MEDICAL ERROR and patient safety have gained increased attention from the public with recent reports of higher than anticipated error rates in health care settings. The Harvard Medical Practice Study found that 3.7% of all hospital admissions result in iatrogenic patient injury, of which 27% of these events result from provider negligence.1 Similar results (2.9% adverse events) were found in a study of hospitals in Utah and Colorado, with negligent causation found in 27% (Colorado) to 33% (Utah) of the cases.2 The mortality rate from medical error in the United States has been estimated at 98,000 deaths/year.3
Efforts to reduce medical error have traditionally relied on identification and punishment of "bad actors" through civil litigation or professional discipline. Malpractice claims, judgments, and settlements are one indicator of the incidence of provider responsibility for medical error. Malpractice in physical therapy has not been studied systematically. Most reports have been anecdotal. A recent report identified a large ($500,000) arbitration agreement for improper use of physical therapy.4 Scott noted that "the number of reported and non-reported physical therapy malpractice cases remains relatively small" but was unable to cite the actual size of the problem.5 Schunk and Thut outlined several areas for increasing malpractice risk for therapists in more autonomous practice models, including responsibility to refer, supervision, and documentation.6 Similarly, Kolber and Lucado have recently emphasized the importance of good patient care documentation to decrease risk exposure to potential physical therapist malpractice.7 An increased emphasis on professionalism is being discussed as the profession recognizes its changing responsibilities as it moves to a more autonomous practice model.8
The changing legal relationship of physical therapists to physicians in states that allow some form of direct public access to physical therapy is controversial. In part, this controversy relates to the potential for medical error, patient harm, and malpractice by physical therapists making inappropriate clinical decisions, especially medical diagnoses. The "sample talking points" of the American Academy of Orthopedic Surgeons on the issue of direct access to physical therapy are illustrative.
Physical therapists claim that direct access will not expand their scope of practice since they may not make medical diagnoses. …