2007 Surgery SummitNovember 5, 2007Liberty Hotel, Boston

Seeking Practical Ways to Improve Patient Safety

Jack Mc CarthyPresident, CRICO/RMF

Snapshot of CRICO Surgery-related Claims2002-2007

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

Surgeons Insured by CRICO

1,376 surgeons out of 10,400 physicians

Top specialties by number of insureds

General surgery – 381

Orthopedic surgery – 195

Ophthalmology – 153

Gynecology (surgery) – 121

ENT – 109

Urology – 66

Neurosurgery – 64

Plastic surgery – 57

Snapshot of CRICO Surgery-related Claims2002-2007

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

Top Issues in Surgery-related Claims2002-2007

% of Cases* Total Incurred

Technical Errors 58% $96,066,821Collateral damage to adjacent organs (i.e. dividing a ureter)

Retained foreign body

Unrecognized injuries (i.e. injury to spleen or bowel)

Communication Breakdowns 43% $67,521,740Informed Consent 19% $28,878,241

Communication among providers

Poor patient rapport

*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.

Systems Problems in Surgery

Persistent problems with supporting systems in and out of the OR

wrong site of operation (i.e., wrong digit surgery persists)

inadequate communication between the consultant and the surgeon

handoffs

resident supervision

Average Indemnity Payment for Surgeons

Average indemnity paid per surgeon defendant:

$532,000 (on cases closed with payment)

Surgeons prevailed 71 percent of the time

Dropped/Denied/Dismissed

56%Settled

27%

Plaintiff Verdict2%

Defense Verdict15%

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.

2007 Surgery SummitNovember 5, 2007Liberty Hotel, Boston

Seeking Practical Ways to Improve Patient Safety