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Variation in expert opinion in medical malpractice review
K L Posner1, R A Caplan, F W Cheney
1Department of Anesthesiology, University of Washington School of Medicine, Seattle 98195-6540, USA. posner@u.washington.edu
Anesthesiology
|November 1, 1996
Summary
Expert opinion in medical malpractice cases often lacks agreement due to implicit review processes. This study found significant disagreement among anesthesiologists assessing care appropriateness in malpractice claims.
Area of Science:
- Medical Law
- Anesthesiology
- Healthcare Quality
Background:
- Expert opinion in medical malpractice relies on implicit, unstated individual judgments.
- Explicit assessment uses predefined criteria, unlike implicit expert review.
- While biases in expert witnesses are known, the impact of implicit review remains unclear.
Purpose of the Study:
- To evaluate the level of agreement among expert reviewers in medical malpractice cases.
- To determine if the implicit nature of expert review contributes to divergent opinions.
Main Methods:
- Anesthesiologist-reviewers independently assessed the appropriateness of care in anesthesia malpractice claims.
- Potential sources of bias were controlled or eliminated to isolate the effect of review type.
- Inter-rater agreement was measured using statistical analysis.
Main Results:
- Thirty anesthesiologists reviewed 103 claims, with agreement on 62% and disagreement on 38%.
- Agreement on appropriateness of care was 27%, and on less than appropriate care was 32%.
- Chance-corrected agreement (kappa) was in the poor-good range (0.37).
Conclusions:
- Divergent opinions among objective medical experts may be common in malpractice claim reviews.
- The implicit nature of expert review appears to contribute to disagreement.
- Findings suggest a need to explore more explicit assessment methods in medical malpractice evaluations.