Doctor malpractice and health care quality

There are those who believe that there is an epidemic of medical or doctor malpractice, based on estimates of medical errors and the number of errors classified as negligence.

Other authorities say that it is litigation, not malpractice, that is far too common.

Which view is right?

In order to determine whether there is too much or too little malpractice litigation, it is necessary to determine how efficient the tort liability system is in compensating patients who are injured by medical errors, and how efficient the system is in denying malpractice compensation for poor treatment outcomes that are not due to provider negligence.

With any type of medical treatment and/or hospital stay, there are always inherent risks.

The number of patients injured in the course of treatment is a common concern. In fact, about two million patients each year suffer hospital-acquired infections.

However, since there is no uniform system for reporting incidents in which a patient is harmed, estimates of the number of patient injuries due to medical error depend on the definitions used by researchers.

The influential Harvard Medical Practice Study defined a medical error as “an injury that was caused by medical management (rather than the underlying disease) and that prolonged the hospitalization, produced a disability at the time of discharge or both.”

The Harvard researchers found some of these injuries were due to negligence, which they defined as medical care that “failed to meet the standards expected of a typical medical practitioner.”

In other words, a patient was harmed by careless treatment. The researchers estimated that 2.9 percent of hospital patients in Colorado and Utah, and 3.7 percent of hospital patients in the state of New York experienced adverse events in 1984.

An Institute of Medicine (IOM) report, To Err Is Human, applied these Harvard estimates to patients nationwide. The IOM concluded:

- Nationwide, 4 million to 5 million hospitalized patients are harmed by medical errors each year.
- Some 44,000 to 98,000 Americans die each year in hospitals as a result of medical errors.