MONTANA MEDICAL LEGAL PANEL

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1 . MONTANA MEDICAL LEGAL PANEL Percent Of Montana Health Care Providers Medical Malpractice Claims & Lawsuits Through 2006 (Not Jury Trials) % Providers Claims & Lawsuits 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% Claims Lawsuits Claim Years MONTANA MEDICAL MALPRACTICE CLAIMS, LAWSUITS, JURY TRIALS, LARGE LOSSES & APPEALS 2000 Through 2006 YEAR 2007 MONTANA MEDICAL LEGAL PANEL REPORT G. Brian Zins, Director, Montana Medical Legal, th Avenue, Helena, Montana (Copy Of Full Report At: May 22, 2007

2 MONTANA MEDICAL MALPRACTICE CLAIMS, LAWSUITS, JURY TRIALS, LARGE LOSSES & APPEALS Annual Report - MONTANA MEDICAL LEGAL PANEL Table Of Contents - Full Report Page 1. EXECUTIVE SUMMARY 2 A. Medical Malpractice Claims Claim Stages 2 B. All-Provider Trends 3 2. MEDICAL MALPRACTICE CLAIM TRENDS 5 A. Trend Number Of Health Care Providers Per Claim 5 B. Trend Number Of Claims 6 3. CLAIMS, LAWSUITS, JURY TRIALS & APPEALS 7 A. All Providers Combined All Years 7 B. All Providers By Provider Type By Year 9 (1) Physicians By Year 9 (2) Hospitals By Year 10 (3) Long-Term Care Facilities By Year 11 (4) Dentists By Year 13 (5) Podiatrists By Year CLAIMS HEARD, SETTLED & DROPPED OVERALL PANEL RAW DATA 16 After the first of each year - for purposes of determining the annual assessment charged to Health Care Providers covered by the and for reporting the progress of the to the Montana Supreme Court - the Annual Report of the Montana Medical Legal is published and made available. A part of the duties of the is the gathering of information and data on the "who, what, when & where" of medical malpractice claims. Data referenced but not included in the following is available upon request. If you have received just an Executive Summary, you may obtain at no charge a copy of the full report at: Providers before the include Montana licensed Physicians (and a few tele-medicine Physicians from other states), Dentists, and Podiatrists that reside in Montana or are in active practice in the State, plus Hospitals and specific Long-Term Care Facilities licensed as health care Facilities (home health agencies, government infirmaries not university or college infirmaries, long-term care facilities, intermediate care facilities for the developmentally disabled, medical assistance facilities, mental health centers, outpatient centers for primary care, outpatient centers for surgical services, rehabilitation facilities, and residential treatment facilities). Dentists were added to the in late 1987 and Podiatrists in late Except where indicated otherwise, all data pertains to claims filed through December 31, All post- data is based on attorney reporting forms, clerk of district court surveys and other independent inquiries of the, including Montana Law Week and Montana Supreme Court data through the same date. Montana Medical Legal Annual Report- Page 1

3 Medical Malpractice Claim Stage Appeal Decisions Medical Malpractice - Montana Supreme Court 1. EXECUTIVE SUMMARY A. Montana Medical Malpractice Claims Claim Stages Claim Years 2000 Through 2006 No. Of Providers Claim Year 2006 NONE (0) From Claim Year 2006 Number & Rates Of Providers Claim Years NONE (0) APPEAL DECISIONS : re were no appeal decisions of the Montana Supreme Court from a judgment in district court, either judge or jury. re has been no appeal decision of a judge or jury trial award where noneconomic damages were awarded under the 1995 cap on such damages. last appeal decision was from claim filing year 1999 (a 1997 incident), decided in 2006, upholding a jury verdict in favor of a Physician and a Hospital. Jury Trials Medical Malpractice - Large Loss Awards (Greater Than $ 999,999) Jury Trials Medical Malpractice Lawsuits District Court Medical Malpractice Medical Malpractice Claims Filed At Medical Legal NONE (0) From Claim Year 2006 NONE (0) From Claim Year 2006 SEVEN (7) 7 Providers were in medical malpractice lawsuits from claim filing year TWO HUNDRED SEVENTEEN (217) 217 claims against 2,795 Providers were filed in 2006: 7.8% of Montana Providers.. TWO (2) LARGE LOSS JURY AWARDS ($ 1 MILLION OR MORE) : Since the 1995 enactment of the legislative Cap on non-economic damages, there have been 2 large loss jury verdicts to which the Cap could apply: (1) A jury awarded $ 1,365,092 against a Hospital in 2005 (2000 incident, claim filed in 2002). pain & suffering were $ 10,000; (2) A jury awarded $ 1,000,000 against a Long-Term Care Facility in 2006 (1998 incident, claim filed in 2001). No Physician, Podiatrist or Dentist has had a Large Loss for any incident occurring after the applicability of the Cap THIRTEEN (13) PROVIDERS IN ELEVEN (11) JURY TRIALS 11 Of 13 Successful Providers 1.9 Providers Per Year Jury Trials : last jury trials were held in 2006: A Podiatrist (filing year 2004 and separately, a Facility (filing year 2001). 2006, a Physician & Hospital were together in a jury trial (filing year 2001). A Hospital was in a jury trial in 2005 (filing year 2002). Providers were all successful, except as to 1 Hospital and 1 Facility. SIX HUNDRED EIGHTEEN (618) PROVIDERS IN LAWSUITS Average Of 88 Providers Per Year Lawsuits : A total of 618 Health Care Providers were in lawsuits filed in district court (including 405 Physicians & 148 Hospitals). As some claims filed in 2006 are open at the, that year s numbers will change, but the equivalent number at this time last year for the year 2005 was 12 Providers in lawsuits. ONE THOUSAND EIGHT HUNDRED SIXTY-FIVE (1,865) PROVIDERS IN ONE THOUSAND FORTY (1,040 CLAIMS Average Of 266 Providers Per Year 149 Claims Per Year : 1,865 Health Care Providers were in 1,040 medical malpractice claims filed with the, out of an annual average of 2,518 licensed Montana Health Care Providers: 10.6% Of Health Care Providers. Montana Medical Legal Annual Report- Page 2

4 B. All-Provider Trends - Montana Medical Malpractice Claims, Lawsuits & Jury Trials following contains summary data for all Montana Health Care Providers, subject to the Montana Medical Legal, after combining the results for individual Providers. Data on an individual Provider basis by year and with raw numbers, with analysis, is contained in the balance of the full 2007 Annual Report of the Montana Medical Legal below. If you are reading the Executive Summary, the full Report is obtainable at: Trend Average Annual PERCENTAGE Of Claims Rate Of Number Of Claims As A Percentage Of Montana Health Care Providers Number Of Claims Filed At volving Any Number Or Type Of Health Care Providers Claim Years % % % % TREND - Average Annual PERCENTAGE Of Licensed Health Care Providers Years Claims Lawsuits Jury Trials % 4.6% 0.12% % 4.2% 0.09% % 3.8% 0.05% % 2.7% 0.03% TREND - Average Annual PERCENTAGE Of All Licensed Physicians Years Claims Lawsuits Jury Trials % 4.2% 0.1% % 3.8% 0.1% % 3.4% 0% % 2.4% 0% Montana Medical Legal Annual Report- Page 3

5 TREND - Average Annual PERCENTAGE Of All Licensed Hospitals Years Claims Lawsuits Jury Trials % 43.6% 0.8% % 43.4% 0.4% % 38.7% 0.4% % 27.0% 0.0% TREND - Average Annual PERCENTAGE Of All Licensed LT Care Facilities Years Claims Lawsuits Jury Trials % 5.5% 0.216% % 4.5% 0.216% % 3.0% 0.000% % 2.8% 0.000% TREND - Average Annual PERCENTAGE Of All Licensed Dentists Years Claims Lawsuits Jury Trials % 0.80% 0.00% % 0.74% 0.00% % 0.78% 0.00% % 0.57% 0.00% TREND - Average Annual PERCENTAGE Of Podiatrists (Accounting For creases Number Of Podiatrists) Years Claims Lawsuits Jury Trials % 3.7% 0.0% % 3.7% 0.6% % 6.6% 0.6% % 4.8% 0.6% Montana Medical Legal Annual Report- Page 4

6 2. MEDICAL MALPRACTICE CLAIM TRENDS a medical malpractice or medical liability claim with the Montana Medical Legal is the starting point in the claim process. Once the Application is filed in proper form, a Patient (or the Representative of a Patient) is entitled to have the claim against a Health Care provider decided by a of three Attorneys and three Health Care Providers, at no -associated cost to the Patient. As a precondition to a lawsuit, a Montana Medical Legal decision must be rendered as to medical malpractice claims against Physicians, Hospitals, Dentists, Podiatrists, and specified Long-Term Care Facilities. claim is against one or more of the specified Health Care Providers covered by the : Licensed Physicians, Dentists, Podiatrists, Hospitals and certain Long-Term Care Facilities. Claims proceed to a decision if not earlier resolved at the stage of the claim process by either settlement of the claim between the parties or the dropping of the claim as to one or more health care providers. As to claims where there is a decision by a selected for the claim, the tracks their progress after the is utilized. A. Trend Of Number Of Health Care Providers Per Filed Montana Medical Malpractice Claim, Steady Decline Average Number Of Health Care Providers Per Filed Claim Many claims involve more than one Health Care Provider quite often one or more Physicians and a Hospital - and the average number of Providers per claims has been steadily dropping: 1 Providers Per Medical Malpractice Claim TREND - ANNUAL 4-YEAR "ROLLING" AVERAGE AVERAGE ANNUAL Number Of Montana Health Care Providers Per Claim Filed At Claim Years Providers in claims that proceed to a post- claim stage settlement or a lawsuit - have a recent rate of 2.3 providers per claim, from attorney reports received from June, 2004 through January, 2006 as to claim filing years Montana Medical Legal Annual Report- Page 5

7 B. Trend Of Filed Montana Medical Malpractice Claims, Recently Declining Claim Frequency Absolute Terms And More So As A Proportion Of Total Health Care Providers absolute number medical malpractice claims filed has fluctuated within a narrow range since 2000, but - as a percentage of total health care providers - a decline has occurred from Trend Average Annual Percentage Of Providers Claims TREND - Rate Of Claims Claim Years Number Of Claims Filed At volving Any Number Or Type Of Health Care Providers Number Of Claims As A Percentage Of Montana Health Care Providers % % % % When the year-by-year data is reviewed, year 2006 shows an absolute drop in the number of filed claims. With the increased number of Health Care Providers in Montana, the rate of claims (number of claims divided by the number of providers) has declined significantly. One year doesn t make a trend, however, which is the reason the collapsed data in the previous Table is used to explore trends: Claim Year SELECT ANNUAL DATA - CLAIMS Number Of Claims Filed At volving Any Number Or Type Of Montana Health Care Providers Number Of Montana Health Care Providers Rate Of Claims Number Of Claims As A Percentage Of Montana Health Care Providers , % , % , % , % , % , % , % Total 1,040 Montana Medical Legal Annual Report- Page 6

8 3. CLAIMS, LAWSUITS, JURY TRIALS & APPEALS A. ALL PROVIDERS COMBINED BY YEAR Appeal decisions by the Montana Supreme Court on judgments of district court judges or juries remain at zero for the time-period. re has been no appeal decision where economic damages were awarded under the 1995 Cap on non-economic damages (applicable to any malpractice claim for covered Providers where the incident is at or after the effective date of November 1, 1995). last appeal decision came from a 1997 incident year claim (filed before the in 1999 and decided in 2006). Montana Supreme Court upheld a jury verdict in favor of a Physician and a Hospital. 2 Large Losses For purposes of this Report, a Large Loss is defined as at or in excess of $ 1 Million awarded to a claimant by a jury. Since the 1995 enactment of the legislative Cap on non-economic damages, there have been 2 large loss jury verdicts to which the Cap could apply: (1) A jury awarded $ 1,365,092 against a Hospital in 2005 (2000 incident, claim filed in 2002). pain & suffering were $ 10,000; (2) A jury awarded $ 1,000,000 against a Long-Term Care Facility in 2006 (1998 incident, claim filed in 2001). No Physician, Podiatrist or Dentist has had a Large Loss for any incident occurring after the applicability of the Cap. Claim Year MONTANA MEDICAL MALPRACTICE DATA ALL MONTANA PROVIDERS (Unadjusted For creases Number Of Licensed Providers) Number Medical Jury Decided Licensed Malpractice Lawsuits Jury Jury Trials Verdict By HCP Claims After Trials Of More Montana At Year- At After A Than Supreme End Lawsuit $999,999 Court , , , , , , , Total 1, appeal rate of medical malpractice claims may well, in addition to the presence of the, have been affected by the presence of other alternate dispute resolution mechanisms in place of late: Optional mandatory mediation after filing of a lawsuit in certain claims and mandatory mediation results as a pre-condition to perfecting an appeal to the Montana Supreme Court, also applicable to medical malpractice claims. Montana s Appeal rate at the lowest in the nation. See: 2006 Annual Report, Montana Medical Legal. Montana Medical Legal Annual Report- Page 7

9 last Physician Large Loss occurred in a 2003 jury trial (incident year 1995, claim filing year 1998), when a jury awarded $ 1,050,000 to a claimant, with the award being affirmed by the Montana Supreme Court. Since incident Year 1977, there have been 3 Large Losses for Physicians, 2 for Hospitals, and 1 for a Long- Term Care Facility. 3 Jury Trials last jury trials were held in 2006: A Podiatrist (filing year 2004 and separately, a Facility (filing year 2001). 2006, a Physician & Hospital were together in a jury trial (filing year 2001). A Hospital was in a jury trial in 2005 (filing year 2002). Providers were all successful, except as to 1 Hospital and 1 Facility. re were 11 jury trials during the claim filing year period. Thirteen Health Care Providers were in those 11 trials, and the Providers were successful except as to 1 Hospital and 1 Long-Term Care Facilitty. Without regard to the trend or change in the rate of jury trials, this is a rate of 1.9 Health Care Providers per year in a jury trial. Lawsuits A total of 618 Health Care Providers were in lawsuits filed in district court (including 405 Physicians & 148 Hospitals). As some claims filed in 2006 are open at the, that year s numbers will change, but the equivalent number at this time last year for the year 2005 was 12 Providers in lawsuits. 4 Medical Malpractice Claims Of the 1,865 Health Care Providers 1,040 were in medical malpractice claims filed with the, out of an annual average of 2,518 licensed Montana Health Care Providers: 10.6% Of Health Care Providers. Trends (Directions Of Change) From Data Trends, however are highly encouraging from the vantage-point of Health Care Providers. A Trend Analysis takes into account the changes in the number of Providers over the time intervals. raw data of claims, lawsuits and jury trials is divided by the number of Providers in each time interval of four years. This determines the percentage of Providers that were involved in those various claim stages. Without even adjusting for the increasing number of Health Care Providers, the absolute number of Providers in claims, lawsuits and jury trials has been recently falling: TREND - Average Annual NUMBER Of Licensed Health Care Providers (unadjusted For creases Number Of Licensed Physicians) Years Claims Lawsuits Jury Trials is unaware of any State that has a lower number or rate of Large Losses. 4 Montana s lawsuit rate is amongst the lowest in the nation. See: 2006 Annual Report, Montana Medical Legal. Montana Medical Legal Annual Report- Page 8

10 After adjustment for the number of Providers by dividing the raw numbers by the number of Providers in each time period the Trend is a recent significant drop in the rate of Providers in claims. As to the rate of Providers in lawsuits and jury trials, that trend is a continuous drop, period by period, since : TREND - Average Annual PERCENTAGE Of Licensed Health Care Providers (Accounting For creases Number Of Licensed Providers) Years Claims Lawsuits Jury Trials % 4.6% 0.12% % 4.2% 0.09% % 3.8% 0.05% % 2.7% 0.03% B. ALL PROVIDERS BY PROVIDER TYPE ALL YEARS (1) PHYSICIANS IN MEDICAL MALPRACTICE CLAIMS BY YEAR Looking at data on an annual basis, there has been a recent drop-off in the number of Physicians in medical malpractice claims, lawsuits and jury trials. During the entire time period covered, there has been an absence of jury trial results for claims and appeals from District Court decided by the Montana Supreme Court: Claim Year PHY Active Practice At Year- End MONTANA MEDICAL MALPRACTICE DATA PHYSICIANS (Unadjusted For creases Number Of Licensed Physicians) Medical Malpractice Claims At Lawsuits After Jury Trials After A Lawsuit Jury Trials Jury Verdict Of More Than $999,999 Decided By Montana Supreme Court , , , , , , , Total 1, Excluded from the above count are three Physicians, where the claims were dismissed from the. Montana Medical Legal Annual Report- Page 9

11 When the annual data for Physicians is collapsed into four-year increments, the trend is clearer. re is a trend towards reduced numbers of Physicians in Lawsuits and in Jury Trials following some lawsuits, with the number of Physicians in claims having just recently dropped. Physicians were successful in all jury trials: TREND - Average Annual NUMBER Of Physicians (Unadjusted For creases Number Of Physicians) Years Claims Lawsuits Jury Trials true trend, however, is to factor in the increased number of Physicians thus computing the rate of change. n the trend as a percentage of licensed Physicians is continuously downward for claims, lawsuits and jury trials. TREND - Average Annual PERCENTAGE Of Physicians (Accounting For creases Number Of Physicians) Years Claims Lawsuits Jury Trials % 4.1% 0.1% % 3.8% 0.1% % 3.4% 0% % 2.3% 0% (2) HOSPITALS IN MEDICAL MALPRACTICE CLAIMS BY YEAR Like Physicians, there has been a dearth of recent jury trials and appeals to the Montana Supreme Court from district court judgments. On an annual basis, there has been a recent drop in the number of Hospitals in lawsuits. Because the decision has not been made by many claims for cases filed at the in 2006, that data will change as time goes on, so for any provider the most current year s data for lawsuits has not been fully determined. 5 re is even a longer time lag for when a jury trial is completed, so that is also true of the most recent years of jury trials. But there has been a recent steady decline in the number of Hospitals in filed medical malpractice claims. Unlike Physicians where no claimants prevailed in a jury trial from filing years , in a filing year 2002 jury trial involving a Hospital, the claimant won at jury trial. During the filing year period, no Hospital lost any other jury trials. That trial was conducted in 2005 (from a year 2000 incident) and the jury awarded $ 1,365,092 to the claimant, including Pain and Suffering damages of $ 10, One other Hospital was involved in a jury trial during the time period, prevailing in that case. 5 Claims against 19 Hospitals filed in 2006 were open at the as of December 31, Likewise, claims against 62 Physicians filed in 2006 were open at the as of December 31, For purposes of this Report, a Large Loss award is defined as a judge or jury verdict for a dollar amount of $ 1 Million or more. Montana Medical Legal Annual Report- Page 10

12 Claim Year following represents the year-to-year data for Hospitals in medical malpractice claims: Licensed HOS At Year- End MONTANA MEDICAL MALPRACTICE DATA HOSPITALS Medical Jury Malpractice Lawsuits Jury Jury Trials Verdict Claims After Trials Of More At After A Than Lawsuit $999,999 Decided By Montana Supreme Court Total Excluded from the above count is one Hospital, where the claim was dismissed from the. Because the number of Hospitals has been relatively steady in Montana, the trend is established without accounting for changes in the number of Hospitals. grouping filing years together, that trend clearly demonstrates a reduction of Hospitals in claims starting in 2002, with the decline in the number of Hospitals in lawsuits steady from , but declining since the 2002 time period: TREND - Average Annual NUMBER Of Hospitals Years Claims Lawsuits Jury Trials (3) LONG-TERM CARE FACILITIES IN MEDICAL MALPRACTICE CLAIMS BY YEAR A Long-Term Care Facility lost one of the two jury trials where a Health Care didn t prevail during filing years A jury awarded $ 1 Million against a Long-Term Care Facility in claim was filed in 2001 and arose from an incident that occurred in Otherwise, jury trials against Facilities have been non-existent since filing year 2001, with the number of Facilities in claims and lawsuits fluctuating within a narrow range when viewed year-by-year. Montana Medical Legal Annual Report- Page 11

13 year-by-year data for Montana Long-Term Care Facilities is as follows: Claim Year MONTANA MEDICAL MALPRACTICE DATA LONG-TERM CARE FACILITIES 7 (Unadjusted For Changes Number Of Long-Term Care Facilities) Licensed LTCF At Year- End Medical Malpractice Claims At Lawsuits After Jury Trials After A Lawsuit Jury Trials Jury Verdict Of More Than $999,999 Decided By Montana Supreme Court Total When the Facility data is viewed in 4-year increments, the trend of the data indicates a narrow fluctuation in the range of Facility participation in claims, but a steady trend of declining involvement in medical malpractice lawsuits. TREND - Average Annual NUMBER Of Long-Term Care Facilities (Unadjusted For Changes Number Of Facilities) Years Claims Lawsuits Jury Trials TREND - Average Annual PERCENTAGE Of Long-Term Care Facilities (Accounting For Changes Number Of Facilities) Years Claims Lawsuits Jury Trials % 5.5% 0.216% % 4.5% 0.216% % 3.0% 0.000% % 2.8% 0.000% 7 legislature, from time to time, changes the definition of a non-hospital facility. As applicable to the, current long-term care facilities are: home health agencies, government infirmaries not university or college infirmaries, long-term care facilities, intermediate care facilities for the developmentally disabled, medical assistance facilities, mental health centers, outpatient centers for primary care, outpatient centers for surgical services, rehabilitation facilities, and residential treatment facilities Montana Medical Legal Annual Report- Page 12

14 (4) DENTISTS IN MEDICAL MALPRACTICE CLAIMS BY YEAR Dentists had a surge of claims in filing year 2003, along with a substantial increase in their involvement in lawsuits. But no Dentist has been involved in a jury trial during filing years Year-by-year, here is the data for Dentists who have not had substantial claims activity except during 2003 and 2006: Claim Year DEN Active Practice At Year- End MONTANA MEDICAL MALPRACTICE DATA DENTISTS (Unadjusted For creases Number Of Dentists) Medical Malpractice Claims At Lawsuits After Jury Trials After A Lawsuit Jury Trials Jury Verdict Of More Than $999,999 Decided By Montana Supreme Court Total trends for Dentists in claims have been essentially steady, fluctuating on average by only 1 claim per four-year average. Similarly, the number of Dentists included in medical malpractice lawsuits has remained fairly stead. TREND - Average Annual NUMBER Of Dentists (unadjusted For creases Number Of Dentists) Years Claims Lawsuits Jury Trials TREND - Average Annual PERCENTAGE Of Dentists (Accounting For creases Number Of Dentists) Years Claims Lawsuits Jury Trials % 0.80% 0.00% % 0.74% 0.00% % 0.78% 0.00% % 0.57% 0.00% Montana Medical Legal Annual Report- Page 13

15 (5) PODIATRISTS IN MEDICAL MALPRACTICE CLAIMS BY YEAR With the low volume of claims involving Podiatrists, patterns are difficult to discern. With a large jump in claims at the and consequent involvement in lawsuits in 2005, there are indications that the level of activity involving Podiatrists was on the rise. But the claim and lawsuit involvement leveled off in Claim Year POD Active Practice At Year- End MONTANA MEDICAL MALPRACTICE DATA PODIATRISTS (Unadjusted For creases Number Of Podiatrists) Medical Malpractice Claims At Lawsuits After Jury Trials After A Lawsuit Jury Trials Jury Verdict Of More Than $999,999 Decided By Montana Supreme Court Total Given the low volume of claims and the small number of Podiatrists, specific patterns are difficult to discern. TREND - Average Annual NUMBER Of Podiatrists (unadjusted For creases Number Of Podiatrists) Years Claims Lawsuits Jury Trials TREND - Average Annual PERCENTAGE Of Podiatrists (Accounting For creases Number Of Podiatrists) Years Claims Lawsuits Jury Trials % 3.7% 0.0% % 3.7% 0.6% % 6.6% 0.6% % 4.8% 0.6% Montana Medical Legal Annual Report- Page 14

16 4. CLAIMS HEARD, SETTLED & DROPPED One measure of the effectiveness of the, a mirror-image of sorts of reduced lawsuits and jury trials, is the presence of settled claims (where the Provider pays a sum of money to the claimant) or abandoned or dropped claims (where the, without any form of compensation, chooses to no longer pursue the claim). This elimination of claims from the litigation system either results in a claim being removed from the process or from the lawsuit jury trial process. result is that about 75% of the settled or abandoned claims can be directly or indirectly attributed to the presence of the : Those claims settled or abandoned at the or after the but before any lawsuit is filed: MONTANA MEDICAL MALPRACTICE SETTLED & DROPPED CLAIMS COMPARED WITH FULLY-CLOSED CLAIMS AT & AFTER THE PANEL All Providers For Years Number Percentage Number All Providers Impacts Impact Impact Fully Post- Dropped Or Settled Closed Before & Before Before Claims Without Suit OR After Suit Claims After Suit Suit Suit Providers Fully-Closed Claims 842 % Dropped BEFORE Decision 35.6% % Settled BEFORE Decision 9.3% % Dropped OR Settled At 44.9% 44.9% % Dropped BEFORE Suit 22.8% % Settled BEFORE Suit 5.6% % Dropped OR Settled BEFORE Suit 28.4% 28.4% % Dropped AFTER Suit 7.0% % Settled AFTER Suit 17.2% % Dropped OR Settled AFTER Suit 24.2% % Dropped OR Settled 97.5% 73.3% TOTAL DROPPED OR SETTLED % Impact - Dropped Or Settled Before Lawsuit As % Dropped Or Settled 75.2% difference in Providers in claims closed at and after the and settled or abandoned equals the number of Providers in jury trial verdicts, final summary judgments and final dismissals by the Court. Another major measures of the effectiveness of the is whether it is a substantial factor in any reduction in the rate of lawsuits and jury trials. Prior data has described the decline in the rate of lawsuits by comparing that rate when no mandatory entry screening panel was in existence versus the current mandatory entry Montana Medical Legal. Montana Medical Legal Annual Report- Page 15

17 That data has shown a high correlation of the presence of the mandatory versus either no panel at all or a voluntary panel. 8 For the time-period of , the rate of Providers in medical malpractice claims that also were in later lawsuits is 33.1%. For Physicians it was 32.3%. Each of these percentages is substantially below the rate of lawsuits in the absence of the, either when there was no panel of any kind or a voluntary-entry in effect OVERALL PANEL RAW DATA MONTANA MEDICAL MALPRACTICE CLAIM STAGES By Provider Type For Years AT THE PANEL Medical Malpractice Type Providers Claims With Decision Claim Stage Physician Hospital Dentist Facility Podiatrist TOTAL IN PANEL CLAIMS 1, ,869 Dropped Before Decision/Hearing Settled Before Decision/Hearing Decisions/Hearings By A ,386 Decisions/Hearings FOR s Decisions/Hearings FOR Providers ,213 Dismissed From - No Result Still Open At Claims 1, ,869 A decision by a includes hearings & decisions on the record. AFTER THE PANEL Medical Malpractice Type Providers Claims With Decision Claim Stage Physician Hospital Dentist Facility Podiatrist TOTAL IN POST-PANEL CLAIMS ,386 Abandoned Or Settled Lawsuit With Completed Jury Trial Jury Trial FOR With Judgment By Judge Judgment By Judge FOR With Appeal Claims Still Pending Post- Claims ,386 A claim is dropped when the claimant seeks no further relief. A settled claim is one where the claimant is paid a sum of money. At the stage, the claim can not go to Court without a Decision first being rendered. After the, a claimant drops a claim by not filing a lawsuit. Judgments By Judge include granted motions for summary judgment & dismissal of claim. Abandoned or Settled claims are either before or after a lawsuit. A lawsuit is not a jury trial. MONTANA MEDICAL MALPRACTICE SETTLED & DROPPED CLAIMS 8 rate of jury trials may well have been further impacted by the presence of the cap on non-economic damages. 9 All Providers: derived from the table on page 7. Physicians Only: derived from the table on page 9. Historically, the percentage of Physicians in medical malpractice claims also in later lawsuits: Without current (51% - 71%, depending on years measured) versus With current (30% - 31%, depending upon years measured. See: 2006 Annual Report, Montana Medical Legal. Montana Medical Legal Annual Report- Page 16

18 By Provider Type For Years Settlement Or Abandonment Type Providers Claims With Decision Stage Of Claim Physician Hospital Dentist Facility Podiatrist TOTAL IN PANEL CLAIMS 1, ,869 Dropped Before Decision/Hearing Settled Before Decision/Hearing TOTAL Number TOTAL % Dropped Or Settled 20.1% 22.8% 15.6% 13.0% 13.0% 20.2% IN POST-PANEL CLAIMS ,386 Dropped Or Settled % Dropped Or Settled 62.1% 53.8% 60.4% 67.8% 52.6% 60.2% TOTAL % SETTLED OR DROPPED 82.2% 76.6% 76.0% 80.8% 65.7% 80.4% MONTANA MEDICAL MALPRACTICE SETTLED & DROPPED CLAIMS COMPARED WITH FULLY-CLOSED CLAIMS AT AND AFTER THE PANEL All Providers For Years From Attorney Reports Of July 1, December 31, 2006 Number Providers Fully Post- Dropped Or Settled Closed Claims Without Suit OR After Suit Claims Providers Fully-Closed Claims 842 DROPPED OR SETTLED AT PANEL 378 All Impacts Before & After Suit Dropped BEFORE Decision % Dropped BEFORE Decision 35.6% Settled BEFORE Decision % Settled BEFORE Decision 9.3% Number Impact Before Suit Percentage Impact Before Suit % Dropped OR Settled At 44.9% 44.9% DROPPED OR SETTLED AFTER PANEL 443 Dropped BEFORE Any Lawsuit Settled BEFORE Any Lawsuit % Dropped BEFORE Suit 22.8% % Settled BEFORE Suit 5.6% % Dropped OR Settled BEFORE Suit 28.4% 28.4% DROPPED OR SETTLED AFTER SUIT 204 Dropped AFTER A Lawsuit 59 Settled AFTER A Lawsuit 145 % Dropped AFTER Suit 7.0% % Settled AFTER Suit 17.2% % Dropped OR Settled AFTER Suit 24.2% % Dropped OR Settled 97.5% 73.3% TOTAL DROPPED OR SETTLED % -END- Montana Medical Legal Annual Report- Page 17