Do Anesthesiologists Have the Highest Malpractice Insurance Rates?
In a word, “No.”
Anesthesia mishaps can lead to critical events such as death or coma, but in recent decades improvements in operating room technology and education have led to fewer such events.
Prior to 1985, anesthesia malpractice claims for death or brain death were most often due to lack of oxygen the patient’s heart or brain. Two significant breakthroughs arrived in the 1980’s to help anesthesiologists care for you: 1) the pulse oximeter, and 2) the end-tidal carbon dioxide monitor.
The pulse oximeter, developed by Nellcor and Stanford anesthesiologist William New, M.D., is a device that clips to a patient’s fingertip. A light-emitting diode shines a red light through the finger, and a sensor on the opposite side of the finger measures the degree of redness in the pulsatile blood flow within the finger. The more red the color of the blood, the more oxygen is present. A computer in the pulse oximeter calculates a score, called the oxygen saturation, which is a number from 0-100%. An oxygen saturation equal to or greater that 90% correlates with a safe amount of oxygen in the arterial blood. A score of 89% or lower correlates with a dangerously low oxygen level in the blood. The pulse oximeter monitor enables doctors to know, second-to-second, whether a patient is getting sufficient oxygen. If the oxygen saturation goes below 90%, doctors will act quickly to diagnose and treat the cause of the low oxygen level. A patient can usually sustain a short period low oxygen saturation, e.g. up to 2 or 3 minutes, without permanent damage to the brain or cardiac arrest by an oxygen-starved heart.
The end-tidal carbon dioxide (CO2) monitor is a device that measures the concentration of CO2 in the gas exhaled by a patient on every breath. During normal ventilation, every exhaled breath contains CO2. When no CO2 is measured, there is no ventilation, and the doctor must act quickly to diagnose and treat the cause of the lack of ventilation.
Prior to the invention of these two monitors, it was possible for an anesthesiologist to mistakenly place a breathing tube in a patient’s esophagus, instead of the trachea, and not know of the error until the patient sustained a cardiac arrest. With the addition of the two monitors, the lack of CO2 (there is no CO2 in the stomach or esophagus) from the end-tidal CO2 monitor immediately indicates that the tube is in the wrong place. The anesthesiologist can then remove the tube, resume mask ventilation with oxygen, and attempt to replace the tube into the windpipe. If the oxygen level to the patient’s blood dips below 90%, this is a second piece of data that indicates that the patient is in danger of brain damage or cardiac arrest.
In addition, in the early 1990’s the American Society of Anesthesiologists created the Difficult Airway Algorithm, which is a step-by-step approach for anesthesiologists to follow when the task of placing a breathing tube for an anesthetic is challenging or difficulty. This Algorithm dictates a standard of care for practitioners, and this advance in education lowered the number of mismanaged airways.
In the 1980’s, surgical anesthesia claims were 80% of closed malpractice claims against anesthesiologists (American Society of Anesthesiologists Closed Claims database). By the 2000’s, this number dropped to 65%. Brain damage represented 9% of claims, and nerve injury accounted for 22% of claims (23% were permanent and disabling, including loss of limb function, or paraplegia or quadriplegia) Less common claims were airway injury (7% of claims), emotional distress, (5% of claims), eye injuries including blindness (4% of claims), and awareness during general anesthesia (2% of claims).
Decreasing anesthesiologist malpractice premiums reflect the decrease in the number of catastrophic anesthesia claims for esophageal intubation, death, and brain death.
In 1985, the average malpractice insurance premium was $36,224 per year for a $1 Million per claim/$3 Million per year policy. By 2009, this decreased to $21,480, a striking 40% drop.
(Anesthesia in the United States 2009, Anesthesia Quality Institute http://aqihq.org/Anesthesia%20in%20the%20US%202_19_10.pdf).
Specialties with the highest risk of facing malpractice claims are neurosurgery (19.1 percent), thoracic and cardiovascular surgery (18.9 percent) and general surgery (15.3 percent). Specialties with the lowest risks are family medicine (5.2 percent), pediatrics (3.1 percent) and psychiatry (2.6 percent). Anesthesiologists rank in the middle of the pack, at 7%. (Malpractice Risk According to Physician Specialty
Jena, et al, N Engl J Med 2011; 365:629-636.) From 1991 to 2005, this article identified 66 malpractice awards that exceeded $1 million dollars, which accounted for less than 1% of all payments. Obstetrics and gynecology accounted for the most payments (11), followed by pathology (10), anesthesiology (7), and pediatrics (7).
The take-home message is that anesthesia has serious risks, but those risks have decreased significantly in recent years because of improvements in monitoring and education. Compared to other specialties, the risk of an anesthesiologist being sued is about average among American medical specialties.
Introducing …, THE DOCTOR AND MR. DYLAN, Dr. Novak’s debut novel. Publication date August 31, 2014 by Pegasus Books. Available on all major online book vendors. THE DOCTOR AND MR. DYLAN can be ordered in print or ebook from Amazon.com. The first four chapters are available for free at Amazon. Read them and you’ll be hooked! To reach the Amazon webpage, click on the book cover image below:
Brief description: Stanford professor Dr. Nico Antone leaves the wife he hates and the job he loves to return to Hibbing, Minnesota where he spent his childhood. He believes his son’s best chance to get accepted into a prestigious college is to graduate at the top of his class in this remote Midwestern town. His son becomes a small town hero and academic star, while Dr. Antone befriends Bobby Dylan, a deranged anesthetist who renamed and reinvented himself as a younger version of the iconic rock legend who grew up in Hibbing. An operating room death rocks their world, and Dr. Antone’s family and his relationship to Mr. Dylan are forever changed.
Equal parts legal thriller and medical thriller, The Doctor and Mr. Dylan examines the dark side of relationships between a doctor and his wife, a father and his son, and a man and his best friend. Set in a rural Northern Minnesota world reminiscent of the Coen brothers’ Fargo, The Doctor and Mr. Dylan details scenes of family crises, operating room mishaps, and courtroom confrontation, and concludes in a final twist that will leave readers questioning what is of value in the world we live in.
Amazon Review: 5.0 out of 5 stars I thoroughly enjoyed reading this September 5, 2014
This book gives you some insight as to the life of a physician.
Many of us wind up in hospitals to undergo some procedure or another and our life is in their hands. It was so interesting to read about their side of the story and the effects it all has on them. The influence of friends and family plays a part in all our lives and so often we forget how much help that can be, too. Dr. Novak follows the path that Carol Cassella blazed in the genre of Anesthesiologist authors.
I thoroughly enjoyed reading this book.
By Mark in Manhattan on September 24, 2014
Format: Kindle Edition
Great beginning. Terrific ending. I’m a junkie for courtroom drama, and this book reminds me of John Grisham’s best. Hard to believe it was written by a doctor. The Dylan character is a hoot. A top-notch novel.
A real page turner!
By Maddiepup on October 1, 2014
Format: Kindle Edition
This book get your attention from the first page — a real page turner. A great mystery with humor intertwined. A great read!!
Learn more about Rick Novak’s fiction writing at