Trends in pathology malpractice claims.

Previously reported analyses of pathology malpractice claims reported to The Doctors Company from 1995 through 2003 uncovered repetitive patterns of specimen type and diagnostic category that contributed to claims. To determine whether these patterns had changed, 276 pathology malpractice claims from 2004 through 2010 were reviewed and are the subject of this report. Claims involving melanoma, breast (specimens and fine needle aspiration), system error, gynecologic cytology, and fine needle aspiration (excluding breast) accounted for 49% of the total claims. There has been a significant decline in the number of claims involving melanoma, breast, and gynecologic cytology, and the factors contributing to this decline are discussed.

Medicolegal aspects of error in pathology.

OBJECTIVE: To discuss the various ways error is defined in surgical pathology. To identify errors in pathology practice identified by an analysis of pathology malpractice claims. DESIGN: Three hundred seventy-eight pathology malpractice claims were reviewed. Nuisance claims and autopsy claims were excluded; 335 pathology claims remained and were analyzed to identify repetitive patterns of specimen type and diagnostic category. SETTING: All pathology malpractice claims reported to The Doctors Company of Napa, Calif, between 1998 and 2003. RESULTS: Fifty-seven percent of malpractice claims involved just 5 categories of specimen type and/or diagnostic error, namely, breast specimens, melanoma, cervical Papanicolaou tests, gynecologic specimens, and system (operational) errors. Sixty-three percent of claims involved failure to diagnose cancer, resulting in delay in diagnosis or inappropriate treatment. CONCLUSION: A false-negative diagnosis of melanoma was the single most common reason for filing a malpractice claim against a pathologist. Nearly one third involved melanoma misdiagnosed as Spitz nevus, "dysplastic" nevus, spindle cell squamous carcinoma, atypical fibroxanthoma, and dermatofibroma. While breast biopsy claims were a close second to melanoma, when combined with breast fine-needle aspiration and breast frozen section claims, breast specimens were the most common cause of pathology malpractice claims. Cervical Papanicolaou test claims were third in frequency behind melanoma and breast; 98% involved false-negative Papanicolaou tests. Forty-two percent of gynecologic surgical pathology claims involved misdiagnosed ovarian tumors, and 85% of these were false-negative diagnoses of malignancy. The most common cause of system errors was specimen "mix-ups" involving breast or prostate needle biopsies.

An insurer's perspective on error and loss in pathology.

OBJECTIVES: To identify errors in surgical pathology practice that lead to malpractice claims, and to define the frequency and severity of pathology malpractice claims and discuss the implications. DESIGN: Three hundred seventy-eight pathology malpractice claims reported to The Doctors Company of Napa, Calif, between 1998 and 2003, were reviewed. Nuisance claims and autopsy claims were excluded; the 335 remaining claims were analyzed. RESULTS: Pathology claim frequency is low. Pathology claim severity is high, especially for claims involving a misdiagnosis of melanoma or a false-negative Papanicolaou test. Fifty-seven percent of claims involved the following 5 categories: breast specimens, melanoma, Papanicolaou smears, gynecologic specimens, and operational error. Sixty-three percent of claims involved failure to diagnose cancer, resulting in delay in diagnosis or inappropriate treatment. CONCLUSION: A false-negative diagnosis of melanoma is the single most common reason for filing a malpractice claim against a pathologist. Nearly one third of misdiagnoses involve melanoma misdiagnosed as Spitz nevus, "dysplastic" nevus, spindle cell squamous carcinoma, atypical fibroxanthoma, and dermatofibroma.

Error in surgical pathology.

A total of 272 surgical pathology claims reported to The Doctors Company from 1998 through 2003 were reviewed. They were analyzed and repetitive patterns involving both specimen type and category of diagnostic error were identified. These patterns were then compared with those uncovered in a prior review of 218 surgical pathology claims reported from 1995 through 1997 to identify trends and see if new patterns of diagnostic error had emerged.

Pitfalls in the diagnosis of malignant melanoma: findings of a risk management panel study.

The misdiagnosis of melanoma is a major cause of malpractice claims involving pathologists and dermatologists. A detailed analysis of individual surgical pathology and cytology claims (excluding Pap smears) reported to The Doctors Company from 1995 through 2001 revealed that 46 of 362 claims (13%) involved the misdiagnosis of melanoma; 70% of these claims were for false-negative diagnoses. Melanoma claims were second only to claims involving breast biopsy. A Melanoma Risk Management Panel of expert dermatopathologists was convened to discuss recurrent "problem areas" identified by the author in claims reviewed from 1998 through 2001. The purpose was to devise useful strategies that pathologists and dermatologists could use in their practices to reduce the risk of diagnostic error and/or patient mismanagement when dealing with melanocytic lesions. The panel's findings and recommendations are the subject of this review.

Diagnostic Pitfalls in Surgical Pathology- Uncovered by a Review of Malpractice Claims: Part II. Breast Fine Needle Aspirations.

Breast fine needle aspiration (FNA) biopsy accounted for 6% of surgical pathology and FNA claims reviewed from 1995-97. The majority of these claims were for false negative breast FNA resulting from sampling error in a woman with a palpable breast mass. Controversies concerning the definition of specimen adequacy for breast FNA are discussed and a strategy for minimizing the management and liability consequences of the problem is proposed. Claims for false positive breast FNA usually result from interpretive error. Int J Surg Pathol 8(3):229-231, 2000