When a physician has several paid claims in cases of medical malpractice that are more likely to move into solo practice. This report was posted in the New England Journal of Medicine. David M. Studdert, a professor of medicine and law at Stanford, explains that roughly 25% of Americans receive their primary care from a solo physician practice. Studdert feels that those physicians who have been deemed as negligent in malpractice cases are probably the “least desirable” professionals to have a solo practice.
Reason for Concern
Studdert feels that “risky” providers who isolate themselves in solo practice are a safety concern. In a solo practice environment, the practitioner has less exposure to colleagues and obviously less peer oversight. Recently there has been a reversal in the trend where physicians with paid malpractice claims relocate to another state. This is largely in response to the implementation of the National Practitioner Data Bank (NPDB) that allows for such data to be shared from state-to-state.
All paid claims of medical malpractice are required to be entered into the NPDB. This database was created by Congress in 1986 largely to prevent practitioners with substandard records from relocating to another state without disclosing such problems. Overall, the NPDB has promoted quality in healthcare and reduced potential “fraud and abuse.”
There is evidence that claims of malpractice are largely “clustered among a small proportion” of medical professionals such as:
- A recent study of over 480,000 physicians revealed that 89% of them had zero successful claims of medical malpractice against them
- Approximately 8.8% of the physicians had one claim
- The largest number of claims existed among a group that equated to just 2.3% of the total
Studdert went further in evaluating the data stating that physicians with tarnished reputations are now no more likely to relocate than others. He estimated that physicians with multiple paid malpractice claims are 45% more likely to leave the profession. He warns that those who continue to practice may be a risk. He feels that error-prone physicians may benefit from practicing in a setting among their peers. The increased communication and varying perspectives may translate to higher quality care.
Two Recent Incidents
Larry M. Isaacs, a surgeon who was practicing in Los Angeles, mistakenly removed the kidney of a patient who was supposed to have surgery on his colon. In another incident, Isaacs inadvertently removed a fallopian tube instead of an appendix. He soon relocated to New York and his history of medical mistakes was revealed to the state's regulators. Isaacs then abruptly moved to Ohio and began practicing. His license in Ohio did not contain any data relating to his many critical errors.
A USA Today study reported in MedPage Today showed that there have been over 250 instances where a physician lost his medical license in one state and began practicing in another. Somehow these physicians managed to find their way to a state where their history was not reviewed. This is exactly the type of scenario that the NPDB was designed to prevent.