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Hematology & Medical OncologyClaims Data Snapshot

Introduction This publication contains an analysis of the aggregated data from MedPro Group’s casesclosing between 2011-2020 in which hematologist/medical oncologist is identified as theprimary responsible service. A malpractice case can have more than one responsible service, but the “primary responsibleservice” is the specialty that is deemed to be most responsible for the resulting patient outcome. Our data system, and analysis, rolls all claims/suits related to an individual patient eventinto one case for coding purposes. Therefore, a case may be made up of one or moreindividual claims/suits and multiple defendant types such as hospital, physician, or ancillaryproviders. Cases that involve attorney representations at depositions, State Board actions, andgeneral liability cases are not included. This analysis is designed to provide insured doctors, healthcare professionals, hospitals,health systems, and associated risk management staff with detailed case data to assistthem in purposefully focusing their risk management and patient safety efforts.

Major allegations by responsible service50%% of case volume by service45%Medical Medical treatmentMultiple allegation types can be assigned to each case; however, only one “major”allegation is assigned that best characterizes the essence of the case. Thedistribution of allegations is similar between oncology and hematology, althoughdiagnostic allegations are slightly more common for hematology.Other**Distribution of total dollars paid*:44%: diagnosis-related39%: medication-related15%: medical treatment2%: otherMedPro Group closed cases, hematology/medical oncology as responsible service, 2011-2020 (N 175); *Total dollars paid expense indemnity, both specialties combined; **Other includes allegations for whichno significant case volume exists

Allegation detailsDiagnosis-related For oncology cases, cancersare the most commonlyinvolved diagnoses. Forhematology cases,malignancies, hemorrhages,and infections are common. These cases reflect narrowdiagnostic focus, inadequatepatient assessments,especially as symptoms areescalating, and failedcommunication amongproviders, particularly whenreporting and/or followingthrough on diagnostic testresults.Medication-related 52% of the medication casesinvolve the management ofchemotherapy regimens(most often in the oncologycases). Another 10% reflectmanagement ofanticoagulant therapy(hematology). Inadequate monitoring ofmedication regimens is oftennoted in anticoagulant cases. Inadequate patientassessments are commoncontributors to thechemotherapy-related cases.MedPro Group closed cases, hematology/medical oncology as responsible service, 2011-2020Medical treatment These cases are broad inscope, involving managementof a variety of treatmentregimens, delays in treatment,and inadequate monitoring. They are often associated withsecondary diagnostic ormedication-relatedallegations.

Clinical severity*Clinical severity categoriesSub-categories% of casevolumeEmotional Injury OnlyLOWMEDIUM3%DefinitionsMental distress or suffering that is generally temporary; includes HIPAA violations,discrimination, involuntary stayTemporary Insignificant InjuryLacerations, contusions, minor scars or rash, where no delay in recovery occursTemporary MinorInfection, fracture set improperly or a fall, where recovery is complete but delayedTemporary Major20%Burns, drug side effect; recovery delayedPermanent MinorLoss of fingers or loss or damage to organs; includes non-disabling injuriesSignificant Permanent InjuryDeafness, loss of limb, loss of eye or loss of one kidney or lungMajor Permanent InjuryHIGHParaplegia, blindness, loss of two limbs or brain damage77%Grave Permanent InjuryQuadriplegia, severe brain damage, lifelong care or fatal prognosisDeathDeath44%% of case volume resulting in patient deathTypically, the higher the clinical severity, the higher the indemnity payments are and the more frequently payment occurs.MedPro Group closed cases, hematology/medical oncology as responsible service, 2011-2020; *National Association of Insurance Commissioners rating scale5

Claimant type & locationAmbulatory: 78%Inpatient: 21%Location% of case volumeOffice/clinic74%Patient room/ICU18%Emergency department1%Other*7%Emergency: 1%MedPro Group closed cases, hematology/medical oncology as responsible service, 2011-2020; *Other includes locations for which no significant case volume exists6

Contributing factorsContributing factors are multi-layered issues or failures in the process of care that appear tohave contributed to the patient outcome, and/or to the initiation of the case, or had a significantimpact on case resolution.Multiple factors are identified in each case because generally, there is not just one issue thatleads to these cases, but rather a combination of issues.Contributing factors reflect both provider and patient issues, but are not programmaticallyassigned to specific individuals. They denote breakdowns in technical skill, clinical judgment,communication, behavior, systems, environment, equipment/tools, and teamwork. The majorityare relevant across clinical specialties, settings and disciplines; thus, they identify opportunitiesfor broad remediation.CRICO Strategies. (2020). The Power to Predict: Leveraging Medical Malpractice Data to Reduce Patient Harm and Financial Loss. Retrieved from lBenchmark-Reports/The-Power-to-Predict

Top* contributing factor categories by allegation100%% of case volume with these factors90%95%88% 56%48%50%Medical treatment40%40%29%30%24% 24%24%20%20%20%18%13%10%10%10%16%12% sBehaviorrelatedAdministrativeDocumentationMore than one factor per case is usually present, therefore totals will not equal 100%.MedPro Group closed cases, hematology/medical oncology as responsible service, 2011-2020; *Those present in / 10% of case volume in at least one allegationTechnical skill

Contributing factors: most common factor details inhematology/medical oncology casesAdministrativeInadequate staff training/education, failure to follow and/or need for policies/proceduresBehavior-relatedPrimarily involves patient non-adherence to follow-up and with treatment regimen, and patientdissatisfactionClinical judgmentInadequate assessments; these include failures to appreciate/reconcile patient signs/symptoms/testresults, failures/delays in seeking consults, narrow diagnostic focus, delays in ordering diagnostic testing,misinterpretation of diagnostic test resultsClinical systemsReflective of delays in scheduling/performing/reporting diagnostic testing, and general failures in thesystem for patient care (including patient follow-up)CommunicationSuboptimal communication among providers regarding patient condition, inadequate patient educationdiscussions centered around risks of medications, and failures to manage patient expectationsDocumentationInsufficient/lack of documentation leading to difficult defense of casesTechnical skillRecognition/management of known complications, poor technique, procedural inexperienceMedPro Group closed cases, hematology/medical oncology as responsible service, 2011-2020

Factors predictive of cases closing with indemnity paidCRICO Strategies analyzed 37,000 cases* to determine which breakdowns in health careprocesses indicate the highest odds of a case closing with an indemnity payment.AdministrativeClinical JudgmentDocumentationFailure to have or followa policy or protocolPatientassessment failuresAbsent or insufficientdocumentation2.451.851.76ODDS RATIOODDS RATIOODDS RATIO*All specialties, closed between 2014-2018; CRICO Strategies. (2020). The Power to Predict: Leveraging Medical Malpractice Data to Reduce Patient Harm and Financial Loss. Retrieved nnual-Benchmark-Reports/The-Power-to-Predict; MedPro Group is a member of CRICO Strategies’ Community Benchmarking System (now known as CandelloCompare) which represents 30% of all US MPL cases.

Hematology/medical oncology: where to focus your efforts Ongoing evaluation of procedural skills and competency with equipment is critically important. Conduct a thorough pre-treatment assessment of the patient. Conduct a thorough pre-treatment assessment of patients for risk factors related to medication regimens and maintain a consistent post-medicationadministration assessment process. Update and review medical and family history at every visit to ensure the best decision-making.Communicate with each other. Maintain open communication across all members of the patient’s health care team, and identify the primary provider who will coordinate care. Talk also to the patient/family, elicit a comprehensive patient history and conduct a thorough informed consent with the patient.Engage patients as active participants in their care. Consider the patient’s health literacy and other comprehension barriers. Recognize patterns of patient non-compliance, and focus on documentationof efforts made to encourage compliance and follow up with treatment. Recognize that patient satisfaction with treatment outcomes can be influenced by a thorough informed consent and education process.Document. Clinical systems The operative record is critically important for detailing the pre-operative patient assessment, intra-operative steps, and post-operative sequence ofevents. Discrepancies or gaps in the details/timing make it much more difficult to build a supportive framework for defense against potentialmalpractice cases.Focus on ‘closing the loop’ with regards to receiving, reporting and acting on test results, including incidental findings. Educate the patient on theimportance of receiving test results, and how to follow up with the provider if results are not received.Administrative Reinforce the need for ongoing staff training/education related to administrative policies/procedures, including those involving clarification of ordersand appropriate medication administration protocols.

MedPro Group dataMedPro is partnered with Candello, a national medical malpractice data collaborative and division of CRICO, the medical malpracticeinsurer for the Harvard-affiliated medical institutions.Derived from the essence of the word candela, a unit of luminous intensity that emits a clear direction, Candello’s best-in-classtaxonomy, data, and tools provide unique insights into the clinical and financial risks that lead to harm and loss.Using Candello’s sophisticated coding taxonomy to code claims data, MedPro is better able to highlight the critical intersectionbetween quality and patient safety and provide insights into minimizing losses and improving outcomes.Leveraging our extensive claims data, we help our insureds stay aware of risk trends by specialty and across a variety of practicesettings. Data analyses examine allegations and contributing factors, including human factors and healthcare system flaws that result inpatient harm. Insight gained from claims data analyses also allows us to develop targeted programs and tools to help our insureds minimizerisk.DisclaimerThis document should not be construed as medical or legal advice. Because the facts applicable to your situation may vary, or the laws applicable inyour jurisdiction may differ, please contact your attorney or other professional advisors if you have any questions related to your legal or medicalobligations or rights, state or federal laws, contract interpretation, or other legal questions.MedPro Group is the marketing name used to refer to the insurance operations of The Medical Protective Company, Princeton Insurance Company,PLICO, Inc. and MedPro RRG Risk Retention Group. All insurance products are underwritten and administered by these and other BerkshireHathaway affiliates, including National Fire & Marine Insurance Company. Product availability is based upon business and/or regulatory approvaland may differ between companies. 2022 MedPro Group Inc. All rights reserved.12