Pediatric Medicolegal Education in the 21st Century

The most recent medical malpractice crisis affecting the nation has underscored the need for improved medicolegal education for pediatric practitioners at all levels of training and experience. Besides issues related to malpractice, the increase in enforcement of state and federal regulatory laws,1 regulations relating to hospital privileges and employment contracts,2 and an evolving and widening oversight by state licensing boards3 has escalated an imperative to expand on current educational efforts. Pediatric educators must support the notion that a sound foundation in medicolegal issues, along with continuing education in these areas, will be as integral to a successful practitioner as is competence in medical diagnosis and management. A solid basis in medicolegal principles is not simply self-serving for the practitioner to reduce the risk of a lawsuit, but good risk management can contribute to improved patient safety and quality of care.4 Each of the periodic surveys on medical liability completed since 1987 by fellows of the American Academy of Pediatrics (AAP) has found that 30% of pediatricians will be sued during their careers, with an average of 1.7 lawsuits per pediatrician.5 Ten percent of pediatricians reported being sued as interns/residents, which can have ramifications for future managed care and hospital credentialing because of the mandatory reporting to the National Practitioner Data Bank. At the end of 2004, there were payment reports in the National Practitioner Data Bank for 1669 allopathic/osteopathic interns and residents.6 Although pediatricians are not sued as frequently as other physicians, they had the fourth highest average malpractice indemnity payout of 28 specialties (behind neurology, neurosurgery, and obstetrics-gynecology) among claims closed in 2004. This payout was 43% higher than the overall average indemnity paid for all physician specialties.7 Despite many malpractice suits being dropped before settlement or trial, the dramatic increase in … Address correspondence to Gary N. McAbee, DO, JD, FAAP, Pediatrics (Neurology), Robert Wood Johnson School of Medicine, 3 Cooper Plaza, Suite 309, Camden, NJ 08103. E-mail: mcabee-gary{at}cooperhealth.edu