title: Negligent care and malpractice claiming behavior in Utah and Colorado.
abstract: BACKGROUND
  Previous studies relating the incidence of negligent medical care to malpractice lawsuits in the United States may not be generalizable. These studies are based on data from 2 of the most populous states (California and New York), collected more than a decade ago, during volatile periods in the history of malpractice litigation.
  
  
  OBJECTIVE
  The study objectives were (1) to calculate how frequently negligent and nonnegligent management of patients in Utah and Colorado in 1992 led to malpractice claims and (2) to understand the characteristics of victims of negligent care who do not or cannot obtain compensation for their injuries from the medical malpractice system.
  
  
  METHODS
  We linked medical malpractice claims data from Utah and Colorado with clinical data from a review of 14,700 medical records. We then analyzed characteristics of claimants and nonclaimants using evidence from their medical records about whether they had experienced a negligent adverse event.
  
  
  METHODS
  The study measures were negligent adverse events and medical malpractice 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 of any adverse event. Of the patients who suffered negligent injury in our study sample, 97% did not sue. Compared with patients who did sue for negligence 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 recipients (OR, 3.6; 95% CI, 1.4 to 9.0), > or =75 years of age (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 injury (OR, 6.3; 95% CI, 2.7 to 14.9).
  
  
  CONCLUSIONS
  The poor correlation between medical negligence and malpractice claims that was present in New York in 1984 is also present in Utah and Colorado in 1992. Paradoxically, the incidence of negligent adverse events exceeds the incidence of malpractice claims but when a physician is sued, there 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 suffer negligence and do not sue, perhaps because their socioeconomic status inhibits opportunities to secure legal representation.
authors.affiliation: Department of Health Policy and Management, Harvard School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA. studdert@rand.org
authors.forename: D M
authors.initials: DM
authors.lastname: Studdert
authors.forename: E J
authors.initials: EJ
authors.lastname: Thomas
authors.forename: H R
authors.initials: HR
authors.lastname: Burstin
authors.forename: B I
authors.initials: BI
authors.lastname: Zbar
authors.forename: E J
authors.initials: EJ
authors.lastname: Orav
authors.forename: T A
authors.initials: TA
authors.lastname: Brennan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D002140:California; D003120:Colorado; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D008484:Medicaid / Q000706:statistics & numerical data; D019300:Medical Errors / Q000331:legislation & jurisprudence / Q000523:psychology* / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D009518:New York; D011203:Poverty / Q000706:statistics & numerical data; D014481:United States; D014589:Utah