What is Medical Malpractice?

Definition of Medical Malpractice

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Medical Malpractice is professional negligence by a healthcare provider that deviates from the accepted standard of care, resulting in harm.

Overview

The Journal of the American Medical Association (JAMA) has noted that medical malpractice is the third leading cause of mortality in the United States after heart disease and cancer. Forbes magazine recently reported that the cost of medical malpractice in the United States is approximately $55.6 billion a year. Medical malpractice is without a doubt, one of the most critical issues for healthcare and arguably one of the biggest “pain points” for providers today.

Medical Professional Liability Insurance, also known as medical malpractice insurance (or medmal insurance) provides coverage to physicians, surgeons, and other healthcare professionals for liability arising from a medical malpractice claim. In simple terms, it protects healthcare providers against claims filed by patients or their families who sue them, alleging harm by their medical negligence or harmful treatment.

The Standard of Care in Malpractice Cases

Healthcare professionals are not expected to be perfect – none of us are! They are, however, required to meet the appropriate standard of care; what a reasonably competent and skilled provider, with similar background and training would have done in the same situation. In order to prove that the standard of care was or was not met, attorneys on both sides may bring in an expert witness to testify. 

If, for example, an OB/GYN is being accused of a medical error, another OB/GYN or specialist in the given field may testify to show that the doctor failed to do something that he should have done or did something that he should not have done.

Establishing the Elements of Proof

A plaintiff alleging medical malpractice must prove the following:

1.     A duty of care was owed by the healthcare provider to the patient

2.     The duty was breached (standard of care was not met)

3.     The breach caused the injury in question

4.     The injury resulted in damages

The burden of proof lies with the plaintiff and their medical malpractice attorneys in a malpractice lawsuit and all 4 elements must be proven for a plaintiff to prevail at trial.

Physicians, dentists, nurses, and healthcare professionals owe a duty of care to those who seek their treatment. This element of proof is rarely disputed in medical malpractice cases, because once a provider agrees to treat a patient, he or she has a professional duty to provide competent care. More importantly, the patient must show that there was a real injury (physical or emotional) as a result of the alleged negligence from the medical procedure.

Causation is a critical element of proof in a medical malpractice lawsuit. While there may be injuries, if the injuries cannot be directly linked to the healthcare provider’s alleged misconduct, there is no case. There are several issues that can make causation difficult to prove in a medmal case, including:

·        Trying to separate the effect of an existing condition from the effect of the negligent medical treatment (did the doctor’s treatment cause the injury or was it already there?)

·        Predicting if the outcome would have been the same, regardless of the provider’s actions (a patient is treated for stomach pain and discharged in the morning, but dies of a stroke at home that evening)

·        Multiple factors attributable to the injury (many things could have caused the injury in question, but it cannot be directly linked to the provider’s care)

If all 4 elements are proven and the jury finds in favor of the plaintiff, a judgement is awarded to indemnify the patient for their losses. 

Types of Damages in a Malpractice Case

There are 2 types of damages in a malpractice case – compensatory and punitive.

Compensatory damages

·        Economic (examples: loss of income, medical expenses, future medical care)

·        Non-economic damages (examples: pain and suffering, scarring, humiliation, permanent loss of an organ or limb, reduced enjoyment of life, etc.)

Punitive damages

Punitive damages are only awarded if the provider’s conduct is found to be willful, wanton, and/or reckless. Whether a healthcare provider can be liable for punitive damages, which are intended to punish a defendant, varies from state-to-state.

Most malpractice insurance policies exclude coverage for punitive damages. Likewise, liability that arises from sexual misconduct, criminal acts, and inappropriate alteration of medical records is also typically excluded from coverage.

Summary

Medical Malpractice Insurance provides coverage to doctors and healthcare professionals for liability arising from allegations of negligent care. Medical malpractice occurs when there is a medical error by a healthcare provider that deviates from the standard of care, resulting in harm to the patient. Standard of care is what a reasonably competent and skilled provider, with similar background and training, would have done in the same situation. A health care professional is not expected to be perfect or practice perfect medicine.

A patient alleging medical malpractice must prove 1) duty of care by the provider, 2) a breach of the standard of care, 3) an injury proximately caused by the breach; and 4) the injury resulted in damages. The burden of proof lies with the plaintiff and their malpractice lawyers in a lawsuit and all 4 elements must be proven for a plaintiff to prevail.

If a jury finds in favor of the plaintiff, or if a malpractice case is settled, damages are awarded to indemnify the patient and/or their family. Damages can be compensatory (economic or non-economic), and in certain situations punitive. Most malpractice policies do not cover punitive damages or those related to sexual misconduct or criminal acts.

Malpractice Insights (the blog for Aegis Malpractice Solutions, LLC) is written to provide general information on medical malpractice insurance and related topics. It is not intended to provide specific legal/insurance advice. By using this blog site you understand that there is no insurance/client relationship between you and the Blog/Website publisher. The Blog/Website should not be used as a substitute for advise provided to you by your insurance agent or from a licensed professional attorney in your state.