Brennan T A, Sox C M, Burstin H R
Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA.
N Engl J Med. 1996 Dec 26;335(26):1963-7. doi: 10.1056/NEJM199612263352606.
We have previously shown that in New York State the initiation of malpractice suits correlates poorly with the actual occurrence of adverse events (injuries resulting from medical treatment) and negligence. There is little information on the outcome of such lawsuits, however. To assess the ability of malpractice litigation to make accurate determinations, we studied 51 malpractice suits to identify factors that predict payment to plaintiffs.
Among malpractice claims that we reviewed independently in an earlier study, we identified 51 litigated claims and followed them over a 10-year period to determine whether the malpractice insurer had closed the case. We obtained detailed summaries of the cases from the insurers and reviewed the litigation files if the outcome of a case differed from the outcome predicted in our original review.
Of the 51 malpractice cases, 46 had been closed as of December 31, 1995. Among these cases, 10 of 24 that we originally identified as involving no adverse event were settled for the plaintiffs (mean payment, $28,760), as were 6 of 13 cases classified as involving adverse events but no negligence (mean payment, $98,192) and 5 of 9 cases in which adverse events due to negligence were found in our assessment (mean payment, $66,944). Seven of eight claims involving permanent disability were settled for the plaintiffs (mean payment, $201,250). In a multivariate analysis, disability (permanent vs. temporary or none) was the only significant predictor of payment (P=0.03). There was no association between the occurrence of an adverse event due to negligence (P = 0.32) or an adverse event of any type (P=0.79) and payment.
Among the malpractice claims we studied, the severity of the patient's disability, not the occurrence of an adverse event or an adverse event due to negligence, was predictive of payment to the plaintiff.
我们之前已经表明，在纽约州，医疗事故诉讼的发起与不良事件（医疗治疗导致的伤害）和过失的实际发生关联不大。然而，关于此类诉讼结果的信息却很少。为了评估医疗事故诉讼做出准确判定的能力，我们研究了51起医疗事故诉讼，以确定预测向原告支付赔偿的因素。
在我们之前一项独立审查的医疗事故索赔中，我们确定了51起已诉讼的索赔，并对其进行了为期10年的跟踪，以确定医疗事故保险公司是否已结案。我们从保险公司获得了这些案件的详细摘要，如果案件结果与我们最初审查中预测的结果不同，我们还审查了诉讼文件。
截至1995年12月31日，51起医疗事故案件中有46起已结案。在这些案件中，我们最初认定不涉及不良事件的24起案件中有10起为原告达成和解（平均赔偿额为28,760美元），被归类为涉及不良事件但无过失的13起案件中有6起达成和解（平均赔偿额为98,192美元），而在我们的评估中发现因过失导致不良事件的9起案件中有5起达成和解（平均赔偿额为66,944美元）。涉及永久性残疾的8起索赔中有7起为原告达成和解（平均赔偿额为201,250美元）。在多变量分析中，残疾（永久性与暂时性或无残疾）是赔偿的唯一显著预测因素（P = 0.03）。因过失导致的不良事件的发生（P = 0.32）或任何类型的不良事件的发生（P = 0.79）与赔偿之间均无关联。
在我们研究的医疗事故索赔中，患者残疾的严重程度而非不良事件或因过失导致的不良事件的发生，可预测向原告的赔偿。
