As physical therapists increase autonomous practice, medical error becomes more important to public safety and public perceptions of the profession. The purpose of this study was to describe malpractice by physical therapists in the United States based on physical therapist malpractice reports in the National Practitioner Data Bank between January 1, 1991, and December 31, 2004. A frequency analysis of data related to physical therapist malpractice reports was performed. The relationship between size of malpractice payment and public policy related to access to physical therapist services and malpractice experience was explored. A total of 664 malpractice reports were found in the study period (mean, 47.73 events annually). California had 114 malpractice events, while Maine and Wyoming had none. The median payment amount for physical therapist malpractice was $10,000 to $15,000. "Treatment-related" events and events related to "improper technique" were the most common reasons for a malpractice report. Incidence of malpractice by physical therapists is low (estimated at 2.5 events/10,000 working therapists/year), and the average malpractice payment is small (<$15,000). Typical physical therapist malpractice involves a direct intervention by an early to mid-career therapist in an urban state. Cumulative physical therapist malpractice incidence in a state was unrelated to public policy related to direct patient access to physical therapy services. J Allied Health 2007; 36:201-208.
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. …