Patient relationships may play key role in reducing pediatric malpractice risk

Documentation is an important component of medical liability risk management, but pediatricians should not overlook another potentially powerful factor: the relationship they establish with patients and families, according to Steven Bondi, JD, MD, FAAP.

Bondi, a pediatric intensivist practicing at Golisano Children's Hospital in Rochester, New York, is a former attorney who has pursued work in risk management and research examining medical malpractice in pediatrics. He also serves as chair of the American Academy of Pediatrics (AAP) Committee on Medical Liability and Risk Management. Bondi discussed strategies for understanding and mitigating liability risk at the AAP 2026 National Conference & Exhibition.

What are common malpractice risks in pediatrics?

Understanding malpractice trends in pediatrics is complicated by limitations in available data, Bondi explained. Researchers generally rely on practitioner surveys, malpractice insurance company data, and the National Practitioner Data Bank, but each source has limitations.

Insurance data, for example, may combine pediatricians with obstetricians or orthopedic surgeons when categorizing certain neonatal or pediatric claims. The National Practitioner Data Bank captures claims that have reached specific stages in the process, potentially leaving other cases unrepresented.

Despite these limitations, Bondi identified several areas pediatricians should recognize.

Birth injuries and hypoxic-ischemic events can pose liability concerns for clinicians caring for newborns. Hyperbilirubinemia represents another area for vigilance.

"It's pretty rare these days, but the lawsuits can be very large in terms of dollar amounts because there's a clear, established standard of care," Bondi said of hyperbilirubinemia-related cases. "So we want to make sure we take diligence caring for those newborns."

Failure to diagnose also remains an important category. Bondi highlighted meningitis and developmental dysplasia of the hip, as well as less common cases involving missed appendicitis and pneumonia.

Is documentation enough to reduce malpractice risk?

Although documentation remains important, Bondi said he encourages pediatricians to think more broadly about risk management.

"The traditional answer to that question is it's all about documentation, and that's a right answer, but it's not the right answer," he said.

Instead, Bondi emphasized the relationship between the clinician and family.

"For me, the point I like to emphasize is that the single most important factor in protecting oneself against malpractice claims is having a solid relationship with the family, and patient too," he said.

Bondi noted that specialties characterized by longitudinal patient relationships, including pediatrics, family medicine, and psychiatry, tend to experience lower rates of malpractice claims. He acknowledged that other factors, including differences in the number and types of procedures performed, may also contribute to those patterns.

What should pediatricians do after an adverse event?

The clinician-family relationship can become particularly important when something unexpected happens, according to Bondi.

Following an adverse event, clinicians may instinctively shy away from difficult conversations. Bondi argued that the opposite approach may be more productive.

"There's an opportunity after there is an unexpected event to have a conversation and put that in context," he said.

Bondi noted that laws governing conversations about errors and adverse events differ by state, making it important for clinicians to understand the protections and requirements where they practice. Even with those considerations, he emphasized the value of communicating early.

Research examining why patients and families pursue malpractice claims also suggests that motivations may extend beyond financial compensation, Bondi said.

"They have to do with wanting someone to take responsibility for what happened, and they want assurances that the event won't happen again," he said.

That makes communication following an adverse event an important component of the clinician-family relationship.

"We, as human beings, are likely to kind of shy away from those conversations when there's been an adverse event, and we really need to do the opposite," Bondi said. "We really need to be more engaging and have a conversation about it."

Bondi cautioned that these conversations require care and judgment, particularly given differences in state laws. Still, his broader message for pediatricians was that risk management extends beyond the medical record. Building trust before problems occur—and maintaining communication when they do—can be an important part of navigating difficult outcomes.

Reference

Bondi S. I am Being Sued! Presented at: American Academy of Pediatrics 2026 National Conference & Exhibition; October 5, 2026; San Diego, CA.