Medical malpractice litigation and daylight saving time

Abstract

Study objectives: Daylight saving time (DST) constitutes a natural quasi-experiment to examine the influence of mild sleep loss and circadian misalignment. We investigated the acute effects of spring transition into DST and the chronic effects of DST (compared to standard time) on medical malpractice claims in the United States over 3 decades.

Methods: We analyzed 288,432 malpractice claims from the National Practitioner Data Bank. To investigate the acute effects of spring DST transition, we compared medical malpractice incidents/decisions 1 week before spring DST transition, 1 week following spring DST transition, and the rest of the year. To investigate the chronic effects of DST months, we compared medical malpractice incidents/decisions averaged across the 7-8 months of DST vs the 4-5 months of standard time.

Results: With regard to acute effects, spring DST transitions were significantly associated with higher payment decisions but not associated with the severity of medical incidents. With regard to chronic effects, the 7-8 DST months were associated with higher average payments and worse severity of incidents than the 4-5 standard time months.

Conclusions: The mild sleep loss and circadian misalignment associated with DST may influence the incidence of medical errors and decisions on medical malpractice payments both acutely and chronically.

Citation: Gao C, Lage C, Scullin MK. Medical malpractice litigation and daylight saving time. J Clin Sleep Med. 2024;20(6):933-940.

Keywords: cognition; emotional reactivity; health care policy; medical errors; performance; sleep deprivation.

Figure 1. Illustration of the malpractice incident and payment decision process.

Hypothesis 1 compares payments that were determined during the daylight saving time (DST) week, pre-DST control, and year-round control periods (A). Hypothesis 2 compares malpractice incidents that occurred during the DST week, pre-DST control, and year-round control periods (B). Hypothesis 3 compares averaged payments that were determined during the DST months and standard time months (C). Hypothesis 4 compares malpractice incidents that occurred during the DST months and standard time months (D).

Figure 2. For Hypothesis 1, we tested whether compensation amount determined would be elevated following the spring daylight saving time (DST) transition, measured by log-transformed payment amounts (A) and the proportion of high payments (B).

Error bars represent standard error (for log-transformed payment amounts) and 95% confidence interval (for proportion of high payments). In DST states, 267,092, 5,641, and 5,461 cases were determined during the year-round control period, pre-DST control week, and DST week, respectively. In control states, 9,822, 207, and 209 cases were determined during the year-round control period, pre-DST control week, and DST week, respectively.

Figure 3. For Hypothesis 2, we tested whether health care professionals would make more severe mistakes (ie, represented by higher payments) when the incidents occurred following the spring daylight saving time (DST) transition, measured by log-transformed payment amounts (A) and the proportion of high payments (B).

Error bars represent standard error (for log-transformed payment amounts) and 95% confidence interval (for proportion of high payments). In DST states, 266,827, 5,904, and 5,463 incidents occurred during year-round control period, pre-DST control week, and DST week, respectively. In control states, 9,844, 189, and 205 incidents occurred during year-round control period, pre-DST control week, and DST week, respectively.

Figure 4. For Exploratory Hypothesis 3, we tested whether malpractice incident payments determined during the 7–8 daylight saving time (DST) months would yield higher payments than those determined during the 4–5 standard time months, measured by log-transformed payment amounts (A) and the proportion of high payments (B).

Error bars represent standard error (for log-transformed payment amounts) and 95% confidence interval (for proportion of high payments). In DST states, 109,501 and 168,693 cases were determined during standard time months and DST months, respectively. In control states, 4,103 and 6,135 cases were determined during standard time months and DST months, respectively.

Figure 5. For Exploratory Hypothesis 4, we tested whether malpractice incidents occurring during the 7–8 daylight saving time (DST) months would be more severe (ie, yielding higher payments) than those occurring during the 4–5 standard time months, measured by log-transformed payment amounts (A) and the proportion of high payments (B).

Error bars represent standard error (for log-transformed payment amounts) and 95% confidence interval (for proportion of high payments). In DST states, 115,474 and 162,720 incidents occurred during standard time months and DST months, respectively. In control states, 4,332 and 5,906 incidents occurred during standard time months and DST months, respectively.