Malpractice in physical medicine and rehabilitation. A review and analysis of existing data

Malpractice issues are a concern for physiatrists, but little information specific to the field is readily available. Medical, legal and economic literature provide profiles of physicians involved in malpractice claims and the types of clinical situations in which suits are brought in general but no specifics on physiatry before 1973. Nine malpractice studies were examined to characterize malpractice claims in the field. The physiatrist's risk relative to other specialties could be studied specifically in three studies of 197,230 claims reported from 182 liability carriers. The number of claims brought was one-third of that predicted relative to the size of the specialty. The number of paid claims was one-fourth of that predicted, and the total dollar indemnity was one-fifth of that predicted. The average indemnity per claim rose 770% over a decade, from $12,000 in 1978 to $92,000 by 1988. Dollar losses were significantly lower than expected compared with other specialties classified by insurance carriers to be of similar risk such as neurology, pediatrics and general/family practice and one specialty considered to be very low, dermatology. Losses for physiatry were more similar to that of the very low risk category specialties such as psychiatry and pathology. One-fourth of successful claims resulting in one-third of the total dollar losses were associated with physical therapy. Cases involving femoral fracture comprised 14% of paid claims accounting for 34% of the total losses. Conditions of the vertebral column accounted for 35% of monetary losses and medication error accounted for 14% of monetary losses. The claim incidence was very low as one study of 71,130 claims identified none against physiatrists, with no more than 110 claims in any single study.