Medical Professional Liability Insurance Closed Claim Annual Report

2012Oklahoma Insurance Department

Five Corporate Plaza3625 NW 56th, Suite 100Oklahoma City, Ok 73112

1.800.522.0071www.oid.ok.gov

JANUARY 1, 2012 – DECEMBER 31, 2012

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The Oklahoma Insurance Department (OID) presents composite data of medical professional liability closed-claim reports for 2012.

The OID publishes this report pursuant to Title 36, Section 6813 of the Oklahoma Statutes. This report contains aggregate numbers from statewide closed-claims data. Information about specific closed claims is confidential pursuant to Title 36, Section 6816 and is unavailable for public inspection.

The OID has established procedures to collect these claim reports and produce this final composite report. However, the closed-claim reports submitted to the Insurance Department are completed without any type of affirmation of data accuracy supplied by the insurance company. The OID makes neither final nor absolute guarantee about the information contained in this report. This information should not be viewed as a substitute for any type of financial or actuarial opinion about a reporting insurer’s claims activities.

The OID collects unedited data from reporting insurers and presents the final aggregate numbers in this annual report. The Oklahoma Insurance Department continues to work with the Oklahoma Legislature and others at the state capitol to more accurately define the statutory requirements and enhance data collection and its understanding.

Questions applicable to this report should be directed to:

Denise M. Engle, CPCU, CIIP, AICDeputy Commissioner of Workers’ CompensationRate and Form Compliance DivisionLicensing and Education DivisionDenise.Engle@oid.ok.gov

Five Corporate Plaza3625 NW 56th, Suite 100Oklahoma City, OK 73112-45111-800-522-0071

OKLAHOMA INSURANCE DEPARTMENTMEDICAL PROFESSIONAL LIABILITY INSURANCECLOSED CLAIM ANNUAL REPORTJANUARY 1, 2012 – DECEMBER 31, 2012

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INSURANCE CLOSED CLAIM ANNUAL REPORT 2012

The policy limits of the medical professional liability insurance policy covering the claim:Annual policy limits, primary coverage.

The policy limits of the medical professional liability insurance policy covering the claim: Per occurrence policy limits, primary coverage.

Insurance Policy Limits Closed Claim Count25,000 3100,000 6125,000 1200,000 2250,000 9500,000 181,000,000 5402,000,000 493,000,000 85,000,000 599,000,000 110,000,000 5Unknown/unreported 1

Insurance Policy Limits Closed Claim Count25,000 3300,000 5500,000 2600,000 21,000,000 481,500,000 12,000,000 93,000,000 4934,000,000 345,000,000 146,000,000 4110,000,000 111,000,000 112,000,000 3Unknown/unreported 45

Medical Specialty Providers CountChiropractor 7Counselor-Mental Health 1Professional counselor 1Professional counselor-family/marriage 1Dentist 76Dental hygienist 1EMT Paramedic 1Registered Nurse 12Nurse anesthetist 3Nurse practitioner 7Licensed practical 4Certified nurse aide/assistant 1Home health aide 4Pharmacist 18Physician (MD) 254Physician inter/resident (MD) 1Osteopathic Physician (DO) 75Physician assistant allopathic 3Podiatrist 8Psychologist 1Massage therapist 1Physical therapist 4Medical technologist 1Other health care practitioner-not classified 1

Hospital administrator 1Not an Individual Defendant 209Unknown 6

The medical occupation/field of the provider who was primarily responsible for the medical malpractice incident that led to the claim.

The most relevant specialty of the provider who was primarily responsible for the medical malpractice incident that led to the claim.

Medical Occupation/Field Providers Count Anesthesiology 13 Cardiovascular diseases 23 Dermatology 5 Emergency medicine 47 Forensic pathology 3 Gastroenterology 8 General / Family Practice 48 General preventive medicine 1 Hospitalist 14

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The most relevant specialty of the provider who was primarily responsible for the medical malpractice incident that led to the claim.

Internal medicine 27 Neurology 2 Obstetrics & Gynecology 31 Ophthalmology 6 Otolaryngology 1 Pediatrics 6 Psychiatry 2 Public health 14 Physical medicine & rehabilitation 8 Radiology 24 Radiation oncology 3 Colon and rectal surgery 5 General surgery 33 Neurological surgery 8 Orthopedic surgery 29 Plastic surgery 12 Thoracic surgery 5 Urological surgery 10 Other specialty, Unspecified, Unknown 237 General dentistry (no specialty) 35 Pediatric Dentistry 42

Type of Health Care Facility Closed Claim CountChiropractic Group / Practice 7Dental Group / Practice 77Optician / Optometric Group / Practice 1Podiatric Group / Practice 3Medical Group / Practice 63Mental health / Substance Abuse Group / Practice 2Home Health Agency / Organization 3General/Acute Care Hospital 411Rehabilitation Hospital 6Federal Hospital 1Rehabilitation Unit 1Nursing Facility/Skilled Nursing Facility 21Adult Day Care Facility 1Intermediate Care Facility for Mentally Retarded/Substance Abuse/ Hospice / Hospice Care Provider 3

The type of health care facility where the medical malpractice incident occurred.

Location within Facility Closed Claim CountCatheterization lab 5Critical care unit 7Dispensary 1Emergency department 83Labor and delivery room 13Laboratory 6Nursery 2Operating room 179Outpatient department 9Patient room 101Pharmacy 1Physical therapy department 5Radiation therapy department 1Radiology department 13Recovery room 6Rehabilitation center 1Special procedure room 21Clinical support center - such as a laboratory or radiology center 4

Office 125Walk-in clinic 12Other department in hospital 19Other/Unknown 88

Outpatient Rehabilitation Center/Comprehensive Outpatient Rehabilitation Center 8

Ambulatory Surgical Center 29Ambulatory Clinic/Center 12Health Center/Federally Qualified Health Center/Community Health Center 2

Mental Health Center/Community Mental Health Center 2

Rural Health Clinic 2Radiology/Imaging Center 2Pharmacy 18Organ Procurement Organization 1Nursing/Health Care Staffing Service 5Other not specified 21

The primary location within a facility where the medical malpractice incident occurred.

Medical Occupation/Field Providers Count

INSURANCE CLOSED CLAIM ANNUAL REPORT 2012continued from page 3

Type of Health Care Facility Closed Claim Count

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City Closed Claim Count

Ada 7Altus 8Alva 2Arapaho 1Ardmore 12Atoka 2Bartlesville 7Bethany 2Blackwell 5Broken Arrow 8Bryan 1Carnegie 1Checotah 2Chickasha 3Claremore 6Colbert 2Cushing 2Drumright 1Duncan 6Durant 5Edmond 12El Reno 3Elk City 2Enid 7Eufaula 1Fairview 1Glenpool 2Grove 1Guthrie 6Guymon 3Hobart 2Holdenville 4Hugo 5Idabel 6Inola 1Kingfisher 3Lawton 37Mannford 1

City Closed Claim Count

McAlester 13McLoud 1Midwest City 18Moore 3Muskogee 21Norman 19Nowata 3Okemah 1Oklahoma City 190Okmulgee 1Owasso 9Pauls Valley 7Pawhuska 1Perkins 1Ponca City 5Poteau 3Sallisaw 1Sapulpa 1Seminole 3Shawnee 19Stigler 1Stillwater 8Stroud 2Sulphur 1Tahlequah 6Tishomingo 3Tulsa 165Tuttle 1Unknown/Un-reported 5

Vinita 1Warner 1Warr Acres 1Wayne 1Weatherford 1Wilburton 1Woodward 1Yukon 3

The geographic location, by city, where the medical malpractice incident occurred.

County Closed Claim Count

Atoka 2Beckham 3Bryan 8Caddo 1Canadian 4Carter 12Cherokee 6Choctaw 5Cleveland 29Comanche 37Craig 1Creek 5Custer 2Garfield 7Garvin 7Grady 4Haskell 1Hughes 4Jackson 8Johnson 3Kay 9Kingfisher 3Kiowa 1Latimer 1Leflore 3Lincoln 1Logan 6Major 1

The geographic location, by county, where the medical malpractice incident occurred.

County Closed Claim Count

McClain 1McCurtain 6McIntosh 3Murray 1Muskogee 21Nowata 3Okfuskee 1Oklahoma 220Okmulgee 2Osage 2Payne 11Pittsburg 15Pontotoc 6Pottawatomie 19Rogers 11Seminole 3Sequoyah 1Stephens 6Texas 3Tulsa 180Unknown 4Washington 6Woods 2Woodward 1

The sex of the injured person on the incident date.

Male44%

Female56%

Female - 393

Male - 309

INSURANCE CLOSED CLAIM ANNUAL REPORT 2012

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The age of the injured person on the incident date.

Perc

enta

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f Cla

ims

Age of injured personunknown less than 1 1-18 19-29 30-39 40-49 50-59 60-69 70-79 80+

0

5

10

15

20

Settlement information that identifies the final method of claim disposition.

Age How many PercentageUnknown 73 10.4less than 1 13 1.91-18 74 10.519-29 38 5.430-39 79 11.3

Age How many Percentage40-49 115 16.450-59 111 15.860-69 99 14.170-79 63 980+ 37 5.3

NPDB code Type of Injury Count1 Emotional injury 622 Insignificant 523 Minor 1314 Major 61

NPDB code Type of Injury Count5 Minor 426 Significant 407 Major 498 Grave 99 Death 189

Unknown 67

The severity of malpractice injury using the National Practitioner Data Bank severity scale.

Temporary Permanent

Method of claim disposition Closed Claim CountClaim is abandoned by the claimant . 333Claim is settled by the parties. 156Directed verdict for the defendant 6Involuntary dismissal 81Judgment for the defendant 24Judgment for the plaintiff 1

Method of claim disposition Closed Claim CountJudgment notwithstanding verdict for the plaintiff (judgment for the defendant) 4

Mediation 85Other type of alternative dispute resolution process 11

Unknown 1

INSURANCE CLOSED CLAIM ANNUAL REPORT 2012

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Timing of Claim deposition Closed Claim CountBefore filing suit or requesting arbitration or a mediation hearing 158

Before trial, arbitration or mediation 398During trial, arbitration or mediation 135After trial or hearing, but before judgment or award 3

After judgment or decision, but before appeal 5

After an appeal 1During review panel or non-binding arbitration 1

Unknown 1

Settlement information that identifies the timing of claim disposition

Reason Closed Claim CountDiagnosis related 136Anesthesia related 8Surgery Related 118Medication Related 55IV & Blood Products Related 3Obstetrics related 13Treatment related 240Monitoring related 34Equipment / Product Related 19Other / Miscellaneous 68Behavioral Health 4Unknown/Unreported 4

The reason for the medical professional liability claim, allegation group

Specific information about the indemnity payments and defense and cost-containment expenses for claims disposed of by a court THAT RESULT in a verdict or judgment that itemizes damages.

The indemnity payment made on behalf of the defendant $1,208,00

Economic damages $60,000Noneconomic damages $750,000Punitive damages, if applicable $0 Total Defense and Cost Containment Expense $1,182,311

Specific information about the indemnity payments and defense and cost-containment expenses for claims that DO NOT result in a verdict or judgment that itemizes damages.

The total amount of the settlement on behalf of the defendant $37,927,732

The insuring entity’s or self-insurer’s best estimate of economic damages included in the settlement

$4,491,849

The insuring entity’s or self-insurer’s best estimate of noneconomic damages included in the settlement

$28,864,161

Total Defense and Cost Containment Expense $23,412,457

DiagnosisRelated

Anesthesia RelatedSurgeryRelated

MedicationRelated

IV& Blood Products Related

ObstetricsRelated

TreatmentRelated

MonitoringRelated

Equipment/Product Related

Other/Miscellaneous

BehavioralHealth

Unknown

Reasonfor Claims

Number of Claims0 50 100 150 200 250

INSURANCE CLOSED CLAIM ANNUAL REPORT 2012

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*2012 Supplemental Information

*This supplemental information is provided as a courtesy by the Oklahoma Insurance Department to supplement your Medical Professional Liability Insurance Closed Claim Annual Report and is not required to be furnished by statute.

The reason for the medical professional liability claim, specific allegation.

NPDB code Reason

Closed Claim Count

100 Failure to use aseptic technique 2101 Failure to diagnose 54102 Failure to delay case when indicated 2104 Failure to identify fetal distress 2105 Failure to medicate 2106 Failure to monitor 26107 Failure to order appropriate medication 2108 Failure to order appropriate test 1109 Failure to perform procedure 6110 Failure to perform resuscitation 2112 Failure to recognize a complication 35113 Failure to treat 23200 Delay in diagnosis 59201 Delay in performance 1202 Delay in treatment 11203 Delay in treatment of identified fetal distress 2300 Administration of blood or fluid problems 3303 Complimentary or alternative medication problem 4304 Equipment utilization problem 5305 Improper choice of delivery method 2306 Improper management 96308 Improper performance 128309 Improperly performed test 1311 Improper technique 18314 Intubation problem 2316 Lab error 2318 Pathology error 2319 Problems with patient monitoring in recovery 1320 Patient monitoring problem 3321 Patient position problem 1322 Problem with appliance 6323 Radiology or imaging error 4324 Surgical or other foreign body retained 9325 Wrong diagnosis or misdiagnosis 13

NPDB code Reason

Closed Claim Count

326 Wrong dosage administered 1327 Wrong dosage dispensed 4328 Wrong dosage ordered of correct medication 3329 Wrong medication administered 9330 Wrong medication dispensed 13332 Wrong medication ordered 1333 Wrong body part 2334 Wrong Blood type 1400 Wrong patient 2402 Wrong procedure or treatment 5404 Contraindicated procedure 3500 Unnecessary procedure 1501 Unnecessary treatment 1502 Communication problem between practitioners 5

504 Failure to instruct or communicate with patient of family 4

505 Failure to report on patient condition 1600 Failure to supervise 4601 Failure/delay in admission to hospital 2702 Failure/delay in referral or consultation 9703 Premature discharge from institution 1704 Breach of contract or warranty 2706 Breach of patient confidentiality 2707 Equipment malfunction 4711 Failure to ensure patient safety 20

715 Failure to obtain consent / lack of informed consent 2

716 (Legal, ethical, or moral) improper conduct 1717 Product liability 5718 Sexual misconduct 2719 Vicarious liability 33899 Cannot be determined from available records. 9999 Allegation not otherwise classified 16099 Unknown 4

Number of claims with payment by insurer 212 Number of claims with no payment by insurer 490Average claim settlement or award with payment by insurer $184,603Total defense and cost containment expense for claims with payment by insurer $13,669,699Total defense and cost containment expense for claims with no payment by insurer $10,925,069Average defense and cost containment for claims with payment by insurer $64,480Average defense and cost containment for claims with no payment by insurer $22,296

INSURANCE CLOSED CLAIM ANNUAL REPORT 2012