Practice guidelines and malpractice litigation: a two-way street.
OBJECTIVE
To understand how practice guidelines are used in malpractice litigation.


METHODS
Review of the open and closed malpractice claims of two medical malpractice insurance companies, and a mailed survey of attorneys who litigate malpractice claims.


METHODS
United States.


METHODS
Two insurance companies and 960 randomly selected malpractice attorneys.


METHODS
Frequency and nature of the use of practice guidelines in litigation; understanding and frequency of the use of practice guidelines by attorneys in malpractice cases.


RESULTS
259 claims opened in 1990-1992 at two insurance companies, including all obstetrics and anesthesia claims and a random sample of other claims, were reviewed. Seventeen of these claims involved practice guidelines, which were used as exculpatory evidence (exonerating the defendant physician) in 4 cases and as inculpatory evidence (implicating the defendant physician) in 12 cases. The only physician or patient factors associated with use of a guideline was a longer physician-patient relationship (P = 0.021). Nine hundred and sixty surveys were mailed and 578 were returned (response rate, 60.1%). Attorneys reported that once a suit is initiated, practice guidelines are likely to be used for inculpatory purposes (inculpatory in 54% of cases; exculpatory in 22.7% of cases). However, guidelines that seem to offer exculpatory value induce attorneys not to bring suits. The only attorney factor associated with increased use of guidelines was a practice in which more than 50% of business was in medical malpractice.


CONCLUSIONS
Guidelines are used both by plaintiffs' and defendants' attorneys in malpractice cases. The emphasis in health reform proposals on guidelines as exculpatory evidence should be carefully considered.
Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115.
A L
AL
Hyams
J A
JA
Brandenburg
S R
SR
Lipsitz
D W
DW
Shapiro
T A
TA
Brennan
D006801:Humans; D008318:Malpractice / Q000331:legislation & jurisprudence*; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D013997:Time Factors; D014481:United States