Purpose

To describe characteristics of closed medical professional liability (MPL) claims against ophthalmologists in the United States.

Design

Retrospective analysis of MPL claims from 2006-2015. Data were obtained from the Physician Insurers Association of America (PIAA) Data Sharing Project (DSP). Comparison was made between ophthalmology and all healthcare specialties for physician demographics, prevalence and costs associated with closed claims, and resolution of claims. The most prevalent chief medical factor, presenting medical condition, operative procedure, outcomes, and resolution of ophthalmology claims were compared between the 2006-2010 and 2011-2015 periods.

Participants

From 2006-2015, 90 743 MPL claims were closed: 2.6% (2325/90 743) of closed claims and 2.2% (564/24 670) of all paid claims were against ophthalmologists.

Methods

Retrospective analysis of MPL claims captured by the PIAA DSP over a 10-year period.

Main Outcome Measures

Subspecialty pertaining to the claim, number of claims closed and paid, indemnity paid, allocated loss adjustment expenses, chief medical factor, presenting medical condition, operative procedure, outcome, and resolution.

Results

Only 24% of closed claims against ophthalmologists resulted in payment. Two-thirds were dropped, withdrawn, or dismissed. Ninety percent of claims that received a verdict were favorable toward the ophthalmologist. Cataract and cornea surgeries were the most prevalent and most costly operative procedures, accounting for 50% of all claims and $47 641 376 and $32 570 148 in total paid indemnity, respectively. Average indemnity was higher for corneal procedures ($304 476) than vitreoretinal procedures ($270 141) or oculoplastic procedures on the eyelid ($222 471) or orbit and eyeball ($183 467). The prevalence and cost of claims related to endophthalmitis declined from 2006-2010 (n = 38/1160 [3.3%]; average indemnity, $516 875) period to the 2011-2015 (n = 26/1165 [2.2%]; average indemnity, $247 083) period. Average indemnity paid ($280 227 vs. $335 578) and amount spent on legal defense ($41 450 vs. $46 391) was slightly lower among ophthalmologists compared with all healthcare specialties, respectively.

Conclusions

Ophthalmology has a relatively low number of malpractice claims reported compared with other healthcare specialties and shows less spending on average indemnity and defense. Further studies are needed to investigate the reasons for the higher prevalence of claims related to cataract and corneal surgeries and the higher average indemnity paid for corneal procedures relative to vitreoretinal or oculoplastic procedures.

中文翻译：

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2006年至2015年美国眼科医疗专业责任索赔回顾

目的

描述美国针对眼科医生的封闭式医疗专业责任（MPL）索赔的特征。

设计

对2006年至2015年MPL索赔的回顾性分析。数据来自美国医师保险协会（PIAA）数据共享项目（DSP）。在眼科和所有医疗专业之间进行了比较，以了解医生的人口统计学信息，与封闭索赔有关的患病率和费用以及索赔的解决方案。在2006-2010年和2011-2015年之间比较了最普遍的主要医疗因素，包括医疗状况，手术程序，结局和眼科治疗要求。

参加者

从2006年至2015年，已结案的MPL索赔案件为90 743件：已结案的索赔率为2.6％（2325/90 743），而所有已付索赔中的2.2％（564/24 670）是针对眼科医生的。

方法

对PIAA DSP在10年内捕获的MPL索赔进行回顾性分析。

主要观察指标

与索赔有关的子专业，已完成并已支付的索赔数量，已支付的赔偿金，已分配的损失理算费用，主要医疗因素，当前医疗状况，手术程序，结果和解决方案。

结果

在针对眼科医生的封闭式索赔中，只有24％产生了付款。三分之二的人被丢弃，撤回或解雇。收到裁定的索赔中有90％对眼科医生有利。白内障和角膜手术是最普遍和最昂贵的手术程序，占所有索赔的50％，分别占总赔偿金的47 641 376美元和32 570 148美元。角膜手术的平均赔偿（304 476美元）高于眼睑的玻璃体视网膜手术（270 141美元）或眼睑整形手术（222 471美元）或眼球和眼球的平均赔偿（183 467美元）。从2006-2010年（n = 38/1160 [3.3％]；平均弥偿金，516,875美元）至2011-2015年（n = 26/1165 [2.2％]），与眼内炎有关的索赔的患病率和费用有所下降（247,083美元）。平均支付的赔款（$ 280 227 vs.

结论

与其他医疗专业相比，眼科报告的医疗事故索赔相对较少，并且平均保险和辩护费用更少。需要进行进一步的研究，以调查与白内障和角膜手术有关的索赔率较高的原因，以及相对于玻璃体视网膜或眼部整形手术而言，角膜手术所支付的平均赔偿金较高的原因。