PHYSICIANS EXPERIENCE WITH ALLEGATIONS OF MEDICAL MALPRACTICE IN THE NEONATAL INTENSIVE-CARE UNIT

Objective. To assess the personal experience of all practitioners of n eonatal intensive care unit (NICU) medicine in the United States with the medical malpractice system; in particular, to assess the circumsta nces of malpractice allegations in which they themselves had personal experience, and to extrapolate from their individual experiences to th e field of neonatology in general. Design. Written survey of all MDs p racticing NICU medicine in the US. Participants. Two thousand four hun dred ninety-eight NICU physicians as determined from three sources: a) the American Board of Medical Specialists; b) the American Academy of Pediatrics Section of Neonatal/Perinatal Medicine; and c) a listing o f neonatologists provided by Ross Laboratories. Main Outcome Measures. Responses to survey questions. Results. We received 1813 responses, r epresenting similar to 75% of all physicians practicing NICU medicine in the US. Overall, 43% of respondents had experienced at least one cl aim of malpractice against them. The probability of a malpractice alle gation increased with years in practice, from similar to 20% for NICU physicians in practice 5 years (65/337), to similar to 60% for NICU ph ysicians in practice >15 years (276/469). Men and women were equally l ikely to have been sued, accounting for years in practice. Physicians practicing in community NICUs were more likely to be sued than those i n university settings. On a scale of 1 to 4 (4 being most reasonable) the median assessment of the reasonableness of malpractice allegations was 1, mean 1.2. On a scale of 1 to 4 (4 being the highest) the media n assessment of effectiveness of the current system in identifying tru e malpractice was 1, mean 1.4. The respondents believed that approxima tely 80% of malpractice allegations were inappropriate; conversely, th ey believed that approximately 80% of true medical malpractice escaped detection. On a scale of 1 to 4 (4 being the highest), the median ass essment of the detrimental effect of the present malpractice system on health care was 4, mean 3.4. Conclusions. Most NICU physicians will b e sued if they practice long enough. In this context, efforts to use m alpractice claims to seek out evildoers (such as underlie the National Practitioners Data Bank) appear ill-conceived. Similarly, exhortation s for physicians to become either more educated or more sensitive are unlikely to reduce malpractice claims. Our data suggest that malpracti ce in the NICU appears to function more like a lottery than like a mec hanism for either quality assurance or just retribution.