Patient Safety and Medical Malpractice: A Case Study

  1. Troyen A. Brennan, MD, JD, MPH; and
  2. Michelle M. Mello, JD, PhD, MPhil*
  1. From the Harvard School of Public Health, Harvard Medical School, and Brigham and Women's Hospital, Boston, Massachusetts.

    Abstract

    The system of tort liability for medical malpractice is frequently criticized for poorly performing its theoretical functions of compensating injured patients, deterring negligence, and dispensing corrective justice. Working from an actual malpractice case involving serious injury but no apparent negligence, the authors explore these criticisms from the perspectives of both the plaintiff–patient and the defendant–physician. They then examine the tort system through the lens of patient safety and conclude that the tensions between the system and patient safety initiatives suggest a need to reexamine our attachment to adversarial dispute resolution in health care. They propose targeted reforms that could improve the functioning of the system and create incentives to improve safety and quality.

    For a list of questions and answers from the Quality Grand Rounds conference, see the Appendix.

    Article and Author Information

    • *This paper was prepared by Troyen A. Brennan, MD, JD, MPH, and Michelle M. Mello, JD, PhD, MPhil, for the Quality Grand Rounds series. Robert M. Wachter, MD, prepared the case for presentation. The case and discussion were presented at the University of California, San Francisco, on 4 December 2002.

    • Grant Support: Funding for the Quality Grand Rounds series is supported by the California Health Care Foundation as part of its Quality Initiative. The authors are supported by general institutional funds.

    • Potential Financial Conflicts of Interest: None disclosed.

    • Requests for Single Reprints: Troyen A. Brennan, MD, JD, MPH, Brigham and Women's Hospital, 75 Francis Street, PBB4, Boston, MA 02115.

    • Current Author Addresses: Dr. Brennan: Brigham and Women's Hospital, 75 Francis Street, PBB4, Boston, MA 02115.

    • Dr. Mello: Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115.

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    1. Ann Intern Med August 19, 2003 vol. 139 no. 4 267-273
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