Breast cancer accounts for more medical malpractice claims and lawsuits than any other disease or condition, and delayed diagnosis is the leading cause of the complaints, according to a new study.
When a delay in diagnosis results in malpractice action, hospitals are among the least likely to be sued, the study said. But the physicians most often sued are radiologists, one of two types of specialists most closely associated with hospitals.
Pathologists, the other specialists most likely to be hospital-based, aren't any more prone than the hospital to be on the paying end of a malpractice action. But when they are, the dollar amount of settlements imposed on them far exceeds those for any other type of provider, according to the study.
The Physician Insurers Association of America examined 487 claims and suits in which a delay in diagnosing breast cancer was at issue and the patient received a payment from a medical malpractice insurance company. The claims were drawn from more than 125,000 patient actions during the past 10 years.
The association said the study was conducted to determine causes of the actions and help physicians recognize the factors critical in diagnosing breast cancer in its early stages.
Among the findings and alerts:
More than 30% of the patients were younger than 40, and 60% were younger than 50, though the medical world considers younger women less likely to be candidates for the disease. Claims for women under 50 accounted for 71% of total payouts. The average payment was 50% higher than for claimants 50 and older.
Mammograms alone weren't the answer to cancer prevention. By definition, a lesion was present in all cases in the study, but mammogram results were reported as negative or "equivocal" in 80% of the cases. Such results were more frequent among women younger than 40, whose breasts are denser, making mammogram detection of lesions more difficult.
The most prevalent reason for delay in diagnosis attributable to physicians was the failure of a physician to be impressed by the physical findings. Failure to follow up with the patient in a timely fashion was the next most prevalent reason. Other principal factors were negative or misread mammograms.
Payments resulting from delayed diagnosis of breast cancer averaged $217,500. But pathologists, while culpable only 2% of the time, were responsible for an average payment of $345,500. Radiologists were involved in nearly 25% of all cases, for an average payment of $182,000, while hospitals figured in 2% of cases for $117,500 on average.
The status of radiologist as top defendant contrasts sharply with the association's 1990 study on breast cancer, in which radiologists were involved only 11% of the time. The average payment for radiologist defendants in the 1995 study was a decrease, however, from $203,000 in the 1990 study.
Obstetricians/gynecologists were the most prevalent class of defendant five years ago at 39%. They trailed radiologists slightly in the most recent study, at 23% of cases, but the average payment of $277,500 eclipsed radiologists' by 50%.