In 2019, a non-insurance malpractice payment was made on behalf of an osteopathic physician (DO) in South Dakota for approximately* $9,950,000. Payment was made in response to a claim of medical malpractice claim involving what was described as a "significant permanent injury" to a male patient between 50 and 60 years old. The nature of the claim is broadly described as: "surgery related." The payment report submitted by a general or acute care hospital described the allegations in the claim as "Unnecessary Procedure."
* The payment amount is approximate because the National Practitioner Data Bank codes payments as a range value. The report's description of $9,950,000 corresponds to a malpractice payment somewhere between $9,900,001 and $10,000,000.Year of Payment: 2019
Location: South Dakota
Allegation: Unnecessary Procedure
Act or Omission: 2011
Payment Range: Between $9,900,001 and $10,000,000
Nature of Claim: Surgery Related
Payer: Self-Insured Organization
Type of Care: Both Inpatient and Outpatient Care
Reporter: A General Or Acute Care Hospital
With respect to any medical malpractice payment, there are three major components of any claim. First, there is the act or omission that gave rise to an injury and whether the provider departed from an accepted standard of practice. Second, there is the nature of the injury itself, which includes several factors like its severity, duration, the impact on the patient’s life, the age and general health of the patient, along with many other elements. Third, there needs to be a causal connection between the negligent act or omission by the provider and the injury itself. Even with a showing of negligence, a medical provider is not legally responsible for an outcome that was not caused by the negligence.
With this in mind, the Data Bank does have some information that can give context to the medical malpractice payments, including the patient’s age, gender, whether it was inpatient or outpatient care, the type of malpractice or medical mistake that was alleged, and the ultimate outcome to the patient.
The information has significant limitations, however, that everyone should keep in mind. For one thing, the information is usually self-reported by the healthcare provider and his or her representatives. When reviewing this information, you should consider whether the patient would have described his or her injury as “minor” or “temporary” or “emotional only.” Further, there are important aspects of any claim valuation that simply cannot work in a database. Flagrant negligence might be coded the same way as what could be described as a smaller error, and one would have no way of knowing from these data. But even with these limitations and even where some required information is missing from any particular report, each of the payment reports in the database have enough to provide some insightful information that can help evaluate medical malpractice claims going forward.
A medical provider's malpractice history can be extremely insightful. A long history of malpractice claims and discipline can certainly affect whether a matter is resolved and for how much. One of the most important goals of the National Practitioner Data Bank is to track providers' disciplinary and malpractice payment history throughout interstate moves or new employment situations.
In addition to this particular malpractice payment, this provider has five other types of reports on record that are certainly worth noting. First, this provider has a total of nine malpractice payments in the database. This is a highly concerning number of medical malpractice payments. To put this number in perspective, throughout over 200,000 payment records, approximately 55% of them are associated with providers with multiple payments. This provider's total of nine malpractice payments is more than 99% of all providers in the database, which is limited to providers with malpractice payment history.
Second, the database reflects that this particular provider had two licensure report(s) on record. These are more unusual among the providers for whom malpractice payments are recorded in the database - only about 15% of the providers with malpractice payments also have at least one licensure report as well.
Third, this provider has a report on record for clinical privileges or panel member action. These reports are important to set limits on what types of actions and procedures a provider is allowed to perform in case they move to another state to practice. Only about 4% of payments in the database are associated with a provider with even one such report on their record.
Fourth, this provider has a DEA report on record. There are a number of reasons why the DEA would take action against a provider, including prescription practices or requiring oversight with controlled substances. There are only 69 payment reports (.03%) in the entire database associated with any provider with even one such report on record.
Fifth, this provider has an exclusion report on record. The Office of the Inspector General keeps a database on providers who are excluded from Medicare, Medicaid, and other federal programs. The provider in this matter has such a report associated with them in the database.
Age: Between 40 and 50 Years Old in 2011 When Allegations Arose
Education Completed: Between 1990 and 2000