Lessons Learned from the IHS and Tribal Health Care
Medical Malpractice Tort Claim Experience
The Indian Health Service (IHS) Risk Management Program (RMP) is responsible for coordinating the clinical peer reviews of all medical malpractice tort claims filed against the Federal government that involve care provided at facilities directly operated by the IHS or by a tribe carrying out contracts, grants, or cooperative agreements pursuant to Public Law 93–638, the Indian Self-Determination and Education Assistance Act. Since the mid-1980s, the IHS-RMP has maintained a database of information on all tort claims that it has processed; by the end of fiscal year (FY) 2006, data had been accumulated on over 1,440 cases. Although analyses of portions of the data have been accomplished in the past, former reviews focused primarily on claim volume, regional incidence, and outcome information. This article is based on an assessment of our agency’s 20-year experience of processing medical malpractice tort claims, with the intent to identify what types of care and adverse outcomes most commonly give rise to allegations of medical malpractice, and from where within the network of IHS- and tribally-operated facilities do the majority of these tort claims arise. Finally, the authors of this article will share their experience with respect to the recurring risk management issues that have been identified during the reviews of these medical malpractice allegations.
Although it is not uncommon for individuals to file multiple claims with respect to one incident of alleged malpractice, the focus of the RMP database and this review reflect the number of incidents (cases), rather than the number of total claims filed. This is an important distinction, because it is the incident itself that deserves the scrutiny of a risk management program; the number of claims filed by various parties affected by an alleged malpractice incident is a poor indicator of the merits of the case in question. It is also important to note that this review includes all alleged cases of medical malpractice during the 20-period, even though many of the claims were determined to have little or no merit after careful and considered review. All of the recorded tort claims were included because often significant risk management issues can also be uncovered from cases where the accusations of improper care were shown to be invalid during the medical review process.
Heath SW, Hooper EY. Lessons Learned from the IHS and Tribal Health Care Medical Malpractice Tort Claim Experience. The IHS Primary Care Provider. June 2008;33(6) [PDF - 4.3 MB].