The climate of medical malpractice in reconstructive urology
Suprita Krishna, MD1, M. Ryan Farrell, MD, MPH2, Divya Parikh, MPH3, Alex J. Vanni, MD2.
1Beth Israel Deaconess Medical Center, Boston, MA, USA, 2Lahey Hospital and Medical Center, Burlington, MA, USA, 3Medical Professional Liability Association, Rockville, MD, USA.
BACKGROUND: Urologic medical malpractice continues to evolve and has the potential to influence physician decision making through efforts to mitigate risk with defensive practice. To date, little is known about the medical malpractice climate in reconstructive urology. We provide data on reconstructive urology malpractice claims and associated costs.
METHODS: National, provider level medical professional liability claims data were obtained from the Medical Professional Liability Association Data Sharing Project from 2014-2018. We utilized ICD 9/10 codes to query claims for reconstructive urology conditions and associated procedures including ureteropelvic junction obstruction (UPJO)/ureteral stricture, urethral stricture, bladder neck contracture, rectourethral fistula, Peyronie’s disease, buried penis repair/penile skin graft procedures, erectile dysfunction, and male incontinence. Defense expenses were reported as allocated loss adjustment expenses (ALAE) for closed claims.
RESULTS: Over the 5-year study period, urology ranked 13 of 29 specialties with 926 closed claims. The majority of claims did not result in an indemnity payment (paid:closed ratio 30%). Total indemnity payments were $101,594,296. The average indemnity payment was $365,447 and average ALAE was $49,490. With respect to presenting reconstructive urology conditions, there were a total of 66 closed claims with a paid:closed ratio of 24%. Total indemnity payments were $3,494,450, average indemnity payment was $218,403, and average ALAE was $45,685. The most common reconstructive urology conditions that resulted in claims were male incontinence (n=25, 38%) and erectile dysfunction (n=19, 29%) followed by UPJO/ureteral stricture (n=7, 11%), urethral stricture (n=6, 9%), bladder neck contracture (n=4, 6%), Peyronie’s disease (n=3, 5%), buried penis (n=2, 3%), and rectourethral fistula (n=0). The most common specified procedures associated with these presenting conditions were procedures on the urethra (n=12) and incontinence procedures (n=7). The severity of patient injury was most commonly mild (emotional, insignificant, or minor temporary injury; n=32, 48%) or moderate (major temporary or minor permanent injury; n=24, 36%).
CONCLUSIONS: The incidence of medical malpractice claims in reconstructive urology is low and the majority of claims do not result in indemnity payments. Male incontinence and erectile dysfunction were the most common presenting conditions associated with claims. These findings can be applied to improve risk mitigation strategies and patient care.
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