Top 3 Reasons for Medical Malpractice Lawsuits in the US
The three most common reasons for medical malpractice lawsuits in the United States are: (1) failure to diagnose, (2) failure to treat, and (3) medication errors/treatment complications.
1. Failure to Diagnose
Diagnostic errors represent the leading cause of serious malpractice claims, with misdiagnosis accounting for the majority of high-severity harm cases. 1
Vascular events (particularly stroke), infections (especially sepsis), and cancers collectively account for 74.1% of all high-severity diagnostic error cases, with these "Big Three" disease categories dominating malpractice litigation. 1
In acute stroke management specifically, failure to diagnose was the most common allegation in malpractice lawsuits, with 36% of cases involving patients who were discharged from the hospital or not admitted, only to be subsequently discovered to have suffered a stroke. 2
Clinical judgment factors were responsible for 85.7% of diagnostic errors across all disease categories, indicating that cognitive failures rather than system issues drive most diagnostic malpractice claims. 1
The historical shift is notable: malpractice allegations changed from errors of commission (doing something wrong) to errors of omission (failing to diagnose) beginning in the mid-20th century, with this trend accelerating geometrically from the 1960s onward. 3
2. Failure to Treat
Failure to provide timely or appropriate treatment represents the second major category of malpractice litigation, often occurring in conjunction with diagnostic failures. 2
In stroke care, 71 cases specifically alleged failure to treat with tPA (tissue-type plasminogen activator), making this one of the most frequent treatment-related allegations. 2
Failure to timely transfer patients to another hospital was associated with a payout rate exceeding 60%, making it one of the allegations most likely to result in financial liability. 2
Seven cases alleged failure to treat or timely treat with thrombectomy for large vessel occlusion, and this number is anticipated to increase substantially given recent changes in practice guidelines demonstrating strong treatment effects. 2
Procedural errors were alleged in 72% of arthroplasty malpractice cases, while post-surgical errors were cited in 32%, demonstrating that treatment failures extend beyond the immediate procedure. 4
3. Medication Errors and Treatment Complications
Medication errors and complications from medical treatment constitute the third major category, with particularly high rates in pediatric and procedural settings. 2
In pediatric ambulatory care, 37% of reported medical errors were attributed to medical treatment, with 85% of these being medication errors. 2
Among medication errors in pediatric settings, 55% were related to ordering, 30% to failure to order, 11% to administration, and smaller percentages to transcribing and dispensing. 2
In total joint arthroplasty, infection was the leading cause of malpractice litigation (22% overall, 33% for knee replacements), followed by nerve injury (20% overall, 38% for hip replacements). 4
In thyroid surgery, recurrent laryngeal nerve injury has become one of the most frequent causes of surgical malpractice claims, with about 50% of closed malpractice claims involving RLN damage and median jury awards of $974,625. 2
Financial and Outcome Considerations
The financial stakes in malpractice litigation are substantial, with significant variation based on case severity and whether cases settle or proceed to trial. 2
The average payout for settlements was $1,802,693, while the average payout for plaintiff verdicts was $9,705,099 in stroke-related cases. 2
Overall, 56% of cases resulted in no payout (defense verdict), 27% were settled out of court, and 17% went to trial resulting in plaintiff verdicts. 2
Of cases that proceeded to jury trial, 76% resulted in defense verdicts and 24% in plaintiff verdicts, suggesting that many claims lack sufficient merit but still impose substantial defensive costs. 2
Critical Pitfalls to Avoid
Telephone consultations carry malpractice risk: Five cases involved physicians named as defendants solely for advice given over the phone, including failures to interpret stroke symptoms or provide appropriate guidance. 2
Documentation is crucial: Cases involving failure to obtain informed consent were more commonly defended (≤40% payout rate), emphasizing the protective value of proper documentation. 2
Specialty involvement matters: Having a neurologist named as a defendant was associated with more favorable outcomes (63% defense verdicts), likely reflecting appropriate specialist involvement. 2
Post-procedural strokes are high-risk: 14.7% of stroke cases occurred after surgical procedures (carotid endarterectomy, obstetric delivery, cardiac catheterization), requiring heightened vigilance in these settings. 2