Professional liability of residents in a children's hospital

Objective: To evaluate the risk of professional liability to house staff within a pediatric hospital setting. Methods: A retrospective study describing the patients, allegations, areas within the hospital where complaints originated, and outcome of all malpractice suits involving residents from 1968 through 1992 at a large pediatric teaching hospital. Results: There were 49 malpractice cases involving residents with or without attending physicians from 886 000 hospital admissions or emergency department visits over the past 20 years (5.5/100 000 patient encounters) compared with 185 malpractice cases involving attending physicians alone at the hospital (20.5/100 000 patient encounters). The incidence of cases originating from the emergency department was 1.8/100 000 compared with 13.9/100 000 from all other areas of the hospital combined. Fifty-two percent of patients had preexisting chronic medical problems. Forty-nine percent of cases were settled out of court, 2% went to trial with a decision in favor of the plaintiff, 22% were dismissed, and 27% of cases remained open as of June 1993. The mean award on behalf of patients from 1968 through 1979 was $580 000 per case with a median payment of $163 000. The mean award from 1980 through 1992 was $760 000 per case with a median payment of $275 000. Conclusions: Malpractice risk is a serious concern for residents and a financial liability for hospitals. Resident physicians in a pediatric teaching hospital were named in 26% of malpractice cases. Most cases were settled or were dismissed and did not go to trial. Risk management training during residency may reduce resident involvement, and by extension, the teaching institution's involvement in malpractice litigation.