Analysis of medication-related malpractice claims: causes, preventability, and costs.
BACKGROUND
Adverse drug events (ADEs) may lead to serious injury and may result in malpractice claims. While ADEs resulting in claims are not representative of all ADEs, such data provide a useful resource for studying ADEs. Therefore, we conducted a review of medication-related malpractice claims to study their frequency, nature, and costs and to assess the human factor failures associated with preventable ADEs. We also assessed the potential benefits of proved effective ADE prevention strategies on ADE claims prevention.


METHODS
We conducted a retrospective analysis of a New England malpractice insurance company claims records from January 1, 1990, to December 31, 1999. Cases were electronically screened for possible ADEs and followed up by independent review of abstracts by 2 physician reviewers (T.K.G. and R.K.). Additional in-depth claims file reviews identified potential human factor failures associated with ADEs.


RESULTS
Adverse drug events represented 6.3% (129/2040) of claims. Adverse drug events were judged preventable in 73% (n = 94) of the cases and were nearly evenly divided between outpatient and inpatient settings. The most frequently involved medication classes were antibiotics, antidepressants or antipsychotics, cardiovascular drugs, and anticoagulants. Among these ADEs, 46% were life threatening or fatal. System deficiencies and performance errors were the most frequent cause of preventable ADEs. The mean costs of defending malpractice claims due to ADEs were comparable for nonpreventable inpatient and outpatient ADEs and preventable outpatient ADEs (mean, $64,700-74,200), but costs were considerably greater for preventable inpatient ADEs (mean, $376,500).


CONCLUSIONS
Adverse drug events associated with malpractice claims were often severe, costly, and preventable, and about half occurred in outpatients. Many interventions could potentially have prevented ADEs, with error proofing and process standardization covering the greatest proportion of events.
Rothschild
Jeffrey M
JM
Division of General Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA. jrothschild@partners.org
Federico
Frank A
FA
Gandhi
Tejal K
TK
Kaushal
Rainu
R
Williams
Deborah H
DH
Bates
David W
DW
D017048:Health Care Costs; D006801:Humans; D008318:Malpractice / Q000191:economics; D008508:Medication Errors / Q000191:economics; D009511:New England; D012189:Retrospective Studies; D012308:Risk Management / Q000191:economics