Negligent care and malpractice claiming behavior in Utah and Colorado

BACKGROUND. Previous studies relating the incidence of negligent medical ca re to malpractice lawsuits in the United States may not be generalizable. T hese studies are based on data from 2 of the most populous states (Californ ia and New York), collected more than a decade ago, during volatile periods in the history of malpractice litigation. OBJECTIVES. The study objectives were (1) to calculate how frequently negli gent and non-negligent management of patients in Utah and Colorado in 1992 led to malpractice claims and (2) to understand the characteristics of vict ims of negligent care who do not or cannot obtain compensation for their in juries from the medical malpractice system. DESIGN. We linked medical malpractice claims data from Utah and Colorado wi th clinical data from a review of 14,700 medical records. We then analyzed characteristics of claimants and nonclaimants using evidence from their med ical records about whether they had experienced a negligent adverse event. MEASURES. The study measures were negligent adverse events and medical malp ractice claims. RESULTS. Eighteen patients from our study sample filed claims: 14 were made in the absence of discernible negligence and 10 were made in the absence o f any adverse event. Of the patients who suffered negligent injury in our s tudy sample, 97% did not sue. Compared with patients who did sue for neglig ence occurring in 1992, these nonclaimants were more likely to be Medicare recipients (odds ratio [OR], 3.5; 95% CI [CI], 1.3 to 9.6), Medicaid recipi ents (OR, 3.6; 95% CI, 1.4 to 9.0), greater than or equal to 75 years of ag e (OR, 7.0; 95% CI, 1.7 to 29.6), and low income earners (OR, 1.9; 95% CI, 0.9 to 4.2) and to have suffered minor disability as a result of their inju ry (OR, 6.3; 95% CI, 2.7 to 14.9). CONCLUSIONS. The poor correlation between medical negligence and malpractic e claims that was present in New York in 1984 is also present in Utah and C olorado in 1992. Paradoxically, the incidence of negligent adverse events e xceeds the incidence of malpractice claims but when a physician is sued, th ere is a high probability that it will be for rendering nonnegligent care. The elderly and the poor are particularly likely to be among those who suff er negligence and do not sue, perhaps because their socioeconomic status in hibits opportunities to secure legal representation.