Eighty-five thousand medical malpractice lawsuits are initiated each year, yet the precise amount of claims evaluated by attorneys is still unknown. The choice to move forward with a lawsuit depends on differentiating between complications that arise from systemic medical mistakes during procedures and those that occur due to random natural errors. Among these lawsuits, two-thirds (approximately 52,000) are dismissed completely and 4,600 conclude with defense verdicts. The remaining third consists of 27,000 settlements and 1,400 plaintiff verdicts. This distribution indicates that there may be more legitimate lawsuits that remain unfiled than those that are officially pursued, leaving many victims without legal options while some innocent doctors endure litigation.
A claimant’s effort to differentiate between medical error and natural error is complicated. Plaintiff attorneys, whose job is to filter claims to identify which ones lead to the total of 85,000 filed cases, frequently depend on potential settlements rather than the source of complications. The 27,000 settlements generate a considerable $2.7 billion each year for plaintiff attorneys, potentially eclipsing the individual merits of the claims.
Defense attorneys profit from this high volume of filings, accumulating $2.5 billion annually through assignments from malpractice carriers, regardless of the outcome or cause. Medical experts, who are frequently hired by attorneys to provide their evaluations, make around $140,000 a year, and may prioritize financial incentives over thorough examination of claims.
Malpractice carriers, influenced by actuarial evaluations, may choose to settle even trivial claims to sidestep the risk of unfavorable jury decisions. The tort system also contributes to this intricacy, with some jury awards reaching over $1 million and cases taking years to resolve; one prominent case culminated in $229 million before being overturned seven years later.
Healthcare systems, now commonly structured as integrated networks, aim to reduce costs under “resource-based practice guidelines,” which may not coincide with a standard of care. This emphasis on cost efficiency can heighten the risk of litigation for practitioners adhering to these guidelines, as they may not necessarily adhere to competent care standards.
Doctors face significant personal financial stakes given their high malpractice premiums, which can exceed $100,000 annually. When network employers cover these expenses, practitioners are less worried about the differences between guidelines and standards of care. The American Medical Association (AMA) has also redefined practice guidelines, aligning them more closely with competence rather than cost; however, leadership ties to networks may undermine their advocacy.
Politicians, many of whom have a background in law, contribute to the problem by enacting tort reforms that often lack depth and primarily serve their own interests. As a result, a culture of mutual dependency and financial incentive continues to uphold a flawed system, harming both claimants and practitioners. A significant proportion of unjust claims exists alongside underrepresented valid cases.
As a physician, confronting an 8.5 percent annual likelihood of being sued, I find these systemic flaws extremely troubling. Even though there is widespread recognition of these problems, substantive reform remains difficult to achieve. It is crucial to keep these challenges in mind, particularly when dealing with litigation.
Howard Smith is an obstetrics-gynecology physician.