The effect of threat of litigation on forensic pathologist diagnostic decision making

Recent litigation involving medical examiners has caused concern over certifying deaths.

We administered a survey of 716 medical examiners regarding the effects of the threat of litigation.

Two hundred twenty-two medical examiners responded (31%). Of those who responded, approximately 13.5% admitted to having modified their diagnostic findings due to threat of litigation, and approximately 32.5% stated these considerations would affect their decisions in the future. Physicians who indicated they had or would modify their diagnoses expressed more concern over the possibility of litigation. Chiefs of services were less likely than staff members to indicate changing diagnoses. Practitioners whose jurisdictions included rural areas were significantly more likely to indicate that litigation considerations would affect their diagnoses in the future, although this was not true with those who had already modified their diagnoses. No correlation was found with elected versus appointed positions, accreditation status, sex, race, geographic location, or board certification.

Although very few medical examiners have actually been sued because of their diagnoses, a demonstrated threat of litigation has a substantial effect on diagnostic decision making.