variation in average medical malpractice payment (per physician claim) using NPDB data for the years 2001-2003. For those years, the U.S. average payment was $276,235 (based on NPDB data), but that payment ranged from a low of $121,313 for the state of Michigan to a high of $483,319 for the state of Connecticut. 21 Source: Author calculations using data from the National Practitioner Data Bank (NPDB), Public Use Data File NPDB0412, accessed May 2005, http://www.npdb-hipdb.com/PUBLICDATA.HTML. Different states have also had significantly different experiences with medical malpractice costs over time. Some states have experienced relatively modest growth, even in recent years, while others have faced rapidly escalating average and total medical malpractice payments. Figures 6 and 7 illustrate the experience of selected states. Figure 6 focuses on the experience of several high (total) expenditure states (California, Florida, Illinois, New Jersey, and Texas) between 1999 and 2003. While all five states saw increases in their malpractice costs, there are striking differences between the experiences of Florida (66% increase between 1999 and 2003 but relatively stable in the early 2000s), New Jersey (47% increase with highly volatile year-to-year changes), and California (11% increase and reasonably stable over the time period). Malpractice and Radiologists in Cook County, IL: Trends in 20 Years of Litigation ;*;bit7 g Leonard Berlin1 OBJECTIVE. The purpose of this article is to report the prevalence and nature of Jonathan W. Berlin2 malpractice litigation involving radiology over a 20-year period and to identify trends among types of lawsuits filed. By recognizing where medicolegal risks lie in radiology, risk-management processes can be developed to minimize malpractice exposure and to improve patient care. MATERIALS AND METHODS. We conducted a retrospective study of all malpractice lawsuits (18,860) filed against physicians in the greater Chicago area between Januany 1 , 1975, and December 31 , 1994. About twelve percent (221 9) involved radiologic procedures or radiologists. These lawsuits were divided into six groups: slip-and-fall, radiation oncology, failure to order a radiologic examination, complications, missed diagnoses, and miscellaneous. The yearly percentage of each category relative to the total number of radiology-related suits was determined, and then each group was furthen divided by specific diagnosis or incident. RESULTS. Along with all medical malpractice lawsuits, radiology-related suits rose dramatically until 1985, when there was a marked but temporary decline caused by tort reform measures enacted in Illinois. Since then, lawsuits have resumed their annual upward climb, although the overall percentage related to radiology has remained relatively constant (1 0-1 5%). The relative number of radiology-related lawsuits in specific categories has changed over the past two decades: the percentages of slip-and-fall, radiation oncology, and miscellaneous cases have decreased, but percentages for the remaining three groups have increased. Lawsuits related to missed diagnoses, which account for the largest category of radiology-related cases, have increased from 34% to 47% of the total. The greatest increase in this category is for breast cancer. Lawsuits claiming injury from complications, the largest subgroup of which is angiography, have grown slightly, but cases alleging failure to order a radiologic examination have shown the greatest percentage increase in the 20-year period, growing from 20% in 1975-1979 to 30% in 1990-1994. This rise is attributed to the greater number of claims involving mammography, CT, MR imaging, and angiography. The growth in failure-to-order lawsuits will have important ramifications as managed care and health reform proposals attempt to limit use of radiologic services. CONCLUSIONS. Notwithstanding the fact that tort reform measures in Illinois decreased the frequency of malpractice litigation temporarily in 1 985 and will likely do so again in 1995, medical malpractice is likely to continue to plague radiologists unabatedly for many years to come. Received April 20, 1995; accepted after revision AJR 1995;165:781-788 May31, 1995. Presented at the 95th annual meeting of the The specter of malpractice litigation has unrelentingly influenced every facet of radioAmerican Roentgen Ray Society, Washington, DC, April 30-May 5, 1995. logic practice for more than two decades. Although the radiologic literature covering the 1 Rush North Shore Medical Center, 9600 Gross general topic of professional liability is abundant, few reports comprehensively docuPoint Ad., Skokie, IL 60076. Address correspon- ment and analyze each malpractice lawsuit involving radiology filed in a specific geodence to L. Berlin. graphic location and time frame. The purpose of this study, which was an outgrowth and 2Department of Radiology, Northwestern Me- expansion of earlier studies published in 1980 [1] and 1986 [2], was to determine the monial Hospital, 710 N. Fairbanks Ct., Chicago, IL , , , . . 60611. prevalence and nature of nadiologic malpractice in the large metropolitan area of Chi0361-803X/95/1654-781 cago over a 20-year period by categorizing the various allegations of wrongdoing levied © American Roentgen Ray Society against physicians involved in radiology and then to identify trends according to type. Downloaded from www.ajronline.org by 2600:1700:3c30:a3d0:f906:a606:b80b:7d98 on 07/20/22 from IP address 2600:1700:3c30:a3d0:f906:a606:b80b:7d98. Copyright ARRS. For personal use only; all rights reserved 782 BERLIN AND BERLIN AJR:165, October 1995 The study led to a recognition of where medicolegal risks lie in radiology, so that risk-management processes can be developed to minimize malpractice exposure and to improve patient cane. Materials and Methods All medical malpractice lawsuits filed in Cook County, IL, a geographic area including Chicago and its immediate suburbs, are listed in a publication entitled the Cook County Jury Verdict Reporter. The population of Cook County is about 6 million and is served by approximately 11 000 physicians, nearly 600 of whom are radiologists. Included in the area are five medical schools and more than 50 hospitals. All issues of the Verdict Reporter published between January 1, 1975, and December 31 , 1994, were reviewed, and every lawsuit naming a