Physicians' experience with allegations of medical malpractice in the neonatal intensive care unit.
OBJECTIVE
To assess the personal experience of all practitioners of neonatal intensive care unit (NICU) medicine in the United States with the medical malpractice system; in particular, to assess the circumstances of malpractice allegations in which they themselves had personal experience, and to extrapolate from their individual experiences to the field of neonatology in general.


METHODS
Written survey of all MDs practicing NICU medicine in the US.


METHODS
Two thousand four hundred 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 of neonatologists provided by Ross Laboratories.


METHODS
Responses to survey questions.


RESULTS
We received 1813 responses, representing approximately 75% of all physicians practicing NICU medicine in the US. Overall, 43% of respondents had experienced at least one claim of malpractice against them. The probability of a malpractice allegation increased with years in practice, from approximately 20% for NICU physicians in practice </=5 years (65/337), to approximately 60% for NICU physicians in practice >15 years (276/469). Men and women were equally likely to have been sued, accounting for years in practice. Physicians practicing in community NICUs were more likely to be sued than those in 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 median assessment of effectiveness of the current system in identifying true malpractice was 1, mean 1.4. The respondents believed that approximately 80% of malpractice allegations were inappropriate; conversely, they believed that approximately 80% of true medical malpractice escaped detection. On a scale of 1 to 4 (4 being the highest), the median assessment of the detrimental effect of the present malpractice system on health care was 4, mean 3.4.


CONCLUSIONS
Most NICU physicians will be sued if they practice long enough. In this context, efforts to use malpractice claims to seek out evildoers (such as underlie the National Practitioners Data Bank) appear ill-conceived. Similarly, exhortations for physicians to become either more educated or more sensitive are unlikely to reduce malpractice claims. Our data suggest that malpractice in the NICU appears to function more like a lottery than like a mechanism for either quality assurance or just retribution.
Meadow
W
W
Department of Pediatrics, The University of Chicago, Chicago, IL 60637, USA.
Bell
A
A
Lantos
J
J
D003153:Community Health Services / Q000706:statistics & numerical data; D003625:Data Collection; D005104:Expert Testimony; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D008505:Medical Staff, Hospital / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D009359:Neonatology / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D018024:Peer Review, Health Care; D010822:Physicians, Women / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D011159:Population Surveillance; D011336:Probability; D011795:Surveys and Questionnaires; D014481:United States; D000078329:Workforce