Deconstructing Negligence: The Role of Individual and System Factors in Causing Medical Injuries
23 Pages Posted: 7 Jul 2007
Medical malpractice litigation and its doctrinal substructure are heavily oriented toward holding individuals, not health care organizations, liable for medical injuries. In contrast, the emerging science of patient safety emphasizes the role of "system failures" in causing injuries, rejecting simple characterizations of error as individual physicians' carelessness or incompetence. In this Article, we examine new evidence about the nature of the relationship between individual and system factors in the production of medical injury, and consider its salience for tort doctrine's conventional view of injury causation. The evidence comes from an analysis of 1,452 closed malpractice claims from five liability insurers across the country. We highlight three key findings. First, the causality of medical injuries is multifactorial and weblike. Second, in analyzing the complex causality that typifies medical injuries, it is difficult to cleanly separate individuals and their failures from the larger environments or systems in which they work. Finally, the pattern of etiologic factors identified suggests that the most promising opportunities for injury prevention lie at the organizational level. Each of these empirical findings is at odds with conceptions of medical error and safety promotion in tort law. The findings suggest the need to expand the possibilities for corporate or enterprise liability in medical malpractice law in order to successfully target the tort deterrent signal.
Keywords: malpractice, liability, medical, deterrence, patient safety
JEL Classification: I1, K13
Suggested Citation: Suggested Citation