An insurer's perspective on error and loss in pathology.
OBJECTIVE
To identify errors in surgical pathology practice that lead to malpractice claims, and to define the frequency and severity of pathology malpractice claims and discuss the implications.


METHODS
Three hundred seventy-eight pathology malpractice claims reported to The Doctors Company of Napa, Calif, between 1998 and 2003, were reviewed. Nuisance claims and autopsy claims were excluded; the 335 remaining claims were analyzed.


RESULTS
Pathology claim frequency is low. Pathology claim severity is high, especially for claims involving a misdiagnosis of melanoma or a false-negative Papanicolaou test. Fifty-seven percent of claims involved the following 5 categories: breast specimens, melanoma, Papanicolaou smears, gynecologic specimens, and operational error. Sixty-three percent of claims involved failure to diagnose cancer, resulting in delay in diagnosis or inappropriate treatment.


CONCLUSIONS
A false-negative diagnosis of melanoma is the single most common reason for filing a malpractice claim against a pathologist. Nearly one third of misdiagnoses involve melanoma misdiagnosed as Spitz nevus, "dysplastic" nevus, spindle cell squamous carcinoma, atypical fibroxanthoma, and dermatofibroma.
Troxel
David B
DB
School of Public Health, Health and Medical Sciences, University of California, Berkeley, California, USA. dtroxel@thedoctors.com
D003951:Diagnostic Errors; D006801:Humans; D007345:Insurance Claim Review; D007351:Insurance, Liability; D008318:Malpractice; D008545:Melanoma / Q000175:diagnosis; D010340:Pathology, Surgical / Q000331:legislation & jurisprudence / Q000592:standards*; D012878:Skin Neoplasms / Q000175:diagnosis