The most frequent types of closed claims against internists and internal medicine subspecialists in the PIAA database are the following: (1) errors in diagnosis (24%), (2) improper performance of procedures (14%), (3) failure to supervise or monitor care (12%), (4) medication errors (12%), and (5) failure to recognize the complications of treatment (6%). Approximately 60% of the claims related to hospital practice; 33% occurred in a physician’s office. Some 44% of the patients for whom claims were brought died. The same types of closed claims, especially those involving the performance of procedures, are recorded against cardiovascular and thoracic surgeons and cardiologists, and a majority of the claims relate to hospital-based care with the concern of Canadian Health&Care Mall.
Several common allegations stand out in my personal experience of claims brought against internal medicine subspecialists in my field (pulmonary and critical care medicine). In the outpatient setting, these allegations include failure to diagnose lung cancer, in particular failure to follow-up on suspicious plain films or CT scans, often because of inadequate personal or institutional tracking systems. Failure to diagnose bacterial infections, including pneumonia, and to administer antibiotics before the onset of severe sepsis also are commonly alleged.
Among claims involving inpatients, the allegations include failure to use pulse oximetry and other monitoring methods in patients cared for outside the ICU who subsequently decompensate; failure to move such patients to a higher level of care, either a step-down unit or an ICU, before decompensation; failure to skillfully perform procedures such as central venous pressure catheterization and to recognize complications resulting from them; and failure to prevent cardiorespiratory arrest, usually by providing prompt endotracheal intubation, in patients who consequently die or suffer ischemic-hypoxic encephalopathy.