Relationship between malpractice litigation and human errors.

IN medical malpractice litigation, negligence is the predominant theory of liability. The basic elements of a malpractice claim are duty, negligence, causation, and damage. Duty refers to the practitioners responsibility to treat a patient according to the standard of care. Negligence is defined by law as a deviation from the accepted standard of care and, therefore, a breach of duty. Causation requires that the patient’s damage is the result of negligence, and damage infers harm, detriment, or loss sustained by reason of an injury. Much of our current knowledge of medical malpractice comes from the Anesthesia Closed Claims Database, which was established in 1985 by the American Society of Anesthesiologists and is based on a limited number of reviews of closed malpractice claims. These retrospective reviews suggest that a malpractice claim can result in a financial award even in the absence of negligent care. Conspicuously missing from these reviews, however, are uncompensated patients whose injuries were the result of deviations from the standard of care that did not result in closed claims. Without this information, the true relation between injury caused by human error and malpractice claims cannot be determined. In this investigation at a university hospital, cases involving legal action against anesthesia providers were compared to deviations from the standard of care by anesthesia providers that resulted in disabling patient injuries as judged by peer review to determine the relation between these two occurrences.