Yesterday I wrote about tort statistics revealed by the 2006-07 "Annual Report of the Tennessee Judiciary." Among the statistics I cited was that there were 584 medical malpractices cases filed in the state of Tennessee and a total of 15 medical malpractice trials.
To put that in perspective, remember that according to the National Institute of Health 98,000 people a year die in the United States from malpractice in hospitals alone. Assuming that Tennessee is neither worse nor better than average, that means that 1986 Tennesseans die each year as a result of malpractice in a hospital setting (because we have about 2% of the nation’s population).
And yet only 584 malpractice cases were filed in the entire state for the fiscal year ending June 30, 2007. Those cases presumably involved not only deaths in hospitals but also injuries in hospitals and deaths and injuries in outpatient settings, nursing homes and surgery centers. They also include cases against pharmacies and home health agencies and outpatient physical therapy centers.
Look at Davidson County. It had 166 medical malpractice cases filed. Using statistics complied the Tennessee Advisory Commission on Intergovernmental Relations, one can determine that Davidson County has about 3200 doctors, 3600 hospital beds and 3000 nursing home beds. Assuming the hospitals run an 60% census (and that is just a guess) Davidson County has just over 788,000 total hospital bed days per year. Assuming a 90% census (another guess) for nursing homes, there are just under 1,000,000 nursing home bed days in Davidson County per year.
That’s about 1,800,000 patient days where patients receiving care and are exposed to the risk of a medical error.
If the average physician performs services for 60 patients per week 48 weeks per year that is another 9,200,000 patient contacts.
Now, we all know that there were more than 166 injuries and deaths caused by medical negligence in Davidson County in the year covered by the Report. Indeed, the NIH statistics tell us that there were about 190 deaths.
So what’s going on? There are lots of explanations. First, lawyers who do medical malpractices cases do not take "small" cases because the costs of prosecuting the cases is significant and the time that must be invested makes pursuit of the cases uneconomical. Most medical errors cause relatively minor injuries. Second, a significant number of patients don’t want to be involved in litigation, which is certainly understandable. Third, a good number of patients (or their survivors) don’t know what happened to give rise to an injury or death and lack the will, sophistication, or energy to investigate it. Fourth, some patients who make inquiry are not told the truth. And undoubtedly there are other reasons as well.
But I think these numbers tell us that (a) there is not an explosion in claims against health care providers and (b) if anything, the legal system has done a poor job providing access to justice for people with "small" cases. The ultimate cost of malpractice in all those cases is borne by the patients and their health insurers (public or private).
The statistics cited above need to be refined slightly. I don’t have the precise number of doctors in the state or in any county, the average census of hospitals or nursing homes, etc. But I think at the end of the day the statistics determined with more reliable figures would demonstrate that the so-called medical malpractice crisis is manufactured.
By the way, here is a link to the Department of Commerce and Insurance Report on Medical Malpractice cases. Please note that it uses calendar years for reporting.