Medical malpractice claims first appeared in the United States in the 1800s, but the frequency of claims did not increase significantly until the 1960s. Today, medical malpractice claims are incredibly common, leading many individuals to seek the expertise of medical malpractice attorneys.
According to research conducted by the Division of Economic and Health Policy Research, one in three physicians have had a medical malpractice lawsuit filed against them at some point in their careers.
In an effort to better understand the geographical distribution of medical malpractice claims, we’ve turned to a valuable resource: the National Practitioner Data Bank.
What is medical malpractice?
Medical malpractice occurs when a patient is harmed because a health care professional deviates from the accepted standard of care.
A medical malpractice claim can be brought against any licensed health care professional.
Examples of actions (or inactions) that commonly result in medical malpractice claims include:
- Failing to diagnose an illness
- Misdiagnosing an illness
- Misreading a lab result
- Prescribing and improper medication or dosage
- Failing to follow proper medical procedure
- Failing to warn a patient of known risks
- Prematurely discharging a patient
In order to establish a medical malpractice claim in most states, a patient must prove the following two elements:
- The health care provider failed to exercise the degree of care and skill expected of a reasonable health care provider in the profession, and
- Such failure was the actual and proximate cause of the patient’s injury.
In a medical malpractice case, the focus of the lawsuit will generally be on what the health care provider should have done in a specific set of circumstances. The standard by which the health care professional is judged is called the “medical standard of care.”
To put it another way, the plaintiff will attempt to persuade the judge or jury that the health care professional failed to act with the same level of care that an ordinary health care professional with the same training and experience would have, and the defendant will attempt to persuade the judge that the health care professional acted competently. Both sides can—and are typically required to—present testimony from experts to support their arguments.
Find out how to locate and vet a medical malpractice attorney.
What is the National Practitioner Data Bank?
The National Practitioner Data Bank (NPDB) is a federal database that collects certain information related to doctors and other health care practitioners. The NPDB was created pursuant to The Health Care Quality Improvement Act of 1986 with the goal of improving the quality of healthcare in the United States.
The NPDB collects a wide range of information concerning medical malpractice claims, including medical malpractice payments, disciplinary actions taken by state medical boards, and criminal convictions related to health care delivery.
Researchers, policymakers, and health care institutions use this information for all sorts of reasons, including to aid in the development of health care policies and to provide hospitals with critical information during credentialing and hiring processes.
Medical malpractice payments across the United States
The concept of medical responsibility has a long history, tracing back to ancient civilizations. In Mesopotamia, the Code of Hammurabi (circa 1900 BC) established a foundation for medical liability, imposing severe penalties on physicians for harm caused to patients.
Similarly, Roman and English laws recognized medical malpractice as a legal wrong, with physicians held accountable for negligence or substandard care. These early laws evolved over time, influencing the development of medical malpractice regulations across Europe and, eventually, in the United States.
In the U.S., medical malpractice claims began appearing more regularly in the 1800s, but it wasn't until the 1960s that lawsuits became more frequent, partly driven by an increasingly litigious society.
In the 1980s and 1990s, medical malpractice claims surged due to increased patient awareness, aggressive advertising by attorneys, and growing concerns about medical negligence. This period saw the rise of the so-called "malpractice crisis," where insurance premiums skyrocketed, leading to greater public awareness of malpractice issues.
Starting in the late 1990s and into the 2000s, many states implemented tort reforms aimed at curbing the number and size of malpractice claims. These reforms included caps on non-economic damages, limitations on attorneys' fees, and the introduction of pretrial screening panels to filter out frivolous lawsuits. Such measures were highly effective in reducing claims. For example, a study in the early 2000s showed that damage caps and shorter statutes of limitations significantly reduced malpractice awards and the overall number of claims.
By 2010, these reforms, combined with changes in healthcare practices, led to a significant reduction in malpractice claims and payments.
The ten states with the most medical malpractice payments
To determine which states had the most medical malpractice payments in 2023 while controlling for population, we calculated the malpractice payment rate per capita for each state.
This was done by dividing the total number of medical malpractice payments in each state in 2023 by the total population of each state. We then multiplied the number by 100,000, which gave us the number of medical malpractice payments per one hundred thousand people.
States or territories with the most medical malpractice payments (2023)
| State | Payments per 100,000 people |
|---|---|
| Pennsylvania | 7.22 |
| Puerto Rico | 7.17 |
| New Mexico | 7.14 |
| New York | 6.23 |
| New Jersey | 6.12 |
| Florida | 5.29 |
| Louisiana | 4.64 |
| Kansas | 4.62 |
| Rhode Island | 4.23 |
| Connecticut | 4.04 |
While certain states may experience unusually high numbers of medical malpractice claims in a given year, these outliers don't always reflect long-term trends. To gain a clearer picture, we examined the data over a ten-year period.
States or territories with the most medical malpractice payments over a ten-year period (2013-2023)
| State | Payments per 100,000 people |
|---|---|
| New York | 82.49 |
| Puerto Rico | 76.54 |
| Pennsylvania | 69.59 |
| New Jersey | 67.77 |
| Louisiana | 65.54 |
| West Virginia | 63.55 |
| New Mexico | 61.34 |
| Florida | 54.77 |
| Kansas | 53.49 |
| Rhode Island | 51.91 |
As you can see, Connecticut appears in the list of states with the most medical malpractice payments for 2023 but is absent from the ten-year trend list. This suggests that Connecticut's high ranking in 2023 may be a slight anomaly. Overall, however, the 2023 list largely mirrors the states with consistently high malpractice payments.
The ten states with the fewest medical malpractice payments
To determine which states had the fewest medical malpractice payments in 2023, we once again calculated the malpractice payment rate per capita for each state and multiplied the number by 100,000 to get the number of medical malpractice payments per one hundred thousand people.
States or territories with the fewest medical malpractice payments (2023)
| State | Payments per 100,000 people |
|---|---|
| Wisconsin | 0.86 |
| South Dakota | 0.87 |
| North Dakota | 1.02 |
| Minnesota | 1.1 |
| North Carolina | 1.18 |
| Alabama | 1.59 |
| Ohio | 1.62 |
| Arkansas | 1.73 |
| Tennessee | 1.74 |
| Iowa | 1.81 |
We also examined the medical malpractice payment data over a ten-year period. Similar to the states with the most medical malpractice payments, the two lists are very similar. Only South Dakota, Arkansas, and Iowa show up in the 2023 list and not the ten-year period list.
States or territories with the fewest medical malpractice payments over a ten-year period (2013-2023)
| State | Payments per 100,000 people |
|---|---|
| Wisconsin | 10.21 |
| Minnesota | 11.74 |
| North Dakota | 13.01 |
| North Carolina | 14.89 |
| Alabama | 15.26 |
| Virginia | 19.79 |
| Texas | 20.21 |
| Idaho | 20.46 |
| Tennessee | 20.62 |
| Ohio | 20.86 |
The ten states with the largest medical malpractice payments
To gain insights into which states had the highest number of large medical malpractice payments, we utilized data from the NPDB. For this section, we focused on payments that exceeded $1 million.
As with other sections of this analysis, we controlled for population. This allowed us to make fair comparisons across states, ensuring that population size did not skew the results.
The states listed below represent the highest per capita rates of medical malpractice payments over $1 million during the most recent ten-year period.
States or territories with the highest per capita rates of medical malpractice payments over $1 million (2013-2023)
| State | $1 million + payments per 100,000 people |
|---|---|
| New York | 11.09 |
| Rhode Island | 10.76 |
| Connecticut | 8.70 |
| Massachusetts | 8.65 |
| Illinois | 6.98 |
| New Jersey | 6.81 |
| New Hampshire | 5.42 |
| New Mexico | 4.77 |
| Georgia | 4.61 |
| Hawaii | 4.32 |
Real-life story: A Philadelphia jury awarded former Eagles captain Chris Maragos $43.5 million in a medical malpractice lawsuit against his doctors. The verdict followed less than three hours of deliberation and found Dr. James Bradley and Rothman Orthopaedics Institute negligent in their treatment of Maragos' 2017 knee injury, which prematurely ended his NFL career. The jury ordered Bradley to pay $29.2 million and Rothman to pay $14.3 million.
Maragos’ lawsuit claimed his doctors failed to properly address a meniscus injury during surgery to repair his torn posterior cruciate ligament, leading to ongoing knee issues and cutting short his professional career. The trial, which featured testimony from fellow Eagles players and extensive medical evidence, concluded with Maragos expressing gratitude for the jury's decision, calling it the beginning of his path to recovery.
Factors that may impact the number of medical malpractice payments
Medical malpractice payments occur for a variety of reasons. It’s important to keep in mind that a high number of claims in a state does not necessarily indicate a lower standard of health care.
Some states, for example, have laws that make it easier for patients to file medical malpractice claims, which likely contributes to a higher payment rate. These laws may include:
- A longer statute of limitations
- Lower damage caps on medical malpractice claims
- More lenient peer-physician affidavit requirements
- Fewer limits on discovery
Interestingly, the city of Philadelphia has experienced an unprecedented surge in the number of medical malpractice claims being filed due to a 2022 law that allows cases to be filed in Philadelphia even if the incident occurred elsewhere, as long as the defendant regularly conducts business in the city.
In the United States, medical malpractice law is typically under the authority of the individual states, as opposed to the federal government. Therefore, the rules that govern medical malpractice claims vary from state to state and have been established largely through decisions of lawsuits filed in state courts.
What’s more, some states have higher concentrations of medical practitioners. In these states, the number of malpractice payments could be greater due to the sheer number of patients receiving treatment, even if the percentage of negligent cases is not necessarily higher.
Similarly, some states may have more doctors who specialize in areas that see a higher number of malpractice claims. According to the American Medical Association, the following physician specialties are more likely to face malpractice claims:
- Obstetrics and gynecology
- General surgery
- Orthopedic surgery
- Emergency medicine
- Radiology
Looking at the geographical distribution of medical malpractice payments can be revealing, but the data should be viewed as one piece of a much larger, more complex puzzle.
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To learn more about medical malpractice in the United States, consider the following articles:
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- Informed Consent Doesn’t Preclude a Medical Malpractice Lawsuit
- Medical Malpractice vs. HMO Malpractice Lawsuits
- Patient Abandonment: Navigating Legal Rights and Remedies for Neglected Patients
- Suing a Healthcare Professional for Misdiagnosis or Failure to Diagnose
- What to Do if You Suspect Medical Malpractice
- How to Find the Best Medical Malpractice Attorney for Your Case
- 5 of the Most Common Types of Birth Injury