Pub. 2 2018 Issue 1

I n the late 1990s and early 2000s, there was widespread concern regarding the underassessment and under treat- ment of pain and the subsequent designation of pain as the fifth vital sign. 1 In response, opioid prescribing pat- terns were modified leading, in part, to the current nation- al alarm regarding large increases in abuse, drug dependence and overdose. More than fifty people die of opioid overdoses each day in the United States prompting the CDC to call it an epidemic of opioid overdoses. 2 The PIAA Data Sharing Project (DSP), was established in 1985, and is an independent and collaborative database of medical professional liability (MPL) claims. To assess the clinical and financial implications of opioid-related MPL claims within the PIAA community, the DSP reviewed 91,000 closed claims and lawsuits reported between 2006 and 2015. Their findings were reported in the PIAA Re- search Notes, September 2017 edition 3 . Three hundred- seventy closed claims were found with the patient out- comes of drug dependence, non-dependent drug abuse, and poisoning. Of these 370 closed opioid-related claims, 114 resulted in an indemnity payment. 2 The PIAA DSP also noted the top five chief medical factors reported for these opioid-related claims and suits were: 1. Medication errors; 2. Failure to supervise or monitor a case; 3. Failure to communicate with a patient; 4. No medical misadventure* and 5. Failure to recognize a complication of a treatment. These five chief medical factors represented ninety per- cent of the 370 opioid-related closed claims. *”No Medical Misadventure” is a claim brought against a clinician who had little or no contact with the patient resulting in an absence of medical misadventure. The claim can still have legal merit and therefore may result in payment. For comparison, PIAA DSP separated the ten-year period of 2006 through 2015 into two five-year periods, 2006 through 2010 and 2011 through 2015. They found an upward trend in both the average indemnity and expense payments. The average indemnity payment increased by thirty-two percent and the average defense costs increased one-hundred percent. In addition, the paid to closed ratio (the percentage of claims or suits closed with an indemnity payment) increased by twenty percentage points during the 2011 to 2015 time frame. Over the same ten-year period, sixteen percent of MICA’s medication related closed claims involved opioid prescrib- ing. Twenty-nine percent of MICA’s opioid-related claims were closed with an indemnity payment, compared to PIAA’s thirty-one percent paid to close ratio. In addition, seventy-one percent of the opioid-related claims at MICA were associated with a patient fatality. Similar to the PIAA DSP, the average defense costs at MICA increased seventy percent when comparing the closed claims reported from 2006 through 2010 to 2011 through 2015. Unlike the PIAA DSP, MICA experienced a thirty- eight percent decrease in the average indemnity from 2006 through 2010 to 2011 through 2015.  A Look at Opioid-Related Closed Claims and Lawsuits 1. Phillips DM. JCAHO pain management standards are unveiled. Joint Commission on Accreditation of Healthcare Organizations. JAMA. 2000; 284(4):428-9. 2. Dowell D, Haegerich T, Chou R. CDC Guideline for prescribing opioids for chronic pain — United States, 2016. Recommendations and reports. 2016 March 18. Available from https://www.cdc.gov/mmwr/volumes/65/ rr/rr6501e1.htm 3. Managing opioids: Prescribing practices and claims. PIAA Data Sharing Project (DSP). PIAA Research Notes. 2017 September. www.UtahAFP.org | 32