Legal debate: assumptions on medical malpractice called into question.

The notion that many medical-malpractice lawsuits are frivolous and intended to generate undeserved riches for plaintiffs and their lawyers isn't borne out in a new study.

A review of almost 1,500 randomly selected malpractice lawsuits in the United States finds that instances of healthy people successfully suing a doctor for malpractice are exceedingly rare and are far outnumbered by cases in which a patient injured by medical error goes uncompensated, health-policy researchers report in the May 11 New England Journal of Medicine.

The Boston researchers who conducted the study acknowledge that doctors pay high malpractice-insurance premiums and that litigation is expensive for all parties. But they find little to suggest that proposed federal laws limiting jury awards to patients would alleviate those costs.

The majority of payments from insurance companies went to people who had been harmed by medical errors, not to people with baseless claims, the data show. That suggests that "moves to combat frivolous litigation will have a limited effect on total costs," the authors say.

Meanwhile, federal legislation to place a $250,000 limit on jury malpractice awards failed in the Senate this week.

In malpractice lawsuits, both sides consult physicians and other experts to bolster their eases, notes study coauthor David M. Studdert, an attorney and health-policy researcher at the Harvard School of Public Health in Boston. He and his colleagues assigned impartial doctors to review these experts' statements and the patients' medical records. Then, the reviewers assessed whether each patient was injured and whether medical errors were to blame.

In the study, about 85 percent of eases were settled out of court, and plaintiffs lost four-fifths of those that did go to trial.

The reviewers found that 97 percent of the 1,452 patients had indeed suffered harm. In about one-third of these patients, the damage wasn't clearly attributable to negligent medical treatment, a wrong prescription, or a misdiagnosis. Most of those claims were correctly denied compensation, the team reports.

Among the plaintiffs who received compensation were 6 uninjured people and 145 injured individuals whose injuries had not been convincingly linked to medical error. On the other hand, 236 plaintiffs who did suffer an injury from medical error received no compensation.

"This research shows that the problem with medical-malpractice litigation is not that too many undeserving people get paid, but rather that not enough deserving people get paid," says Tom Baker, an attorney at the University of Connecticut in Hartford.

Nevertheless, 73 percent of plaintiffs whose claims had merit received compensation, according to the study. That figure suggests that the fact-finding involved in litigation, although expensive and time-consuming, "does a pretty good job of sorting out valid from invalid claims," says Neil Vidmar, a social psychologist at Duke University in Durham, N.C. "This is as thorough a study as has ever been undertaken of these issues" he adds.

Litigating a malpractice claim through trial can take as long as 6 years.

The new findings indicate that streamlining the process would yield more savings than simply capping payouts, says Studdert. He points out that in New Zealand and some Scandinavian countries, special courts arbitrate medical disputes.