Variation in Expert Opinion in Medical Malpractice Review
27 Jul 2007
Karen L. Posner, Ph.D. Research Associate Professor, Anesthesiology. Robert A. Caplan, M.D. Clinical Professor, Anesthesiology; and Chair, Committee on Professional Liability, American Society of Anesthesiologists. Frederick W. Cheney, M.D. Professor and Chair, Anesthesiology.
Review of article published in: Anesthesiology 1996; 85:1049-54
It has been observed that expert opinions expressed in medical malpractice matters are contradictory at times. Some have drawn the conclusion that this circumstance is the result of bias on the part of the experts who are hired by the opposing sides in a claim or lawsuit. However, there may be other factors at work. One hypothesis is that the contradictions occur because expert opinion in medical malpractice is a form of implicit assessment, based on unstated individual opinion. This contrasts with explicit assessment processes, which are characterized by criteria specified and stated before the assessment. Although sources of bias that might hinder the objectivity of expert witnesses have been identified, the effect of the implicit nature of expert review has not been firmly established.
In order to investigate the matter, pairs of anesthesiologists, acting as reviewers, independently assessed the appropriateness of care in anesthesia malpractice claims. With potential sources of bias eliminated or held constant, the level of agreement was measured.
Results: Thirty anesthesiologists reviewed 103 claims. Reviewers agreed on 62% of claims and disagreed on 38%. They agreed that care was appropriate in 27% and less than appropriate in 32%. Chance-corrected levels of agreement were in the poor-good range (kappa = 0.37; 95% CI = 0.23 to 0.51).
Conclusions: Divergent opinion stemming from the implicit nature of expert review may be common among objective medical experts reviewing malpractice claims.
Received from the Departments of Anesthesiology, University of Washington School of Medicine, and the Virginia Mason Medical Center, Seattle, Washington. Submitted for publication May 1, 1996. Accepted for publication July 19, 1996. Supported by the American Society of Anesthesiologists. Preliminary results presented at the 1991 Annual Meeting of the American Society of Anesthesiologists, San Francisco, California, October 29, 1991.
