WASHINGTON -- A new study of medical malpractice case finds that, contrary to popular belief, unjustified payments are rare.
The study, published yesterday in Annals of Internal Medicine, says that doctors' care was, in fact, substandard in most cases in which patients won payment for injuries.
Conversely, the study says, "physicians usually win cases in which physician care was deemed to meet community standards."
In concluding that unjustified payments are not common, the study contradicts the conventional wisdom among doctors, which holds that malpractice litigation is a lottery and that verdicts often depend on the whims of jurors.
The study suggests that doctors' perceptions of the malpractice problem are worse than the reality. President Bush contends that "crazy lawsuits" against doctors and hospitals are a major factor contributing to the explosive growth in the cost of health care. Mr. Bush has proposed legislation to curb malpractice lawsuits and to limit damage payments.
The study is one of the first systematic attempts to assess the quality of care in malpractice cases. It is based on 8,231 cases filed in New Jersey over the past 15 years.
In New Jersey, as in other states, most payments result from settlements negotiated by lawyers for patients and for insurance companies. Juries found in favor of doctors in 76 percent of the 976 cases where there was a jury verdict.
The data were drawn from the state's doctor-owned insurance company, the biggest insurer of doctors in New Jersey. But the authors said their findings were relevant to the nation as a whole.
"The physicians studied in New Jersey are comparable to doctors in the rest of the nation," said the chief author of the report, Dr. Mark I. Taragin, an assistant professor at the University of Medicine and Dentistry of New Jersey, in Piscataway. "The results of this study are likely to apply to the United States as a whole.
The frequency and amount of payments here are similar to those reported in previous national studies."
When Dr. Taragin reported his findings to state legislators in a symposium Wednesday at the University of Medicine and Dentistry, State Sen. Jack G. Sinagra, a Republican from East Brunswick, said: "All the legislators were surprised. One would think a medical school and a doctor giving a session on tort reform would have a predisposed bias against attorneys, but Dr. Taragin did not."
In each New Jersey case, the doctor's performance was classified as defensible or indefensible, based on evaluations by the doctor-owned insurance company. If the company had any bias, it would tend to favor the doctors and to label their care as acceptable. But in almost half the cases where care was considered indefensible, the doctors themselves admitted error.
Dr. Taragin said: "The current system often comes to the right decision about whether a payment should be made in medical malpractice cases. And the amount of payment correlated closely with the severity of injury. People with more severe injuries generally received higher payments."
The doctors' actions were considered defensible in 5,132 of the 8,231 malpractice cases examined in New Jersey. Care was considered indefensible in 2,000 cases because it fell below the standard set by doctors of similar training and experience.
In the remaining 1,099 cases, the experts were unsure whether the care was adequate. Patients won payments in 3,514 cases. The doctors' actions were judged indefensible in 1,813 of these cases and defensible in 1,054, while the quality of care was unclear in 647 cases. A payment was made in 91 percent of cases where the doctor's conduct was considered substandard, and in 21 percent of cases where the doctor's care was considered defensible.
But the authors suggest that payments were actually appropriate in most of the "defensible cases" because the doctors made some errors that were not apparent at first.