Professional Liability in a Pediatric Emergency Department

Abstract

The risk of professional liability resulting from care given in the pediatric emergency department is a growing concern. This retrospective study examined the patients, diagnoses, and outcome of all threatened and actual claims that originated in the emergency department of a pediatric teaching hospital from 1977 through 1988. Twenty-five cases were identified by the hospital risk manager from approximately 320 000 visits (8.0 cases/100 000 visits); 22 charts were available for review. Ages of the patients ranged from 2 weeks to 13 years (mean 2.9 years, median 3.0 years). The patients' payment status was private insurance (n = 10), state public aid (n = 5), and no third-party payment source was listed for 7 children. Ten patients (46%) visited the emergency department between midnight and 8:00 AM, when an attending physician was not present. Return visits within 2 weeks for the same complaint occurred in 10 cases. The majority of the patients were discharged home (n = 18), and all of them had appropriate, adequately documented discharge instructions. The final diagnoses fell into four general categories: minor trauma/abuse (n = 7), neoplasms/chronic illnesses (n = 7), infectious diseases (n = 6), and appendicitis (n = 2). Review of the charts before knowledge of the legal outcome raised quality-of-care issues in 41% of the cases (n = 9). The legal claims were categorized as failure to diagnose (n = 16) and inappropriate treatment (n = 6). No claims went to trial, 12 were dropped by the family, 5 patients received some payment, 3 claims were unfounded, and 2 cases remain open. Legal fees incurred in 16 cases over the 10-year period totaled $191 677, and the total payment to families was $43 850. Conclusions: (1) malpractice claims were uncommon in the emergency department studied; (2) a disproportionate number of claims occurred when an attending physician was not in the emergency department; (3) no one specific diagnosis was overrepresented in the majority of claims; (4) visiting the emergency department more than once for the same complaint increased the risk of professional liability; and (5) the cost of the associated legal fees was more than four times the money paid to families.