VARIATION IN EXPERT OPINION IN MEDICAL MALPRACTICE REVIEW

Background: Expert opinion in medical malpractice is a form of implici t assessment, based on unstated individual opinion. This contrasts wit h explicit assessment processes, which are characterized by criteria s pecified and stated before the assessment. Although sources of bias th at might hinder the objectivity of expert witnesses have been identifi ed, the effect of the implicit nature of expert review has not been fi rmly established. Methods: Pairs of anesthesiologist-reviewers indepen dently assessed the appropriateness of care in anesthesia malpractice claims. With potential sources of bias eliminated or held constant, th e level of agreement was measured. Results: Thirty anesthesiologists r eviewed 103 claims. Reviewers agreed on 62% of claims and disagreed on 38%. They agreed that care was appropriate in 27% and less than appro priate in 32%. Chance-corrected levels of agreement were in the poor-g ood range (kappa = 0.37; 95% CI = 0.23 to 0.51). Conclusions: Divergen t opinion stemming from the implicit nature of expert review may be co mmon among objective medical experts reviewing malpractice claims.