Malpractice claims on emergency physicians: time and money.

BACKGROUND: Emergency medicine, with its limited time for patient encounters, unpredictable flow, and lack of a continuing patient-physician relationship, is a particularly high-risk field with regards to the issue of medical liability. There have been limited studies on the financial and time exposure emergency physicians face when confronted with a liability suit. OBJECTIVES: Provide practicing physicians with guidance as to what can be expected if they are confronted with a medical malpractice claim, and contribute to the literature as the issue of tort reform is debated. METHODS: Retrospective study of all closed malpractice claims involving emergency physicians insured by the Illinois State Medical Inter-insurance Exchange covering the 10-year period 1995 to 2004. RESULTS: Of 450 claims, there were 200 cases served. The median incident-to-close time was 45.5 months (interquartile range [IQR] 30.6-69.9). The median expense per claim served was $14,091 (IQR $3448-$44,363); 19.5% of cases resulted in an indemnity with a median of $220,000 (IQR $117,500-$700,000). Cases in which an indemnity was eventually made tended to be filed 7.7 months faster (p = 0.065) and took 14.1 months longer to close (p < 0.05). In cases with a payout of ≥ $1,000,000, 80% were in the ≤ 1-year age group. CONCLUSION: In this study, emergency physicians with malpractice suits can expect resolution of the case to take over 45 months after an alleged incident, and their malpractice insurer will incur over $14,000 in expenses regardless of the suit outcome. Cases involving patients aged ≤ 1 year may incur higher indemnity payments.

Esophageal foreign body sensation: a rare presentation of angioedema.

Angioedema remains a rare but potentially life-threatening complication of angiotensin-converting enzyme (ACE) inhibitor use. Most presentations involve edema of the tongue or oral pharynx. However, in recent years, a visceral form involving the gastrointestinal tract also has been described. We present the case of a rare presentation of esophageal and retropharyngeal edema related to ACE inhibitor use. A review of ACE inhibitor-related angioedema is also presented.