title: The Detection, Analysis, and Significance of Physician Clustering in Medical Malpractice Lawsuit Payouts.
abstract: There is evidence that most adverse events result from individual errors and that most malpractice suits with payouts reflect both patient injury and error.
  
  
  
  There are outlier physicians with regard to the frequency and total amount of malpractice payouts.
  
  
  
  Using the public use file of the National Practitioner Data Bank (NPDB), we sought the percentage of physicians who lay above several cutoff points with regard to total amounts of payments and number of payments. We looked at the frequency with which outliers were likely to have additional paid claims and to be disciplined by their hospitals and state boards.
  
  
  
  Approximately 1.8% of physicians were responsible for half of the $83,368,588,200 reported to the NPDB over 25 years. Within that group, 12.6% had an adverse licensure action reported to the NPDB, and 6.3% had a clinical privileges action reported. Physicians who were in the high dollar payout category and had one malpractice claim payout had a 74.5% chance of another payout, more than twice the rate for all physicians who had a single payout (chi-square, P < 0.0001). The likelihood that that physician would have additional payments increased as the number of previous payments increased. Total dollar payouts per physician better predicted future payouts than numbers of payouts. (For 1, 2, and 3 payouts, the P value was less than 0.0001 for each category.) Limitations: Neither a prospective nor a randomized study was feasible. Sorting by specialty was not done. Malpractice cases are an indirect measure of adverse events.
  
  
  
  There is a clustering of payments in medical malpractice cases among a small group of physicians. These findings point up the need to oppose the negative impact of such outlier physicians on the safety of patients.
authors.affiliation: From the Division of Practitioner Data Banks, Bureau of Health Professions, Health Resources and Services Administration, US Department of Health and Human Services.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Oshel
authors.affiliation: St. Mary's Medical Center, West Palm Beach, Florida.
authors.forename: Philip
authors.initials: P
authors.lastname: Levitt
mesh_terms: D016000:Cluster Analysis; D006801:Humans; D008318:Malpractice / Q000331:legislation & jurisprudence*; D016749:National Practitioner Data Bank / Q000331:legislation & jurisprudence*; D010820:Physicians / Q000592:standards*; D011446:Prospective Studies; D014481:United States