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Surprising findings in analysis of 10 years of medical claims, litigation

Surprising findings in analysis of 10 years of medical claims, litigation

AUSTIN, Texas — Patient falls at medical facilities, allied health care providers and history repeating itself were three surprise findings in analyzing the causes of medical claims and litigation over a 10-year period, executives at Sedgwick Claims Management Services Inc. said Monday.

In the analysis of Sedgwick's more than 96,000 incidents, claims and lawsuits that resulted in $6.3 billion paid for indemnity and allocated loss adjustment expenses from 2003-2013, Ann D. Gaffey, a consultant at Sedgwick, said she was “quite surprised” when falls at medical facilities turned out to be the No. 1 cause of claims.

Ms. Gaffey told a session of the American Society for Healthcare Risk Management's annual conference in Austin, Texas, that, at an average cost of $47,000 per claim, education of all health care workers on often common-sense ways to avoid falls is one way to reduce the exposure.

She also advised building a team to triage every fall in a medical facility to make sure of quick, appropriate testing and treatment to avoid a seemingly minor incident from becoming deadly.

“This is really an opportunity to snag 100% of the low-hanging fruit,” Ms. Gaffey told attendees during the session.

Jayme D. Vaccaro, director of professional liability claims at Sedgwick, said another “aha moment” in the analysis of claims over the 10-year period is that “allied health providers,” such as nurse practitioners and physician assistants, often are involved in care decisions or lack of appropriate action that lead to claims involving neurological damage to patients.


Health care organizations should closely examine the supervision provided by doctors and anesthesiologists to allied health care providers, she said. Allied health care providers are at times targeted by plaintiff lawyers, Ms. Vaccaro said.

Both women said the analysis also found that “history is repeating itself over and over again” when it comes to emergency cesarean sections that can cause damage to the mother or the child.

Aside from building a solid team and training the team members, including doctors, on the many aspects that can accompany an emergency cesarean section, Ms. Gaffey said one essential element when trying to avoid or mitigate a potential lawsuit is to submit the placenta from a childbirth for a pathological examination that will provide information on the conditions before and during the birth.

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