Misdiagnosis is the main reason for medical malpractice lawsuits involving children, a recent study found.
A missed, failed or wrong diagnosis—largely the result of inadequate medical assessments—is the top allegation in claims involving children ages one month to 17 years, and is also the second-most common allegation in claims involving infants less than one month old, according to a study by The Doctors Company, the country’s largest physician-owned medical malpractice insurer.
For the study, the company reviewed 1,215 claims closed from 2008 through 2017 that were filed against physicians in 52 specialties and subspecialties. The study focused on four age groups: neonate (less than one month old), first year (one month through 11 months), child (one through nine years) and teenager (10 through 17 years).
The report details the allegations, factors that led to injuries, and ways to reduce risk of harm to children. For example, poor communication between the physician and the patient or family was a factor in 15% to 22% of claims, depending on the age of the child.
System failures, such as not notifying treating physicians of critical test results, also accounted for a significant number of patient injuries.
“Our research sheds light on the need to provide detailed explanations to parents or guardians regarding symptoms that should prompt immediate care when the child is sent home,” said Darrell Ranum, J.D., study author and vice president of patient safety with The Doctors Company. “It is also particularly important that physicians keep language and cultural barriers top of mind when providing these detailed explanations. All our recommendations are focused on advancing the practice of good medicine.”
The top 10 physician specialties named as defendants represented 72% of all pediatric patient claims, according to the study, with obstetrics named in 24% of claims. Of the 1,215 claims, 37% resulted in a payment to the claimant with a mean indemnity payment of $630,400 and a mean expense of $157,600. Pediatric patients less than one month old had the highest mean indemnity ($936,800) and median indemnity payment ($300,000).
The study also found that 76% of claims were filed within three years of the event; by five years 85% of claims had been filed. Three percent of pediatric claims were filed more than 10 years after the injury. This highlights the importance of quality documentation. Years after the alleged harm, it is still a factor in defending claims, the company said.
In the claims reviewed, the brain was the most commonly injured body part: neonatal patients (48%), first year (36%), children (36%) and teenagers (11%). Younger patients suffer high-severity injuries at a higher rate, according to the claims review: 75% of neonates and 65% of first-year pediatric patients.
The claims analysis found that children older than one year experienced more injuries from trauma, communicable disease, and malignancies. Teenagers experienced trauma and illness, and teenaged females may also face the dangers of pregnancy and childbirth.
The study findings reveal that healthcare providers must improve existing strategies, policies, and procedures to limit errors and oversights when treating children, said William Getman, M.D., a pediatrician with the Austin Regional Clinic: “Changes made and strategies adopted as a result of this study’s findings and recommendations will not only reduce the likelihood of a malpractice claim, they will also improve patient care.”
“As doctors, we must intensify our efforts to effectively communicate—both verbally and in writing—with patients and their families,” Getman said. “The risk of medical malpractice claims involving children can be reduced by clearly communicating when patients need to return for follow-up visits, about warning signs that require immediate action, and about referrals to other specialists.”
The study also highlights that the perinatal period especially deserves close scrutiny, he said: “During this period, claims are more common, injuries are more severe, and indemnities paid are the highest.”