Clinical assessment of malpractice case scenarios in an anesthesiology department

Study Objective: To deter,nine whether anesthesiologists agree with each ot her when assessing actual malpractice clinical scenarios, whether their ass essments comport with the actual malpractice verdicts, and whether they can accurately guess jury verdicts. Design: Survey study requesting anesthesiologists to review 12 malpractice case scenarios, administered twice. Setting: Academic medical center department of anesthesiology. Measurements and Main Results: Mean interphysician agreement, mean Likert values assess ing relative negligence, mean agreement with jury verdicts, mean success at predicting actual jury verdicts for 12 actual jury verdict case scenarios. Respondent anesthesiologists appeared homogeneous by training and years of experience. They showed high (>80%) agreement among themselves in their as sessments of the malpractice case scenarios over the two administrations (p = 0.13). In addition, mean Likert values as to relative negligence assessm ents by respondent anesthesiologists were not significantly different betwe en administrations by case (p = 0.09 to 1.00). However, of the eight cases with complete or virtually complete agreement between respondent anesthesio logists, three (37.5%) disagreed with the verdict rendered by the actual ju ries. In addition, anesthesiologists showed significant disagreement (>30%) among themselves in four of the case scenarios, indicating there may not b e agreement regarding the standard of care in these clinical circumstances. Finally, anesthesiologists predicted jury verdicts poorly, with success ra tes of 50% or less in seven of the 12 case scenarios. Conclusions: For this sample of homogeneous anesthesiologists who demonstra ted high clinical agreement, if appears that the malpractice system may not be able to function on ifs own terms in adjudicating malpractice claims. A lthough there was agreement among respondent anesthesiologists, these asses sments were in direct opposition to actual verdicts, a significant percenta ge of cases resulted in disagreements as to the appropriate standard of car e, and anesthesiologists could not successfully predicted jury verdicts. Th e malpractice system appears to be operating far from its theoretical ideal if these results could be applied more generally. Thus, in practice, the l egal system, which is to provide an optimal level of injury deterrence, may De a poor method to limit patient injury improve patient safety, and provi de compensation to negligently injured patients in the health delivery syst em. (C) 1999 by Elsevier Science Inc.