Placing “Standard of Care” in Context: The Impact of Witness Potential and Attorney Reputation in Medical Malpractice Litigation

Previous empirical studies have speculated about the role that factors other than negligence play in the resolution of medical malpractice claims. The present study identifies and evaluates the impact of three “strategic variables” in the medical malpractice litigation process: the witness potential of the defendant physician, the witness potential of the plaintiff, and the reputation of the plaintiff's attorney. These factors, unrelated to standard of care, make a difference in the outcome of medical malpractice cases. Data were collected from insurance company files on cases filed in the North Carolina state courts between 1991 and 1995. Analyses revealed that when the insurers’ outside (physician) reviewers rated liability as probable, based on standard of care, settlement occurred in most of the cases. However, when liability was rated as uncertain or unlikely, strategic variables such as perceived witness potential and the reputation of the plaintiff's counsel were significant predictors of case outcome. Cases in which the defendant physician had a strategic advantage were much less likely to settle, while cases in which the plaintiff had a strategic advantage were much more likely to settle.