Doctors on Guard: The Impact of Medical Malpractice Litigation

Illustrated by Jennifer Broza

The medical world now exists in a litigious environment, which is seen most clearly by the prominence of medical malpractice lawsuits. Medical malpractice litigation can weigh heavily on physicians and hospitals by impacts on their reputation and credibility as well as economic burden. The creation of this litigious environment within the healthcare system has placed pressure on hospitals and healthcare workers to avoid malpractice litigation. What is the effect of this on these physicians’ practices and preparation within and for their careers? 

Part of what makes these medical malpractice cases such a prominent and controversial form of litigation is how deep these cases can run; they can have a great impact on the lives of the healthcare professionals themselves, the lawyers and of course, the victims. The magnitude of impact can be demonstrated by the awarded money alone, as seen in the over $200 million award given to Alan Navarro [1]. Navarro went to an emergency room at a Florida hospital showing symptoms of a stroke. While the emergency room doctors told him that he had a headache, Navarro was left brain-damaged and disabled. After taking his case to court, a Florida jury awarded Navarro $100.1 million in punitive damages and $116.7 million in compensatory damages [1]. The case of Neil Armstrong further illustrates the potentially strong impact of these cases on all parties involved. Mr. Armstrong died two weeks after undergoing heart surgery, and his two sons suggested that his death had been the fault of two physicians at the hospital. In response, the hospital paid the Armstrong family $6 million to handle the matter privately [2]. This private handling of the Armstrong case shows that the threat of devastating publicity due to medical malpractice lawsuits can cause hospitals to act questionably.  

In a scientific study published in the New England Journal of Medicine, researchers studied the risk of malpractice lawsuits based on various physician specialties and the resulting indemnity payments. The conclusion of this report is a noticeable difference across specialties both for risk of medical malpractice lawsuits and size of the resulting indemnity payments. Regardless, there is a high risk for these lawsuits across all specialties; the report notes that “the projected proportion of physicians facing a malpractice claim by the age of 65 years was high” and “it was estimated that by the age of 65 years, 75% of physicians in low-risk specialties had faced a malpractice claim, as compared with 99% of physicians in high-risk specialties” [3]. The probability of physicians encountering malpractice litigation during their practice exceeds the majority; this makes it clear how these lawsuits are such a prominent looming threat for physicians and hospitals.  

All physicians swear by the Hippocratic Oath, which serves as a baseline ethical and moral code for medicine. “In the oath, the physician pledges to prescribe only beneficial treatments, according to his abilities and judgment; to refrain from causing harm or hurt; and to live an exemplary personal and professional life” [4]. Clearly, ensuring patient safety is supposedly one of the most integral parts of a physician’s practice, but the very existence of medical malpractice litigation can put that value into question. The researchers of a study that investigated the impact of malpractice litigation risk on physicians’ behavior regarding patient safety noted that “physicians practice behaviors that run counter to patient safety. These behaviors include practicing defensive medicine… failing to report incidents… and hesitating to disclose incidents to patients” [5]. The practice of these behaviors is a clear, direct connection to the increased litigation of medicine; for example, physicians often practice defensive medicine by “ordering imaging tests and diagnostic measures for assurance” or “eliminating high risk procedures and avoiding patients with complications” [6]. This type of behavior is driven by a desire to avoid malpractice litigation and can have financial and safety implications for the patient. 

In a book published that analyzes the Malpractice System, the author regards that: 

Physicians… often become demoralized, and depressed providers are not likely to be enthusiastic patient safety leaders. Tort law is adversarial by nature, while a culture of safety is collaborative… In a safety-conscious culture, doctors and nurses willingly report their mistakes as opportunities to make themselves and the system better… something they are unlikely to do in a litigious environment. [7

When a hospital must operate in a litigious environment, its workers alter the way that they approach difficult situations; in this litigious environment, a culture of prioritizing avoiding devastating malpractice lawsuits over improving the hospital’s care can be created. 

The American healthcare system is an incredibly complex and layered system that intertwines with other sectors of American society, and it is possible that the most notable intersection is with the legal system. The intersections between the medical world and the legal world have been increasingly apparent, as seen by the significant presence of medical malpractice litigation. The pressure of these lawsuits is so great that it has forced hospitals to act as if they are in a litigious environment, prompting physicians to sometimes prioritize avoiding malpractice litigation over patient safety, avoid reporting some incidents and practice defensive medicine. The COVID-19 pandemic has emphasized the importance of public health and reminded everyone of just how intertwined medicine and health can become with other aspects of life. As these intersections become apparent, it is imperative to the survival of our morals in healthcare that we develop systems and cultures that deter this prioritization of hospital reputation and career of the physician over genuine patient safety. Our healthcare providers are supposed to hold genuine regard for patient safety with the utmost importance, and we cannot allow for an overly litigious environment to destroy this standard; they cannot be in a position where they are forced to decide between the maintenance of their career and the wellbeing of their patient. 

Edited by: Alexandra Dram

Illustrated by: Jennifer Broza

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