1 The medical liability environment in San Juan: results of the 2008 survey.
Subject: Cirujanos (Investigacion cientifica)
Cirujanos (Evaluacion)
Encuestas (Historia)
Encuestas (Analisis de casos)
Pub Date: 06/01/2009
Publication: Name: Puerto Rico Health Sciences Journal Publisher: Universidad de Puerto Rico, Recinto de Ciencias Medicas Language: Spanish Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2009 Universidad de Puerto Rico, Recinto de Ciencias Medicas ISSN: 0738-0658
Issue: Date: June, 2009 Source Volume: 28 Source Issue: 2
Geographic: Geographic Name: Puerto Rico
Accession Number: 201212350
Full Text: 1 The Medical Liability Environment in San Juan: Results of the 2008 Survey. Norma I. Cruz MD; District of San Juan, Puerto Rico College of Physicians and Surgeons

Introduction: Puerto Rico has a rate of 5.6 malpractice award payments per 100,000 people, while the average across the United States is 2.4 per 100,000 *. A survey was performed to evaluate the effect that this high rate of malpractice claims has had in our community. The survey was sponsored by the District of San Juan of the Puerto Rico College of Physicians and Surgeons. Method: In August 2008 a questionnaire consisting of 15 items which evaluated medical liability was mailed to all physicians in the San Juan District. The questionnaire requested information on basic demographics, medical specialty, insurance company used, annual premium paid, umbrella coverage, changes made in medical practices to decrease medical liability risk, malpractice claims received during the last ten years, and whether awards exceeding insurance coverage were paid. Physicians were requested to return the completed questionnaires by FAX or mail to the main office of the Puerto Rico College of Physicians and Surgeons. All information received was analyzed using the computerized statistical program SPSS (Statistical Package for the Social Sciences). Results: There were 951 completed questionnaires returned. Since we successfully mailed the questionnaire to 3,148 physicians, we estimated that 30% of the group participated in the survey. The mean age of the responders was 53 [+ or -] 12 and 74% were males. The mean time in practice was 22 years and 87% were specialists. The main professional liability insurance carrier was SIMED (76%) followed by Triple S (13%). Umbrella coverage, in addition to basic liability insurance, was carried by only 8% of the responders. Changes in their medical practices to decrease medical liability risk had been made by 70% of the physicians. Currently, 48% of physicians do not accept emergency cases and 50% do not accept high risk patients. If we add the responders that indicated they plan to "close their office", "leave Puerto Rico", or "retire", it appears that Puerto Rico would lose 57% of its medical manpower. Malpractice claims were received at least once in the previous ten years by 40% of the physicians. If the high risk specialties were independently analyzed, the survey found that 64% of surgeons, 63% of orthopedists and 57% of obstetric/gynecology specialists received malpractice claims during the study period. The awards requested by these claims exceeded the insurance coverage 75% of the time. After the final court decision was reached, 20% of the payments exceeded physicians' insurance coverage. Conclusion: The adverse medical liability environment has affected the majority of physicians in San Juan, leading 70% of them to make changes in their practices to decrease the liability risk. As a result of these changes, the number of physicians willing to care for high risk and emergency patients has decreased significantly. The survey indicated that 40% of physicians received malpractice claims within the study period and the awards exceeded the physicians' insurance coverage 20% of the time.

* The National Report Card on the State of Emergency Medicine 2009: Evaluating the Emergency Care Environment State by State. American College of Emergency Physicians. Available at: URL: http:// www.emreportcard.org.
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