• Laura C Myers, Jillian Skillings, Lisa Heard, Joshua P Metlay, and Elizabeth Mort.
• Division of Pulmonary/Critical Care Medicine, Massachusetts General Hospital, Boston, MA; Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, MA. Electronic address: lcmyers@partners.org.
• Chest. 2019 Nov 1; 156 (5): 907-914.

BackgroundMedical malpractice data can be leveraged to understand specialty-specific risk.MethodsMalpractice claims were examined from the Comparative Benchmarking System (2007-2016), a national database containing > 30% of claims data in the United States. Claims were identified with either internal medicine or pulmonary/critical care (PCC) physicians as the primary provider involved in the harm. Claim characteristics were compared according to specialty and care setting (inpatient vs outpatient), and multiple regression analysis was performed to predict claim payment.ResultsClaims involving PCC physicians differed from those involving internal medicine physicians in terms of harm severity, allegation, final diagnosis, procedure involvement, payment rate, and contributing factors. The majority of claims involving PCC physicians resulted from inpatient care (63%), of which only 26% occurred delivering intensive care. Eighty-one percent were from harm events that resulted in death/permanent injury. The most common diagnosis was laceration during a procedure for inpatient claims (6%) and lung cancer for outpatient claims (28%). Thirty-one percent of claims overall involved procedures. Although only 26% were paid, the median indemnity per paid claim of $285,769 ranked PCC as the twelfth highest of 69 specialties. The two variables associated with indemnity payment were outpatient care (OR, 1.70; 95% CI, 1.01-2.86) and temporary harm (OR, 0.36; 95% CI, 0.15-0.87).ConclusionsMalpractice claims involving PCC physicians were distinct from claims involving internal medicine physicians. Although only one-quarter of claims was paid, the indemnity per claim was high among specialties. Specialty-specific prevention strategies must be developed to mitigate both patient harm and provider malpractice risk.Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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