LAUSR

Introduction: The medical malpractice liability system aims to identify poorly performing providers and improve the quality and safety of health care by deterring negligence, but there is concern that the current system may not accomplish these objectives. We evaluated whether interventional cardiologists who previously lost or settled a malpractice lawsuit had higher risk-adjusted mortality rates (RAMR) for percutaneous coronary intervention (PCI) in New York State. Methods: We used the Physician Profile website to identify information on demographics as well as lost or settled malpractice lawsuits for interventional cardiologists in New York State between 2010 and 2016. Publicly reported data from the New York State Department of Health was used to determine RAMR for interventional cardiologists who performed PCIs between 2014 and 2016. We then fit a multivariable linear regression model to examine the association between a prior lost or settled malpractice lawsuit and RAMR among interventional cardiologists, adjusted for years in practice, domestic vs. foreign medical graduate, and case volume. Results: We identified 201 interventional cardiologists in New York State between 2014-2016, of whom 16 (8.0%) had lost or settled a malpractice lawsuit. Those with these prior malpractice lawsuits were more likely to be male (100%), domestic graduates (62.5%), spent more years on average [Standard Deviation] in clinical practice (28.8 [9.3] vs. 20.9 [11.2]), and had higher average case volumes (557.0 [290.1] vs. 386.0 [302.1]). After multivariable adjustment, interventional cardiologists with a prior lost or settled malpractice lawsuit had similar RAMRs than those without such a lawsuit (difference: -0.02%, 95% confidence interval -0.47% to +0.42%). Conclusions: We found no relationship between having lost or settled a prior malpractice lawsuit and PCI mortality rates among interventional cardiologists in New York State. These findings raise the possibility that prior malpractice claims do not reliably identify poor-performing providers.