Proposals to reform the medical malpractice system often include caps on payouts, under the assumption that such large awards drive up overall health care costs. This analysis of data from the National Practitioner Data Bank examined the characteristics of catastrophic payouts, in which the plaintiff received $1 million or more. The investigators found that catastrophic payouts accounted for less than 8% of all paid malpractice claims, and they made up only 0.05% of total yearly health care expenditures. Catastrophic payments most frequently arose as a result of a diagnostic error and were more likely to occur for anesthesia and obstetric complications resulting in severe injury or death. The intersection between patient safety and the malpractice system was discussed by Dr. Troyen Brennan in a past AHRQ WebM&M interview.