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  • Surgeons represent 13 percent of CRICO-insured physicians and a disproportionate 31 percent of the CRICO cases over the past 5 years to date (2002 through September 2007).
  • The numbers include attendings, fellows and residents.
  • Consistent with the cases, surgeons represent one-third of all CRICO physician defendants and one-third of CRICO’s incurred losses --which is an aggregate of expenses, reserves, and payments on open and closed cases.
  • Surgical claims are often driven by complications . Even in the best of hands, complications can occur. Examples include: significant postoperative hemorrhage visceral, vascular and peripheral nerve injuries retained instruments and sponges failed procedures, and other unplanned returns to surgery Unrealistic patient expectations also contribute. Analyses of the data derived from the surgery claims revealed technical errors, communication breakdowns, and system problems . Cases alleging technical error accounted for 58 percent of the cases and close to a hundred million dollars over the past 5 years. Communication breakdowns were noted to be a factor in 43 percent of the claims. There can be multiple issues in a single case so totals do not add to 100. A subset of the communication cases involved informed consent .
  • A deeper analysis of every case flushed out persistent problems in the systems. What we have learned from deeply analyzing the surgery claims? A lot of what happens is related to system complexity.
  • When there is a payment made on behalf of a surgeon defendant, the average payment is over a half million . For background - The average payment paid per OB/GYN defendant (on cases closed with payment) was $700,000. The average payment paid on behalf of a Medicine defendant (on cases closed with payment) was $476, 000
  • Surgeons prevails 71 percent of the time which is similar to the rest of CRICO.
  • [PowerPoint]

    1. 1. 2007 Surgery Summit November 5, 2007 Liberty Hotel, Boston Seeking Practical Ways to Improve Patient Safety Jack Mc Carthy President, CRICO/RMF
    2. 2. Snapshot of CRICO Surgery-related Claims 2002-2007 Surgery includes General Surgery, Neurosurgery, Orthopedic Surgery, Bariatric Surgery, Colorectal Surgery, Cardiac Surgery, Otorhinolaryngology (with Plastic), Hand Surgery, Ophthalmology, Otolaryngology (No plastic), Plastic (NOC), Pediatric Surgery, Oncology (Surgical), Thoracic Surgery, Urology Surgery, Vascular Surgery, Transplant, Podiatry. Surgeons represent 13% of CRICO-insured physicians Surgery accounts for 31% of CRICO cases
    3. 3. Surgeons Insured by CRICO <ul><li>1,376 surgeons out of 10,400 physicians </li></ul><ul><li>Top specialties by number of insureds </li></ul><ul><ul><li>General surgery – 381 </li></ul></ul><ul><ul><li>Orthopedic surgery – 195 </li></ul></ul><ul><ul><li>Ophthalmology – 153 </li></ul></ul><ul><ul><li>Gynecology (surgery) – 121 </li></ul></ul><ul><ul><li>ENT – 109 </li></ul></ul><ul><ul><li>Urology – 66 </li></ul></ul><ul><ul><li>Neurosurgery – 64 </li></ul></ul><ul><ul><li>Plastic surgery – 57 </li></ul></ul>
    4. 4. Snapshot of CRICO Surgery-related Claims 2002-2007 Surgery includes General Surgery, Neurosurgery, Orthopedic Surgery, Bariatric Surgery, Colorectal Surgery, Cardiac Surgery, Otorhinolaryngology (with Plastic), Hand Surgery, Ophthalmology, Otolaryngology (No plastic), Plastic (NOC), Pediatric Surgery, Oncology (Surgical), Thoracic Surgery, Urology Surgery, Vascular Surgery, Transplant, Podiatry. Surgeons represent 30% of physician defendants Surgery accounts for 28% of incurred losses
    5. 5. Top Issues in Surgery-related Claims 2002-2007 *A case may have more than one issue identified. N=407 PL cases asserted 1/1/02–9/30/07 with a responsible service of surgery. Surgery includes General Surgery, Neurosurgery, Orthopedic Surgery, Bariatric Surgery, Colorectal Surgery, Cardiac Surgery, Otorhinolaryngology (with Plastic), Hand Surgery, Ophthalmology, Otolaryngology (No plastic), Plastic (NOC), Pediatric Surgery, Oncology (Surgical), Thoracic Surgery, Urology Surgery, Vascular Surgery, Transplant, Podiatry. Poor patient rapport Communication among providers $28,878,241 19% Informed Consent $67,521,740 43% Communication Breakdowns Retained foreign body Unrecognized injuries (i.e. injury to spleen or bowel) Collateral damage to adjacent organs (i.e. dividing a ureter) $96,066,821 58% Technical Errors Total Incurred % of Cases*
    6. 6. Systems Problems in Surgery <ul><li>Persistent problems with supporting systems in and out of the OR </li></ul><ul><ul><li>wrong site of operation (i.e., wrong digit surgery persists) </li></ul></ul><ul><ul><li>inadequate communication between the consultant and the surgeon </li></ul></ul><ul><ul><li>handoffs </li></ul></ul><ul><ul><li>resident supervision </li></ul></ul>
    7. 7. Average Indemnity Payment for Surgeons <ul><li>Average indemnity paid per surgeon defendant: </li></ul><ul><li>$532,000 (on cases closed with payment) </li></ul>
    8. 8. Surgeons prevailed 71 percent of the time N=421 PL cases closed 1/1/02-9/30/07 with a responsible service of surgery. Surgery includes General Surgery, Neurosurgery, Orthopedic Surgery, Bariatric Surgery, Colorectal Surgery, Cardiac Surgery, Otorhinolaryngology (with Plastic), Hand Surgery, Ophthalmology, Otolaryngology (No plastic), Plastic (NOC), Pediatric Surgery, Oncology (Surgical), Thoracic Surgery, Urology Surgery, Vascular Surgery, Transplant, Podiatry.
    9. 9. 2007 Surgery Summit November 5, 2007 Liberty Hotel, Boston Seeking Practical Ways to Improve Patient Safety

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