Gilbert Welch et al., Overdiagnosed: Making People Sick in the Pursuit of Health (2011) \; Michelle Mello et al., National Costs of the Medical Liability System, 29(9) Health Aff. 1569 (Sept. 2010) (estimating defensive costs of $45 billion); William Thomas et al., Low Costs of Defensive Medicine, Small Savings from Tort Reform, 29(9) Health Aff. 1578 (Sept. 2010); Laura D. Hermer and Howard Brody, Defensive medicine, cost containment, and reform, 25(5) J Gen Intern Med. 470 (2010); Frank A.  Sloan and John H. Shadle, Is There Empirical Evidence for ‘Defensive Medicine’? A Reassessment, 28(2) J. Health Econ. 481 (2009); James Gibson, Doctrinal Feedback and (Un)reasonable Care, 94 Va. L. Rev. 1641 (2008); Tom Baker, The Medical Malpractice Myth (2005); David Studdert et al., Defensive Medicine Among High-Risk Specialist Physicians, 293 JAMA 2609 (2005); Richard A. Deyo, Cascade Effects of Medical Technology, 23 Ann. Rev. Pub. Health 23 (2002); Daniel P. Kessler and Mark B. McClellan, The Effects of Malpractice Pressure and Liability Reforms on Physicians’ Perceptions of Medical Care, 60 Law and Contemporary Problems 81 (1997); Daniel P. Kessler and Mark B. McClellan, Do Doctors Practice Defensive Medicine?, 8 Q. J. Econ. 353 (1996); Eric E. Fortess & Marshall B. Kapp, Medical Uncertainty, Diagnostic Testing, and Legal Liability, 13 L. Med. & Health Care 213 (1985).

Note 9. Malpractice Insurance

For more on malpractice insurance, how it operates, and its impact on medical practice, see William M. Sage, Medical Malpractice Insurance and the Emperor’s Clothes, 54 DePaul L. Rev. 463 (2005); Frank A. Sloan, Randall R. Bovbjerg and Penny Githens, Insuring Medical Malpratice (Oxford 1991); Frank A. Sloan, Experience Rating: Does it Make Sense for Medical Malpractice Insurance?, 80(2) Am. Econ. Rev. 128 (1990).

Notes: Alternative Dispute Resolution

Note 2. Arbitration

On the enforceability of arbitration agreements in health care, see Marc Ginsberg, The Execution of an Arbitration Provision as a Condition Precedent to Medical Treatment: Legally Enforceable? Medically Ethical?, 42 Mitchell Hamline L. Rev. 273 (2016); Myriam Gilles, Operation Arbitration: Privatizing Medical Malpractice Claims, 15 Theor. Inquiries L. 671 (2014); Note, Unintended Side Effects: Arbitration and the Deterrence of Medical Error, 89 N.Y.U. L. Rev. 1806 (2014); Symposium, 74 Law & Contemp. Probs. 1 (Summer 2011); Kenneth DeVille, The Jury Is Out: Pre-Dispute Binding Arbitration Agreements for Medical Malpractice Claims, 28 J. Leg. Med. 333 (2007); Kathy L. Cerminara, Contextualizing ADR in Managed Care: A Proposal Aimed at Easing Tensions and Resolving Conflict, 33 Loy. U. Chi. L. J. 547 (2002); Symposium: Medical Malpractice Dispute Resolution, 28 Cap. U. L. Rev. 249 (2000).

Note 3. Mediation

On the pros and cons of mediation as an alternative to malpractice litigation, see Chris Stern Hyman et al, Interest-Based Mediation of Medical Malpractice Lawsuits: A Route to Improved Patient Safety?, 35(5) J. Health Polit. Policy L. 797 (2010); Rita Lowery Gitchell & Andrew Plattner, Mediation: A Viable Alternative to Litigation for Medical Malpractice Cases, 2 DePaul J. Health Care L. 421 (1999).