Malpractice: Where does your state rank?

While doctors and the media generally focus on the occasional multimillion-dollar verdict, relatively few cases actually make it to court; most are dropped, dismissed, or settled before trial. In fact, according to NPDB data, court verdicts account for less than 4 percent of all malpractice payments.

Until now, there's been no easy way for doctors to compare their states in terms of the frequency and severity of paid claims. But the Kaiser Family Foundation's statehealthfacts.org has done just that, analyzing 2003 data (the latest year available) from the Data Bank. The site ranks the 50 states according to the number of paid claims per 1,000 active physicians, and by the average payment per claim.

To get some perspective, we compared the NPDB rankings with the AMA's list of "states in crisis," as it was in 2003, to match the year of NPDB's data. While the AMA list does include seven of the top 10 states on the NPDB list of those with the highest average malpractice payments, several of the AMA's crisis states rank below the NPDB's national average of $291,236: Kentucky, Mississippi, Missouri, Washington, and Wyoming. Hawaii, the state with the highest average claims payment, isn't even on the AMA list.

To explain these disparities, the AMA says its list of crisis states is based on a variety of factors including the cost of malpractice insurance and the total number of malpractice claims-not just those that result in payments, which are the only ones reported to the NPDB. Although most malpractice claims never make it to court and don't result in any payment, doctors must still deal with them, and their insurance carriers must still defend against them.