California: Malpractice Payment of $275,000 for Injury to a Female Patient (2022)

In 2022, a non-insurance malpractice payment was made on behalf of a physician (MD) in California for approximately* $275,000. Payment was made in response to a claim of medical malpractice claim involving what was described as an emotional injury to a female patient of unknown age. The nature of the claim is broadly described as: "treatment related." The payment report submitted by a self-insured entity described two separate allegations of "Improper Performance."

* The payment amount is approximate because the National Practitioner Data Bank codes payments as a range value. The report's description of $275,000 corresponds to a malpractice payment somewhere between $270,001 and $280,000.

Claim at a Glance

Year of Payment: 2022

Location: California

First Allegation: Improper Performance

Second Allegation: Improper Performance

Act or Omission: 2019

Second Act or Omission: 2020

Payment Range: Between $270,001 and $280,000

Nature of Claim: Treatment Related

Payer: Self-Insured Organization

Type of Care: Outpatient

Reporter: A Self-insured Entity

Claim Insights

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.

Provider History Includes a Licensure Report

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 five malpractice payments in the database. 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 five malpractice payments is more than 94% of all providers in the database, which is limited to providers with malpractice payment history.

Second, the database reflects that this particular provider has a licensure report 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 two exclusion reports 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.

Provider Detail

Alerts 10

California

Physician (MD)

Age: Between 40 and 50 Years Old in 2019 When Allegations Arose

Education Completed: Between 2000 and 2010

Malpractice Payments 5
There are other payments in the database associated with this provider:
YearStateAmountAllegation
2019California$27,500Failure-to-Obtain Consent or Lack of Informed Consent
2020California$27,500Improper Performance
2022California$275,000An Otherwise Unclassified Allegation
2022California$275,000Improper Performance
2022California$275,000Improper Performance
Licensure Reports 1
Adverse actions by the state licensing board are reported to the NPDB. Some of these actions are public, but some are not. All adverse actions must be reported in this database, whether or not they are public.
DEA Reports 1
These reports are submitted when the Drug Enforcement Administration takes action based on controlled substance registration.
Exclusion Reports 2
This report means a temporary or permanent barring from participation in a federal or state health-related program, e.g. Medicare and Medicaid, such that those entities will not reimburse the provider for services.
Clinical Privilege Reports 1
Clinical privileges are rights that providers have to work on staff at a medical facility and to perform particular procedures. When the facility restricts those privileges because of an investigation into improper conduct or incompetence, a report is required. Adverse actions restricting clinical privileges also give rise to these reports.
Payments

Similar Claims

Here are other claims involving an allegation of Improper Performance and an outcome of what was described as an emotional injury to a patient of unknown age.
YearStateAmountAllegation
2024California$72,500Improper Performance
2024Georgia$125,000Improper Performance
2022California$275,000Improper Performance
2020Oklahoma$4,500Improper Performance
2019Florida$97,500Improper Performance
2019Michigan$22,500Improper Performance
2018Georgia$12,500Improper Performance
2017Missouri$97,500Improper Performance
2017Florida$52,500Improper Performance
2017Wisconsin$995,000Improper Performance