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Zaman M, Li JH, Dhir M. Malpractice Claims Following Major Liver and Pancreatic Surgeries: What Can we Learn? J Surg Res 2024; 298:291-299. [PMID: 38640614 DOI: 10.1016/j.jss.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/08/2024] [Accepted: 03/21/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION General surgery is a highly litigious specialty. Lawsuits can be a source of emotional distress and burnout for surgeons. Major hepatic and pancreatic surgeries are technically challenging general surgical oncology procedures associated with an increased risk of complications and mortality. It is unclear whether these operations are associated with an increased risk of lawsuits. The objective of the present study was to summarize the medical malpractice claims surrounding pancreatic and hepatic surgeries from publicly available court records. METHODS The Westlaw legal database was searched and analyzed for relevant malpractice claims from the last two decades. RESULTS Of 165 search results, 30 (18.2%) cases were eligible for inclusion. Appellant cases comprised 53.3% of them. Half involved a patient death. Including co-defendants, a majority (n = 21, 70%) named surgeons as defendants, whereas several claims (n = 13, 43%) also named non-surgeons. The most common cause of alleged malpractice was a delay in diagnosis (n = 12, 40%). In eight of these, surgery could not be performed. The second most common were claims alleging the follow-up surgery was due to negligence (n = 6). Collectively, 20 claims were found in favor of the defendant. Seven verdicts (23.3%) returned in favor of the plaintiff, two of which resulted in monetary awards (totaling $1,608,325 and $424,933.85). Three cases went to trial or delayed motion for summary judgment. There were no settlements. CONCLUSIONS A defendant verdict was reached in two-thirds of malpractice cases involving major hepatic or pancreatic surgery. A delay in diagnosis was the most cited claim in hepatopancreaticobiliary lawsuits, and defendants may often practice in nonsurgical specialties. While rulings favoring plaintiffs are less frequent, the payouts may be substantial.
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Affiliation(s)
- Muizz Zaman
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, New York; Department of Surgery, SUNY Upstate Medical University, Syracuse, New York.
| | - Jian Harvard Li
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, New York
| | - Mashaal Dhir
- Department of Surgery, SUNY Upstate Medical University, Syracuse, New York.
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2
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Fritz C, Rajasekaran K. Delayed in diagnosis of upper aerodigestive tract cancers: A comprehensive review of medical malpractice cases. Head Neck 2023. [PMID: 37144329 DOI: 10.1002/hed.27390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/28/2023] [Accepted: 04/25/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Factors that prompt litigation and influence outcomes for malpractice cases involving cancers of the upper aerodigestive tract are incompletely described. METHODS Westlaw, a national legal database, was searched for medical malpractice claims related to upper aerodigestive tract cancer for all years available. RESULTS Of the 122 cases meeting inclusion criteria, 106 (86.9%) involved allegations of failure to diagnose or delay in diagnosis. Tongue, larynx, and nasopharynx cancers were more frequently litigated than would be expected based on their incidence (tongue, 38.7% of aerodigestive tract litigation vs. 26.9% of aerodigestive tract cancers; larynx, 33.0% vs. 22.3%; nasopharynx, 10.4% vs. 4.6%). Payouts were made in over half of diagnosis failure lawsuits (56.6%), which carried an average award of $2840690 [IQR 850219-2537509]. CONCLUSIONS An awareness of litigation on cancers of the upper aerodigestive tract holds the potential to improve patient care and help otolaryngologists avoid potential risks for litigation.
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Affiliation(s)
- Christian Fritz
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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3
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Marrone M, Caterino C, Musci G, Cazzato G, Ingravallo G, Lupo C, Casatta N, Stellacci A, Armenio A. Photography as the Sole Means of Proof: Medical Liability in Dermatology. Diagnostics (Basel) 2023; 13:diagnostics13061033. [PMID: 36980340 PMCID: PMC10047858 DOI: 10.3390/diagnostics13061033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 02/25/2023] [Accepted: 03/07/2023] [Indexed: 03/12/2023] Open
Abstract
Malignant melanoma is a cutaneous malignancy resulting from the uncontrolled proliferation of melanocytes and poses a challenge diagnostically because neoplastic lesions can mimic benign lesions, which are much more common in the population. Doctors, when they suspect the presence of melanoma, arrange for its removal and the performance of a histological examination to ascertain its diagnosis; in cases where the dermatoscopic examination is indicative of benignity, however, after the lesion is removed, histological examination is not always performed, a very dangerous occurrence and a harbinger of further medico-legal problems. The authors present a court litigation case of an “alleged” failure to diagnose malignant melanoma in a patient who died of brain metastases from melanoma in the absence of a certain location of the primary tumor: the physician who had removed a benign lesion a few months earlier was sued, and only thanks to the presence of photographic documentation was the health care provider able to prove his extraneousness. The aim of this paper is to formulate a proposal for a dermatological protocol to be followed in cases of excisions of benign skin lesions with a twofold purpose: on the one hand, to be able to prove, in a judicial context, the right action on the part of the sanitarians; on the other hand, to avoid the rise of so-called “defensive medicine”.
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Affiliation(s)
- Maricla Marrone
- Section of Legal Medicine, Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Cristina Caterino
- Section of Legal Medicine, Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Gianluca Musci
- Section of Legal Medicine, Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Gerardo Cazzato
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy
- Correspondence: ; Tel.: +39-3405203641
| | - Giuseppe Ingravallo
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Carmelo Lupo
- Innovation Department, Diapath S.p.A., Via Savoldini n.71, 24057 Martinengo, Italy
| | - Nadia Casatta
- Innovation Department, Diapath S.p.A., Via Savoldini n.71, 24057 Martinengo, Italy
| | - Alessandra Stellacci
- Section of Legal Medicine, Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Andrea Armenio
- Plastic Surgery Department, IRCCS Istituto Tumori “Giovanni Paolo II”, V.le O. Flacco, 65, 70124 Bari, Italy
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Forrest C, Madden D, O'Sullivan MJ, O'Reilly S. Learning From Medical Litigation. JCO Oncol Pract 2023; 19:160-163. [PMID: 36652657 DOI: 10.1200/op.22.00763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Clara Forrest
- Academic Track Intern Programme, Intern Network Executive, School of Medicine, University College, Cork, Ireland
| | | | | | - Seamus O'Reilly
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland.,Cancer Research@UCC, University College Cork, Cork, Ireland
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5
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Eloy JD, Pashkova AA, Amin M, Anthony C, Munoz D, Gubenko Y, Patel S, Korban A, Perales A, Svider PF, Eloy JA. Protecting the Airway and the Physician: Lessons from 214 Cases of Endotracheal Intubation Litigation. Anesthesiol Res Pract 2022; 2022:8209644. [PMID: 36312452 PMCID: PMC9613385 DOI: 10.1155/2022/8209644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/03/2022] [Indexed: 11/28/2022] Open
Abstract
Objective Medicolegal examination of an intervention as common as endotracheal intubation may be valuable to physicians in many specialties. Our objectives were to comprehensively detail the factors raised in litigation to better educate physicians on strategies for minimizing liability and augmenting patient safety. Methods Publicly available court records were searched for pertinent litigation. Ultimately, 214 jury verdict and settlement reports were examined for various factors, including outcome, award, geographic location, defendant specialty, setting in which an injury occurred, patient demographics, and other causes of malpractice. Results Ninety-two cases (43.0%) were resolved in the defendant's favor, with the remaining cases resulting in out-of-court settlement or a plaintiff's verdict. Payments from these cases were considerable, averaging $2.5 M. The most frequent physician defendants were anesthesiologists (59.8%) and emergency-physicians (19.2%), although other specialties were well represented. The most common setting of injury was the operating room (45.3%). Common factors included sustaining permanent deficits (89.2%), death (50.5%), and anoxic brain injury (37.4%). Injuries occurring in labor and delivery mostly involved newborns and had among the highest awards. Conclusions Litigation involves injuries sustained in numerous settings. The most common factors present included sustaining permanent deficits, including anoxic brain injury. The presence of this latter injury increased the likelihood of a case being resolved with payment. Finally, deficits in informed consent were noted in numerous cases, stressing the importance of a clear process in which the physician explains specific risks (such as those detailed in this analysis), benefits, and alternatives.
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Affiliation(s)
- Jean Daniel Eloy
- Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Anna A. Pashkova
- Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Molly Amin
- Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Christy Anthony
- Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Daisy Munoz
- Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Yuriy Gubenko
- Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Shivani Patel
- Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Anna Korban
- Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Andrea Perales
- Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Peter F. Svider
- Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology–Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
- Department of Neurological Surgery, University of Medicine and Dentistry of NJ, New Jersey Medical School, Newark, NJ, USA
- Center for Skull Base and Pituitary Surgery, University of Medicine and Dentistry of NJ, New Jersey Medical School, Newark, NJ, USA
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6
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Mahalingam M. Reforms, Errors, and Dermatopathology Malpractice: Then and Now: A Comprehensive Retrospective. Adv Anat Pathol 2022; 29:81-96. [PMID: 34561375 DOI: 10.1097/pap.0000000000000319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Medical malpractice occurs when a hospital, doctor, or other health care professional, through a negligent act or omission, causes an injury to a patient. The negligence might be the result of errors in diagnosis, treatment, aftercare, or health management. To be considered medical malpractice under the law, the claim must violate the standard of care, the injury must be caused by the negligence and, last but most certainly not least, the injury must result in significant damages. This review is an overview of medicolegal issues specific to the practice of Dermatopathology with the caveat that most are likely pertinent to other specialties of pathology as well. The safety of patients remains the priority in pathology as it does in any medical undertaking, and this is no different in the practice of Dermatopathology. The review is broadly divided in 2 parts-we begin with an overview of tort reforms, advocated by physicians to reduce costs associated with malpractice defense. In the second part we address practical issues specific to the practice of pathology and dermatopathology. These include among others, errors-related to the biopsy type, inadequacy of clinical information regarding the lesion that is biopsied, role of interstate dermatopathology as well as examples of select entities commonly misdiagnosed in dermatopathology. In the last decade, artificial intelligence (AI) has moved to the forefront of technology. While research into the uses of AI in pathology is promising, the use of AI in diagnostic practice is still somewhat uncommon. Given that AI is not fully integrated routinely as a diagnostic adjunct, its' impact on pathology-specific medicolegal issues cannot, as yet at least, be defined. Restriction of medical malpractice is of particular relevance in the COVID-19 era, a period that is anything but normal. The response of states with specific pandemic-related guidelines is addressed with the caveat that this particular issue is only covered in select states. Furthermore, given that the COVID pandemic is only a year old, while it does not appear to have had an immediate impact on pathology-specific medicolegal matters, it is possible that the role of COVID on this issue, if any at all, will and can only be fully defined a few years down the line.
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Affiliation(s)
- Meera Mahalingam
- *Department of Dermatology, Tufts University School of Medicine, Boston
- †Dermatopathology Section, VA Consolidated Laboratories, Department of Pathology and Laboratory Medicine, West Roxbury, MA
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Delayed Diagnosis Is the Primary Cause of Sarcoma Litigation: Analysis of Malpractice Claims in the United States. Clin Orthop Relat Res 2020; 478:2239-2253. [PMID: 32496320 PMCID: PMC7491906 DOI: 10.1097/corr.0000000000001340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sarcoma care is highly litigated in medical malpractice claims. Understanding the reasons for litigation and legal outcomes in sarcoma care may help physicians deliver more effective and satisfying care to patients while limiting their legal exposure. However, few studies have described malpractice litigation in sarcoma care. QUESTIONS/PURPOSES (1) What percentage of sarcoma malpractice cases result in a defendant verdict? (2) What is the median indemnity payment for cases that result in a plaintiff verdict or settlement? (3) What are the most common reasons for litigation, injuries sustained, and medical specialties of the defendant physicians? (4) What are the factors associated with plaintiff verdicts or settlements and higher indemnity payments? METHODS The national medicolegal database Westlaw was queried for medical malpractice cases pertaining to sarcomas that reached verdicts or settlements. Cases from 1982 to 2018 in the United States were included in the study to evaluate for trends in sarcoma litigation. Demographic and clinical data, tumor characteristics, reasons for litigation, injuries, and legal outcomes were recorded for each case. A univariate analysis was performed to identify factors associated with plaintiff verdicts or settlements and higher indemnity payments, such as tumor characteristics, defendant's medical or surgical specialty, reason for litigation, and injuries sustained. A total of 92 cases related to sarcomas were included in the study, of which 40 were related to bone sarcomas and 52 were related to soft-tissue sarcomas. Eighty-five percent (78 of 92) of cases involved adult patients (mean age ± SD: 40 ± 15 years) while 15% (14 of 92) of cases involved pediatric patients (mean age ± SD: 12.5 ± 5 years). RESULTS Thirty-eight percent (35 of 92) of the included cases resulted in a defendant verdict, 30% (28 of 92) resulted in a plaintiff verdict, and 32% (29 of 92) resulted in a settlement. The median (interquartile range [IQR]) indemnity payment for plaintiff verdicts and settlements was USD 1.9 million (USD 0.5 to USD 3.5 million). Median (IQR) indemnity payments were higher for cases resulting in a plaintiff verdict than for cases that resulted in a settlement (USD 3.3 million [1.1 to 5.7 million] versus USD 1.2 million [0.4 to 2.4 million]; difference of medians = USD 2.2 million; p = 0.008). The most common reason for litigation was delayed diagnosis of sarcoma (91%; 84 of 92) while the most common injuries cited were progression to metastatic disease (51%; 47 of 92) and wrongful death (41%; 38 of 92). Malpractice claims were most commonly filed against primary care physicians (26%; 28 of 109 defendants), nononcology-trained orthopaedic surgeons (23%; 25 of 109), and radiologists (15%; 16 of 109). Cases were more likely to result in a ruling in favor of the plaintiff or settlement if a delay in diagnosis occurred despite suspicious findings on imaging or pathologic findings (80% versus 51%; odds ratio 3.84 [95% CI 1.34 to 11.03]; p = 0.02). There were no differences in indemnity payments with the numbers available in terms of tumor type, tumor location, defendant specialty, reason for litigation, and resulting injuries. CONCLUSIONS Many lawsuits were made against primary care physicians, nononcology-trained orthopaedic surgeons, or radiologists for a delayed diagnosis of sarcoma despite the presence of imaging or histologic findings suspicious for malignancy. Although previous studies of bone and soft-tissue sarcomas have not shown a consistent association between time to diagnosis and decreased survival, our study suggests that physicians are still likely to lose these lawsuits because of the perceived benefits of an early diagnosis. CLINICAL RELEVANCE Physicians can mitigate their malpractice risk while reducing delays in diagnosis of sarcomas by carefully reviewing all existing diagnostic studies, establishing closed-loop communication protocols to communicate critical findings from diagnostic studies, and developing policies to facilitate second-opinion consultation, particularly for imaging studies, with an experienced sarcoma specialist. Musculoskeletal oncologists may be able to help further reduce the rates of malpractice litigation in sarcoma care by helping patients understand that delays in diagnosis do not necessarily constitute medical malpractice.
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8
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Tripathi R, Ezaldein HH, Rajkumar K, Bordeaux JS, Scott JF. Characteristics of State and Federal Malpractice Litigation of Medical Liability Claims for Keratinocyte Carcinoma, 1968 to 2018. JAMA Dermatol 2020; 155:812-818. [PMID: 31090874 DOI: 10.1001/jamadermatol.2019.0430] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance The prevalence of keratinocyte carcinoma (KC) exceeds that of all other malignant neoplasms combined. Despite the steady rise of payments for medical malpractice liability claims over time, data regarding the characteristics of malpractice litigation for KC are scarce. Objective To identify state and federal appellate medical malpractice liability cases for KC and determine the factors associated with the verdicts. Design, Setting, and Participants This retrospective review of KC-related malpractice litigation under state or federal jurisdiction reviewed the LexisNexis Academic database of state and federal cases, legal reviews, and case law. All appellate medical malpractice cases at the state and federal levels involving basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) from January 1, 1968, through December 31, 2018, were identified. Main Outcomes and Measures Demographic characteristics of the cases and plaintiffs, verdict, health care specialty of the defendant, setting of the litigation, rationale for the lawsuit and verdict, factors associated with the case outcome, and monetary payout in cases won by the plaintiff. Results In total, 83 cases were included in our analysis (34 BCC cases and 49 SCC cases; 47 [57%] male plaintiffs). Sixty-two cases (75%) were decided in favor of the defendant. More KC-related malpractice cases were won by defendants in more recent years than were won by plaintiffs (mean year, 2004 [SD, 11 years] vs 1998 [SD, 14 years]; P = .03). Twenty-five cases (30%) each occurred in the Northeast and the South, and 45 (54%) involved private practices. Most cases involved KCs occurring on the face, head, and/or neck (39 [47%]), the genitalia (22 [27%]), or the extremities (15 [18%]). More than half of defendants were dermatologists (19 [23%]), family medicine physicians (15 [18%]), or oncologists (8 [10%]). Jurisprudence for KC-related malpractice cases most often occurred at the state level (49 [59%]). The most common causes of litigation were failure to diagnose (18 [22%]), misdiagnosis (18 [22%]), and delay in treatment (11 [13%]). More female than male plaintiffs won their malpractice cases (11 of 35 [31%] vs 5 of 43 [12%]; P = .03). More cases involving SCC than BCC led to a decision favoring the plaintiff (13 of 47 [28%] vs 3 of 31 [10%]; P = .05). In cases won by the plaintiff, the median monetary payout was $179 654 and the mean payout was $909 801 (range, $11 537-$5 320 161). Conclusions and Relevance This study sheds light on the characteristics and settings of KC malpractice litigation claims, which is vital information for discovering potential areas of quality improvement, patient safety initiatives, and education for patients and health care professionals.
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Affiliation(s)
- Raghav Tripathi
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Harib H Ezaldein
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Jeremy S Bordeaux
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jeffrey F Scott
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Bordonaba-Leiva S, Gómez-Durán EL, Balibrea JM, Benet-Travé J, Martin-Fumadó C, Bescos Atin C, Mareque-Bueno J, Arimany-Manso J. Twenty four years of oral and maxillofacial surgery malpractice claims in Spain: patient safety lessons to learn. Oral Maxillofac Surg 2019; 23:187-192. [PMID: 31037563 DOI: 10.1007/s10006-019-00756-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 04/04/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE Oral and maxillofacial surgery (OMS) malpractice risk is of special interest due to both the aesthetic component of some procedures and the complexity of the pathologies involved. This study aims to identify relevant factors involved in OMS professional liability (PL) claims to help achive better management of risks and improve patient safety. METHODS We performed a retrospective analysis of 315 OMS claims opened between 1990 and 2014 from the database of the PL Department of the Catalonian Council of Medical Colleges, and identified their clinical, economical and juridical characteristics. RESULTS OMS showed a high rate of compensation (33.8%). Dental implant surgery, third molar surgery and rhinoplasty presented the greatest exposure to claims, and in these cases, lack of osteointegration of dental implants, neurologic injury of inferior dentoalveolar/lingual nerves and a poor aesthetic result were the most frequently compensated sequelae. Statistically, significant association was found between this perioperative complications group and the presence of PL. Poorly documented patient information (informed consent document) was also significantly related with PL outcome. CONCLUSIONS OMS is a specialty of medium risk for claims, especially oral surgery cases. Surgical complications, such as neurologic damage after oral/head and neck procedures and poor aesthetic results, do occur and deserve special attention to improve patient safety, as well as patient-information procedure.
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Affiliation(s)
- Sergio Bordonaba-Leiva
- Department of Oral and Maxillofacial Surgery, Germans Trias i Pujol University Hospital; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Esperanza L Gómez-Durán
- Area de Praxi, Col-legi de Metges de Barcelona, Passeig Bonanova, 47, 08017, Barcelona, Spain.
- Departamento de Medicina, Universitat Internacional de Cataluña, Barcelona, Spain.
| | - José M Balibrea
- Department of General and Digestive Surgery, Vall Hebrón University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep Benet-Travé
- Area de Praxi, Col-legi de Metges de Barcelona, Passeig Bonanova, 47, 08017, Barcelona, Spain
| | - Carles Martin-Fumadó
- Area de Praxi, Col-legi de Metges de Barcelona, Passeig Bonanova, 47, 08017, Barcelona, Spain
| | - Coro Bescos Atin
- Department of Oral and Maxillofacial Surgery, Vall Hebrón University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Javier Mareque-Bueno
- Department of Oral and Maxillofacial Surgery, Quirón-Dexeus University Hospital, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Josep Arimany-Manso
- Area de Praxi, Col-legi de Metges de Barcelona, Passeig Bonanova, 47, 08017, Barcelona, Spain
- Unidad de Medicina Legal y Forense, Departamento de Salud Pública, Universidad de Barcelona, Barcelona, Spain
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10
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Shin SH, Lee W, Kim SY, Jo G, Mun JH, Cho SI. Analysis of Judicial Precedents Cases Regarding Skin Cancer from 1997 to 2017 in Republic of Korea. Ann Dermatol 2019; 31:300-306. [PMID: 33911595 PMCID: PMC7992736 DOI: 10.5021/ad.2019.31.3.300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/13/2018] [Accepted: 12/19/2018] [Indexed: 01/01/2023] Open
Abstract
Background Both medical disputes and the incidence of skin cancer are increasing in Korea. Objective The aim of this study was to figure out the medical litigation related to skin cancer and propose a method to prevent the medical disputes. Methods Skin cancer-related judgments were searched by The Supreme Court of Korea's Written Judgment Management System based on the keywords for skin cancer. The search system included sentenced cases at the Lower Courts, the Appellate Courts, and the Supreme Court from 1997 to 2017. Results Seven cases were selected as the litigation cases related to skin cancer. Four cases (57.1%) presented malignant melanoma, while the rest presented squamous cell carcinoma, metastatic skin cancer, and peripheral T cell lymphoma (1 case in each). Four cases resulted in death from cancer metastasis, and 3 cases presented as sequelae. The legal issues related to the medical disputes could be categorized as follows: misdiagnosis, delayed diagnosis, performance error, and lack of informed consent. Delayed diagnosis and lack of informed consent were the most common issues (n=4) in the precedents. Five cases (71.4%) were sentenced the awarded amounts to the plaintiff, including 2 cases of settlement decision. The average awarded amount was 42,553,644±27,567,455 Korean won. Conclusion Physicians should pay attention to the cases of the skin cancer to prevent medical malpractice and disputes. The practices pertaining to proper diagnosis, treatment plans, and obtaining an informed consent should be followed during the course of treating skin cancer.
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Affiliation(s)
- Su Hwan Shin
- Doctoral Program in Medical Law and Ethics, Yonsei University, Seoul, Korea.,Blue Urology Clinic, Seoul, Korea
| | - Won Lee
- Division of Medical Law and Bioethics, Department of Medical Humanities and Social Sciences, Yonsei University College of Medicine, Seoul, Korea.,Asian Institute for Bioethics and Health Law, Yonsei University, Seoul, Korea
| | - So Yoon Kim
- Division of Medical Law and Bioethics, Department of Medical Humanities and Social Sciences, Yonsei University College of Medicine, Seoul, Korea.,Asian Institute for Bioethics and Health Law, Yonsei University, Seoul, Korea
| | - Gwanghyun Jo
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Je-Ho Mun
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Soo Ick Cho
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
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11
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Arimany Manso J, Martin Fumadó C, Mascaró Ballester J. Medical Malpractice Issues in Dermatology: Clinical Safety and the Dermatologist. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2018.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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12
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Fritz MA, Postma GN. Where am I? Transnasal esophagoscopy outside the normal esophagus. EAR, NOSE & THROAT JOURNAL 2018; 96:E44. [PMID: 29236282 DOI: 10.1177/014556131709601210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Medical malpractice is costly and disruptive, and it is important to prevent. We conducted a study with the objective to look at medical malpractice in robotic surgery overall, to evaluate reasons for litigation, and to comment on possible strategies to avoid litigation with transoral robotic surgery. We used the Westlaw computerized database to identify all state and federal verdict summaries in medical malpractice cases. We found 17 cases alleging malpractice that involved the use of robotic surgery. In all, the plaintiffs in 6 cases (35%) contended that an open rather than a robotic approach should have been used, 5 (29%) alleged negligent credentialing, 4 (24%) alleged training deficiencies, 2 (12%) alleged manufacturing problems, and 1 (6%) charged that robotic surgery should have been performed instead of open surgery (1 case involved two of these allegations). In 11 cases (65%), plaintiffs charged that robotic surgery contributed to an undesirable outcome, and in 6 cases (35%) they raised concerns about informed consent. In all, only 5 of the 17 lawsuits (29%) resulted in plaintiff verdicts or settlements; damages ranged from $95,000 to $7.5 million. We believe the courts should not play a major role in establishing safety guidelines for the introduction of new technology such as robotic surgery. Instead, training and credentialing guidelines should be established by appropriate national associations and societies to assist hospitals in doing so.
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Affiliation(s)
- Mark A Fritz
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University, Augusta, GA, USA
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Arimany Manso J, Martin Fumadó C, Mascaró Ballester JM. Medical Malpractice Issues in Dermatology: Clinical Safety and the Dermatologist. ACTAS DERMO-SIFILIOGRAFICAS 2018; 110:20-27. [PMID: 30077393 DOI: 10.1016/j.ad.2018.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 05/17/2018] [Accepted: 06/22/2018] [Indexed: 12/11/2022] Open
Abstract
Clinical safety and medical liability are first-order concerns in today's medical practice. It is important to understand the circumstances under which medical acts fail to live up to the accepted standard of care and to recognize the impact that malpractice claims have on physicians. Practitioners must also grasp the concept of medical error, studying malpractice claims in order to identify the areas where improvement is needed. The risk of accusations of malpractice in dermatology is comparatively low, both in Spain and worldwide. However, a great variety of clinical scenarios in dermatology can potentially give rise to a claim, and malignant melanoma is most susceptible to risk. Dermatologists should know which actions during clinical consultation merit particular attention and care. Clinical practice carries inherent risk of malpractice claims, but taking certain recommended precautions can prevent them.
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Affiliation(s)
- J Arimany Manso
- Servicio de Responsabilidad Profesional, Área de Praxis, Colegio de Médicos de Barcelona, Consejo de Colegios de Médicos de Catalunya, Barcelona, España; Unidad de Medicina Legal y Forense, Departamento de Salud Pública, Facultad de Medicina, Universidad de Barcelona, Barcelona, España.
| | - C Martin Fumadó
- Servicio de Responsabilidad Profesional, Área de Praxis, Colegio de Médicos de Barcelona, Consejo de Colegios de Médicos de Catalunya, Barcelona, España; Departamento de Medicina, Facultad de Medicina, Universitat Internacional de Catalunya, Barcelona, España
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Lydiatt DD, Sewell RK. Medical Malpractice and Sinonasal Disease. Otolaryngol Head Neck Surg 2018; 139:677-81. [DOI: 10.1016/j.otohns.2008.06.027] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2007] [Revised: 06/09/2008] [Accepted: 06/18/2008] [Indexed: 11/29/2022]
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Li Y, Gao D, Tu M, Luo YZ, Deng ZH. Investigation of pathology malpractice claims in China from 2002-2015. J Forensic Leg Med 2017; 48:30-34. [PMID: 28431271 DOI: 10.1016/j.jflm.2017.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 03/20/2017] [Accepted: 04/12/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To examine pathology-related medical claims in China and identify the most common errors to result in such claims. METHOD A retrospective analysis was performed of 71 forensic evaluation reports carried out in two Chinese institutes of forensic medicine between 2002 and 2015 due to suspicion of medical malpractice. The judicial outcomes of each case were also reviewed when available. RESULTS Of 71 cases, 54 cases had judicial outcomes. The most frequently claimed events were false-negative diagnoses of skin cancer, invasive ductal carcinoma of the breast, and osteosarcoma; and false positive diagnoses of uterine cervical squamous cell carcinoma, gastric carcinoma, and soft tissue carcinoma. The most common cause of error (82%, 56 of 68) was pathological misinterpretation. Plaintiffs in most cases (89%, 48 of 54) received compensation. CONCLUSION Our data are in agreement with other findings regarding the most frequent medical malpractice allegations related to pathology. Addressing the issues at the root of these claims would lead to a decline in the number of medical errors. Quality assurance programs and good pathologist-clinician communication may decrease the risk of litigation.
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Affiliation(s)
- Yuan Li
- Department of Forensic Pathology, West China School of Preclinical and Forensic Medicine, Sichuan University, Chengdu 610041, PR China
| | - Dong Gao
- Shanghai Key Laboratory of Forensic Medicine, Institute of Forensic Science, Ministry of Justice, No. 1347 West Guang Fu Road, Shanghai 200063, PR China
| | - Meng Tu
- Department of Forensic Pathology, West China School of Preclinical and Forensic Medicine, Sichuan University, Chengdu 610041, PR China
| | - Ying-Zhen Luo
- Department of Forensic Pathology, West China School of Preclinical and Forensic Medicine, Sichuan University, Chengdu 610041, PR China
| | - Zhen-Hua Deng
- Department of Forensic Pathology, West China School of Preclinical and Forensic Medicine, Sichuan University, Chengdu 610041, PR China.
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Marshall DC, Punglia RS, Fox D, Recht A, Hattangadi-Gluth JA. Medical Malpractice Claims in Radiation Oncology: A Population-Based Study 1985-2012. Int J Radiat Oncol Biol Phys 2015; 93:241-50. [PMID: 26232856 DOI: 10.1016/j.ijrobp.2015.05.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 05/13/2015] [Accepted: 05/26/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to determine trends in radiation oncology malpractice claims and expenses during the last 28 years and to compare radiation oncology malpractice claims to those of other specialties. METHODS AND MATERIALS We performed a retrospective analysis of closed malpractice claims filed from 1985 to 2012, collected by a nationwide medical liability insurance trade association. We analyzed characteristics and trends among closed claims, indemnity payments (payments to plaintiff), and litigation expenses. We also compared radiation oncology malpractice claims to those of 21 other medical specialties. Time series dollar amounts were adjusted for inflation (2012 was the index year). RESULTS There were 1517 closed claims involving radiation oncology, of which 342 (22.5%) were paid. Average and median indemnity payments were $276,792 and $122,500, respectively, ranking fifth and eighth, respectively, among the 22 specialty groups. Linear regression modeling of time trends showed decreasing total numbers of claims (β = -1.96 annually, P=.003), increasing average litigation expenses paid (β = +$1472 annually, P ≤ .001), and no significant changes in average indemnity payments (β = -$681, P=.89). CONCLUSIONS Medical professional liability claims filed against radiation oncologists are not common and have declined in recent years. However, indemnity payments in radiation oncology are large relative to those of many other specialties. In recent years, the average indemnity payment has been stable, whereas litigation expenses have increased.
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Affiliation(s)
- Deborah C Marshall
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Rinaa S Punglia
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Dov Fox
- School of Law, University of San Diego, San Diego, California
| | - Abram Recht
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Jona A Hattangadi-Gluth
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California.
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Abstract
BACKGROUND Dermatologists face a litany of professional and legal risks in practice. OBJECTIVE To review cases of disciplinary and legal action against dermatologists in Canada. METHODS The Canadian Medical Protective Association, all 10 provincial medical colleges, and the Canadian Legal Information Institute were contacted to obtain data on legal or disciplinary action taken against dermatologists in their records. A literature review was performed regarding litigation against dermatologists in other countries. RESULTS Six dermatologists in Canada faced disciplinary action in the last 5 to 30 years. Seven dermatologists and 5 other specialists in Canada faced lawsuits relating to dermatology in the last 1 to 144 years. Procedures and therapy are the most frequently sources of lawsuits against dermatologists both at home and abroad. CONCLUSION Dermatologists need to remain vigilant to avoid disciplinary action and lawsuits from their increasing and varied interactions with patients.
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Affiliation(s)
- Eiman Nasseri
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL, USA
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Svider PF, Blake DM, Sahni KP, Folbe AJ, Liu JK, Baredes S, Eloy JA. Meningitis and legal liability: an otolaryngology perspective. Am J Otolaryngol 2014; 35:198-203. [PMID: 24074731 DOI: 10.1016/j.amjoto.2013.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Meningitis is a potential complication in otolaryngologic procedures and conditions. Severe sequelae make understanding factors involved in relevant malpractice litigation critical. We analyze pertinent litigation for awards, outcomes, patient demographic factors, and other alleged causes of malpractice. METHODS Pertinent jury verdict and settlement reports were examined using the Westlaw legal database (Thomson Reuters, New York, NY). RESULTS Twenty-three cases (60.5%) involved non-iatrogenic injuries, including inadequate treatment or failure to diagnose sinusitis or otitis media, while 15 (39.5%) involved iatrogenic cases, mostly rhinologic procedures. 36.8% of cases were resolved for the defendant, 28.9% with juries awarding damages, and 34.2% with settlements. Although not statistically significant, mean damages awarded were higher than settlements ($2.1 vs. 1.5M, p=0.056), and cases involving pediatric patients were more likely to be resolved with payment than those with adult litigants (80.0% vs. 52.2%, p=0.08 respectively). Other frequent alleged factors included permanent deficits (63.2%), requiring additional surgery (41.1%), death (34.2%), cognitive deficits (21.2%), deafness (15.8%), and inadequate informed consent (33.0% of iatrogenic cases). CONCLUSIONS Practitioners facing litigation related to meningitis may wish to consider these findings, notably for cases involving death or permanent functional deficits, as cases with out of court settlements tended to be resolved with lower payments. Cases involving misdiagnosis may be more likely to be resolved with payment compared with iatrogenic cases. By understanding the issues detailed in this analysis and including them in the informed consent process for patients undergoing rhinologic and otologic procedures, otolaryngologists may potentially improve patient safety and decrease liability.
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Hong SS, Yheulon CG, Wirtz ED, Sniezek JC. Otolaryngology and medical malpractice: A review of the past decade, 2001-2011. Laryngoscope 2013; 124:896-901. [DOI: 10.1002/lary.24377] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/31/2013] [Accepted: 07/31/2013] [Indexed: 01/16/2023]
Affiliation(s)
- Steven S. Hong
- Department of Otolaryngology; Tripler Army Medical Center; Honolulu Hawaii U.S.A
| | | | - Eric D. Wirtz
- Department of Otolaryngology; Tripler Army Medical Center; Honolulu Hawaii U.S.A
| | - Joseph C. Sniezek
- Department of Otolaryngology; Tripler Army Medical Center; Honolulu Hawaii U.S.A
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Svider PF, Sunaryo PL, Keeley BR, Kovalerchik O, Mauro AC, Eloy JA. Characterizing liability for cranial nerve injuries: A detailed analysis of 209 malpractice trials. Laryngoscope 2013; 123:1156-62. [DOI: 10.1002/lary.23995] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 11/11/2012] [Accepted: 12/24/2012] [Indexed: 11/10/2022]
Affiliation(s)
- Peter F. Svider
- Department of Otolaryngology-Head and Neck Surgery; University of Medicine and Dentistry of New Jersey; New Jersey Medical School; Newark; New Jersey
| | - Peter L. Sunaryo
- Department of Otolaryngology-Head and Neck Surgery; University of Medicine and Dentistry of New Jersey; New Jersey Medical School; Newark; New Jersey
| | | | - Olga Kovalerchik
- Department of Otolaryngology-Head and Neck Surgery; University of Medicine and Dentistry of New Jersey; New Jersey Medical School; Newark; New Jersey
| | - Andrew C. Mauro
- University of Michigan Law School; Ann Arbor; Michigan; U.S.A
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Torres A, Reyter I, Nino T. Medicolegal Aspects. Dermatol Surg 2012. [DOI: 10.1002/9781118412633.ch59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Medicolegal Issues with Regard to Melanoma and Pigmented Lesions in Dermatopathology. Dermatol Clin 2012; 30:593-615, v-vi. [DOI: 10.1016/j.det.2012.06.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Simonsen AR, Duncavage JA, Becker SS. Malpractice in Head and Neck Surgery. Otolaryngol Head Neck Surg 2012; 147:69-73. [DOI: 10.1177/0194599812439152] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To examine the sources of litigation related to the practice of head and neck surgery. Study Design Analysis of malpractice claims directly related to the diagnosis and treatment of head and neck disease provided by 16 medical liability insurance companies. Setting Not applicable. Subjects and Methods Data were obtained from 16 members of the Physician Insurers Association of America. All claims were either filed or closed between 1978 and 2007. Claims were evaluated for patient age, the cause for the claim, any surgical complications, and indemnity paid. Results Three hundred fifteen claims were identified between 1978 and 2007. The mean patient age was 48 years (median, 47 years). The greatest number of claims came from the 36- to 45-years age group (n = 68, 24.6%). Perioperative complications represented the largest cause of claims (n = 169, 53.7%), followed by delay of or missed diagnosis (n = 109, 34.6%) and persistence or recurrence of disease (n = 21, 6.7%). Among perioperative complications, nerve injuries were the largest group (n = 64, 20.3%), followed by airway-related claims (n = 27, 8.6%), esophageal injuries (n = 14, 4.4%), poor cosmetic results (n = 14, 4.4%), vessel injuries (n = 11, 3.5%), and postoperative infections (n = 2, 0.6%). Overall, mortalities resulted in 62 (19.7%) claims. Conclusions Four important risks for malpractice litigation in head and neck surgery were identified: young patient age, perioperative complications, delay of or missed diagnosis, and persistence or recurrence of disease.
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Affiliation(s)
- Andrew R. Simonsen
- University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
| | | | - Samuel S. Becker
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Becker Nose and Sinus Center, Voorhees, New Jersey, USA
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Abstract
Although dermatology does not lead the list of specialties most commonly sued for malpractice, anyone who has been the recipient of a malpractice claim is often traumatized both personally and professionally. Every day dermatologists must address various ethical concerns that have legal implications. Herein, we chose to discuss the following such issues: (1) the ethical and legal necessity of submitting a clinically benign appearing lesion for dermatopathologic review; (2) the ethical and legal considerations regarding frequency of screening after a patient has been diagnosed with melanoma; (3) the multiple ethical and legal considerations involved with the misdiagnosis of a melanoma; (4) the complex ethical and legal considerations of a dermatologist making a clinical diagnosis in a nonprofessional social and public setting; and (5) the ethical and legal implications of sharing care of patients with other dermatologists and specialists.
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Moshell AN, Parikh PD, Oetgen WJ. Characteristics of medical professional liability claims against dermatologists: data from 2704 closed claims in a voluntary registry. J Am Acad Dermatol 2011; 66:78-85. [PMID: 21757256 DOI: 10.1016/j.jaad.2010.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 11/26/2010] [Accepted: 12/04/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Physician Insurers Association of America established a voluntary registry in 1985 that contains 239,756 closed claims. The registry is maintained for educational programs to reduce patient injury and medical professional liability (MPL) claims. OBJECTIVE This report provides a description of MPL claims against dermatologists. METHODS Descriptive techniques are used to present summary information for the dermatologic claims in the registry. RESULTS Of 239,756 closed claims, 2704 (1.1%) involve dermatologists. Of the 2704 closed claims, 775 (28.7%) resulted in an average indemnity payment of $137,538. The most common allegation was improper procedure performance. The most prevalent procedure was operative procedures on the skin. Error in diagnosis was the next most common allegation. The most common diagnosis was malignant melanoma. Malignant melanoma claims were paid in 42.2% of cases with an average indemnity payment of $436,843. LIMITATIONS The data are subject to selection and reporting biases. In addition, the registry does not contain exposure data, so incidences and prevalences are not calculable. CONCLUSIONS MPL issues are important to all practicing dermatologists. The most common allegation against dermatologists in this study was improper performance of operative procedures on the skin, excluding skin grafts. Error in diagnosis of malignant melanoma was the next most common allegation. Malignant melanoma claims were paid in 42.2% of cases with an average indemnity payment of $436,843. By focusing on the risk management of these procedures and this diagnosis, dermatologists can have the largest impact on reducing patient injuries and consequent MPL claims.
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Affiliation(s)
- Alan N Moshell
- Division of Dermatology, Department of Medicine, Georgetown University, Washington, DC, USA
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Nash JJ, Nash AG, Leach ME, Poetker DM. Medical malpractice and corticosteroid use. Otolaryngol Head Neck Surg 2011; 144:10-5. [PMID: 21493380 DOI: 10.1177/0194599810390470] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To analyze malpractice litigation trends related to the administration of corticosteroids and the reported complications. STUDY DESIGN Retrospective. SETTING Tertiary medical center. SUBJECTS AND METHODS The WESTLAW database was reviewed from March 1996 to November 2008. Data were compiled on the demographics of the defendant, plaintiff, expert witness specialty, allegation, complication, indication for steroids, verdict, and judgment. RESULTS Eighty-three cases met inclusion criteria and were selected for review. The most common conditions for which steroids were prescribed were pain (23%), asthma or another pulmonary condition (20%), a dermatologic condition (18%), a nondermatologic autoimmune condition (17%), and allergies (6%). Allegation of negligent use was the most common reason for a suit being filed (65%), followed by lack of proper informed consent (36%), failure to diagnose or misdiagnosis (22%), multiple allegations (25%), and wrongful death (4%). Verdicts for the defendant predominated (59%), whereas 24 cases (29%) were found for the plaintiff, and 10 cases (12%) settled out of court. The range of monetary awards was from $25,000 to $8.1 million. Complications reported were often multiple and included avascular necrosis (39%), mood changes (16%), visual complaints (14%), and infectious complications (14%). Three cases involved otolaryngologists. CONCLUSION Although other specialties were more often involved in suits, otolaryngologists frequently prescribe corticosteroids and must be diligent in explaining potential side effects of steroids. The informed consent process, documentation, and close monitoring of patients are critical to avoid potential litigation.
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Affiliation(s)
- John J Nash
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA
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Marghoob AA, Changchien L, DeFazio J, Dessio WC, Malvehy J, Zalaudek I, Halpern AC, Scope A. The most common challenges in melanoma diagnosis and how to avoid them. Australas J Dermatol 2009; 50:1-13; quiz 14-5. [DOI: 10.1111/j.1440-0960.2008.00496_1.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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High WA. Malpractice in Dermatopathology—Principles, Risk Mitigation, and Opportunities for Improved Care for the Histologic Diagnosis of Melanoma and Pigmented Lesions. Clin Lab Med 2008; 28:261-84, vii. [DOI: 10.1016/j.cll.2007.12.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Singh H, Sethi S, Raber M, Petersen LA. Errors in cancer diagnosis: current understanding and future directions. J Clin Oncol 2007; 25:5009-18. [PMID: 17971601 DOI: 10.1200/jco.2007.13.2142] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Errors in cancer diagnosis are likely the most harmful and expensive types of diagnostic errors. We reviewed the literature to understand the prevalence, origins, and prevention of errors in cancer diagnosis, focusing on common cancers for which early diagnosis offers clear benefit (melanoma and cancers of the breast, colon, and lung). METHODS We searched the Cochrane Library and PubMed from 1966 until April 2007 for publications that met our review criteria and manually searched references of key publications. Our search yielded 110 studies, of which nine were prospective studies and the remaining were retrospective studies. RESULTS Errors in cancer diagnosis were not uncommon in autopsy studies and were associated with significant harm and expense in malpractice claims. Literature on prevalence was scant. For each type of cancer, we classified preventable errors according to their origins in patient-physician encounters in the clinic setting, diagnostic test or procedure performance, pathologic confirmation of diagnosis, follow-up of patient or test result, or patient-related delays. CONCLUSION The literature reflects advanced knowledge of contributory factors and prevention for diagnostic errors related to the performance of procedures and imaging tests and emerging understanding of pathology errors. However, prospective studies are few, as are studies of diagnostic errors arising from the clinical encounter and patient follow-up. Future research should examine further the system and cognitive problems that lead to the many contributory factors we identified, and address interdisciplinary interventions to prevent errors in cancer diagnosis.
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Affiliation(s)
- Hardeep Singh
- Health Policy and Quality Program, Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA.
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Tzeng HM. Model testing on the crisis interventions and actions to prevent medical disputes: a Taiwanese nursing perspective. J Clin Nurs 2006; 15:554-64. [PMID: 16629964 DOI: 10.1111/j.1365-2702.2006.01365.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES This study investigated the contributions of comprehensiveness and necessity scales on crisis interventions and actions toward nursing practice-related medical disputes in Taiwanese hospitals and institutions' demographic characteristics, to overall satisfaction toward nursing-related crisis management policies and interventions and overall satisfaction toward their institution's crisis management system. BACKGROUND In a health-care environment that is focused on cost containment, for overworked nurses and understaffed medical wards, patients still expect nurses to provide high quality, compassionate care. Patients usually regard nurses as the principal link between the technical and interpersonal aspects of their care. However, current hospital systems tend to require patients to be self-reliant in managing their own care. Patient mistrust of medical care providers might have contributed to the current medical error/dispute crisis. METHODS In this cross-sectional study, the subjects were nursing directors of Taiwanese hospitals (197 valid subjects). The author developed the questionnaire used in this study. RESULTS The ordinal logistic regression analyses demonstrated that being a public hospital managed by the government, being a hospital operated by a corporate body, the more comprehensive the technical/structural aspect and the assessment aspect and the more needed the psychological aspect, contribute to higher general satisfaction levels toward nursing-related crisis management. The more comprehensive the strategic aspect and having more acute beds, contributes to higher satisfaction levels with their institution's overall crisis management activities. CONCLUSIONS These findings inferred a possible change in a hospital's resource allocation or power structure when dealing with issues of patient care quality, including nursing practice-related crisis management policies, interventions and actions. RELEVANT TO CLINICAL PRACTICE: A good crisis management system may help to keep a crisis from worsening, which might lead to a serious situation that includes malpractice litigation. It is believed that the questionnaire used in this study may be used as a diagnostic tool for assessing a crisis management system within a hospital's nursing environment.
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Abstract
BACKGROUND Dermatologists need objective information that will help them make rational risk management decisions. OBJECTIVE We asked, "What can be learned from the limited sources available regarding the clinical situations associated with malpractice litigation against dermatologists?" METHODS We searched 2 legal databases, one jury verdict and settlement reporter, and reviewed and analyzed a major report from an association of physician insurers. RESULTS A wide variety of clinical circumstances give rise to malpractice claims. Melanoma is still associated with high risk, and common conditions are associated with relative claim frequency. The clinical details currently available do not encourage optimal responses to reports of malpractice cases. CONCLUSION Information that clinicians can use in their own risk management efforts can be derived from available sources, but more reliable objective data is needed.
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Affiliation(s)
- Sandra Read
- Department of Dermatology, Georgetown University School of Medicine, USA
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