Closed liability claims analysis and the medical record.

An analysis of 353 closed claims involving obstetrician-gynecologists revealed that the 40 highest-paid claims (11.3%) accounted for 88.7% of the total dollars spent. Newborn obstetrics, maternal obstetrics, and delayed-diagnosis claims represented 80%. Five doctors represented in the top 13 claims had another one or two claims among the highest 40. Only one of these physicians is still in good standing with the insurance company. Twelve claims (30%) were judged to be nonmeritorious, resulting in indemnity in five cases. Most of these claims illustrated either deficits with the medical record or system failures. A number of these problems could be prevented by avoiding system failures and by regarding the medical record as a legal document. Lawsuits occasionally resulted in an unfair distribution of dollars to injured parties and led to justifiable restriction of few physicians. It is critical that there be a record of why something was done. If the record is silent, there is no defense. An erroneous decision may be defensible if the reasons leading to it are recorded in the chart.