June 1998 Bulletin

Study finds 58% claims abandoned, settled

Failure to diagnose claims due mainly to missed diagnoses of fracture or tumor

By Lynn C. Garner, MD; and Dennis B. Brooks, MD

A Committee on Professional Liability study of 72 malpractice claims of alleged failure to diagnose, filed between 1983 and 1997, found 42 (58 percent) of the claims were abandoned or settled without any payment. Twenty-eight claims (39 percent) were settled with payment.

Only two cases went to trial. One resulted in a defense verdict and the other in a plaintiff verdict. In the defense verdict, the defendant orthopaedist was found not liable for the death of a 39-year-old person who died of colon cancer some time after being evaluated by the orthopaedist for sciatica. For the plaintiff's verdict case, the jury awarded the estate of the plaintiff $700,000 for the failure to diagnose a pulmonary embolus which caused an 18-year-old person's death.

For the 72 claims, defense costs totaled $2,425,000. The average cost was $34,000 and the median cost was $18,000. The defense costs ranged from zero to $172,000. The Committee on Professional Liability's team of reviewers believed that there was no negligence by the orthopaedic surgeon in 46 of the claims (64 percent) and perhaps some negligence in 11 of the claims (15 percent).

Failure to diagnose claims most commonly arose from missed diagnoses of fracture or tumor. Sixty percent of claims involved fractures; 20 percent involved tumors. The remainder of the diagnoses encountered included infection, failure to recognize complications under casts, pulmonary embolus, cervical HNP, rotator cuff tear, partial nerve laceration and vascular injuries.

The findings of the study underscore the importance of attention to detail and a thorough history and physical examination. The clinical "pearls" gleaned from the study are identical to those found in previous closed claim studies targeting fractures or specific anatomic sites.

Risk management comments related to fracture failure to diagnose are summarized here. Each of these missed diagnoses were encountered in the committee's closed claim review.

Diagnoses that failed to identify tumors were problematic in several cases. Committee reviewers found little to criticize and only a few cases involving what they considered to be negligent care. Soft tissue sarcoma and lymphoma were commonly missed. Clinical errors encountered were failure to follow up on abnormal tests; and failure to pursue work-up of atypical and refractory pain.

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