In 2019, a medical malpractice insurance company made a payment on behalf of a physician (MD) in Tennessee for approximately* $495,000. Payment was made in response to a claim of medical malpractice claim involving what was described as a "major temporary injury" to a male patient between 70 and 80 years old. The nature of the claim is broadly described as: "surgery related." The payment report submitted by a medical malpractice payer described the allegations in the claim as "Wrong Procedure or Treatment."
* The payment amount is approximate because the National Practitioner Data Bank codes payments as a range value. The report's description of $495,000 corresponds to a malpractice payment somewhere between $490,001 and $500,000.Year of Payment: 2019
Location: Tennessee
Allegation: Wrong Procedure or Treatment
Act or Omission: 2017
Payment Range: Between $490,001 and $500,000
Nature of Claim: Surgery Related
Payer: Insurance Company - Primary Coverage
Type of Care: Inpatient
Reporter: A Medical Malpractice Payer
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 another report on record. Specifically, this provider has three clinical privileges or panel member reports on record. 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.
Age: Between 40 and 50 Years Old in 2017 When Allegations Arose
Education Completed: Between 2000 and 2010