The effect of litigation on surgical practice in the USA

How do practicing physical therapists perceive anatomy education?

The purpose of this investigation was to explore the perceptions of the sufficiency and relevancy of physical therapy anatomy education among early, mid, and late career physical therapists. A survey was distributed via email through clinical networks in the greater Mid-Atlantic region, the American Physical Therapy Association Pennsylvania chapter (APTA-PA), and the American Council of Academic Physical Therapy (ACAPT) Educational Research division. 194 physical therapists responded to the survey. The survey included questions regarding how anatomy was learned in physical therapy school and Likert scale questions investigating opinions of anatomy education. Frequencies were calculated to determine the methods of anatomy education and Likert scale responses. One-way Analysis of Variance (ANOVA) was performed to compare the Likert scale responses from the groupings of survey participants. Respondents across all years of practice felt that their anatomy education was sufficient and relevant to their clinical practice and that schools dedicated enough time to teaching anatomy. Respondents who had a dissection component in their anatomy curriculum were more likely to view dissection as essential. Length of time in practice did not influence opinions on the sufficiency or relevancy of anatomy education. Dissection continues to be included in most physical therapy anatomy courses and perceived as essential for learning. Practicing physical therapists' anatomy education was viewed as sufficient and relevant with few recommendations for change. Perceptions of clinicians should be incorporated into curriculum design and reform and be gathered on an ongoing basis as more students from programs without anatomical donors graduate and enter clinical practice.

Clinical Negligence Claims Against Vascular Surgery in the United Kingdom: An Observational Study

BACKGROUND

Claims for clinical negligence awarded to patients and their families are on the increase. The annual "cost of harm" is approximately £7-9 billion in the United Kingdom. In 2017, the National Health Service (NHS) resolution service reported that they mediated more claims than in their entire history. Vascular surgery is a specialty with a disproportionately higher number of claims for clinical negligence. The aim of this observational study was to review the trends of clinical negligence claims in vascular surgery within the United Kingdom. The costs and the primary cause for the complaint were evaluated.

METHODS

A retrospective observational study was performed. Clinical negligence claims in vascular surgery between the financial years of April 2005/2006 to April 2018/2019 were requested from NHS resolution under the Freedom of Information Act. Data were provided on November 8, 2019. All data were anonymized, and any categories containing fewer than five claims were removed to protect the identity of claimants.

RESULTS

Over the 13-year period, 1,189 claims in vascular surgery were identified, with the annual mean (range) being 91 (20-134) claims per year. Of 1,189 claims, 875 (74%) are closed with payments made to the claimants. The mean annual total payment was £10,015,373. Delay in treatment was the most common cause for litigation claims in vascular surgery with 157 closed claims costing £33,255,248 over the 13-year period. Lower limb amputation was the most common primary injury claim with 140 closed cases but had a larger financial cost at £64,155,969.

CONCLUSIONS

Clinical negligence claims in vascular surgery within the United Kingdom have been increasing steadily over the last 13 years and with a changing claims culture is expected to continue. The most common cause for claims with damages paid was delay in treatment, and lower limb amputation was the most common injury suffered. Improved consent, better communication with patients, and a higher surgical skill level could significantly reduce the number of future claims.

Medical liability insurance claims after treatment of varicose veins

Objective:

Since insight into the reason for filing claims after treatment of varicose veins of the lower extremity might help prevent future claims, we determined the incidence of and reasons for medical liability insurance claims after such treatments in the Netherlands.

Method:

We performed a retrospective review of all medical liability insurance claims after varicose vein treatment handled by MediRisk between January 1993 and December 2007.

Results:

A total of 144 claims were filed of which 104 were closed by the end of the study period. Nerve injury ( n = 28), skin necrosis following sclerotherapy ( n = 17), deep vein injury ( n = 11) and insufficient communication ( n = 9) accounted for more than 60% of all claims. Claims were equally distributed among registrars and consultants. Some 41 of the 104 closed claims were accepted. In 27 of the accepted cases, the physician had obviously failed in providing the care as expected from a medical practitioner allowed to perform these treatments. The majority of these 27 claims were due to injury of nerves ( n = 11) or deep veins ( n = 9).

Conclusion:

The incidence of claims after treatment of varicose veins in the Netherlands is low. Proper knowledge of anatomy and adequate communication, along with the introduction of less invasive treatments might prevent future claims.

Errors and malpractice in interventional radiology

Interventional radiology is an invasive specialty with the potential for errors as with other invasive specialties. A critical analysis of the different types of errors may help radiologist undertake the corrective measures. Standardize interventional procedures with protocols applicable to clinical practice are necessary to avoid the malpractice and, therefore, the related medical-legal issues. In this article, we present an overview of principal differences between errors and malpractice with particular regard to the issues in interventional radiology. Specific topics discussed in this article are the approaches to preventing errors and, thus, to avoiding the malpractice in interventional radiology.

Binding pancreaticoenteric anastomosis: from binding pancreaticojejunostomy to binding pancreaticogastrostomy

Potential mechanisms of occurrence of pancreatic leakage mainly include leakage from the needle hole and from the seam at the adjacent stitch, anastomotic blood supply, tension at the anastomosis, poor anastomotic healing, etc. Binding pancreaticojejunostomy (BPJ) is a safe and effective technique that avoids the primary complication of pancreatic anastomosis leakage. There are two problems with BPJ: a high discrepancy in the size of pancreas stump and the jejunal lumen; sutures on to the pancreas for fixation might cause exudation of pancreatic juice into the abdominal cavity. In order to avoid these two problems, binding pancreaticogastrostomy (BPG) is designed and successfully performed clinically with encouraging results. BPG is good for accommodating a large pancreas stump, and the binding technique is very helpful in minimizing the leak rate of pancreaticogastrostomy.

Litigation after laparoscopic cholecystectomy: an evaluation of the Dutch arbitration system for medical malpractice

BACKGROUND

Medical liability is a great concern in current surgical practice. The medical liability system in the US is under discussion in surgical literature, as the system is associated with high costs and expensive liability premiums. The aim of this study was to evaluate the Dutch arbitration system for claims filed after bile duct injury (BDI).

STUDY DESIGN

Data were extracted from the largest Dutch insurance company for medical liability. Outcomes of the claim and factors associated with awarded financial compensation were determined.

RESULTS

BDI litigation after laparoscopic cholecystectomy occurred in 0.08% (+/- 0.02% SD) without a substantial increase. Currently, 88 of 133 claims are closed after a median duration of 2 years (range 5 months to 6.5 years). In 61 of 88 cases (69%) liability was rejected, and in 16 cases (18%) liability was acknowledged. Median compensation (in Euros) was euro 9.826,07 (range euro 15,88 to euro 55.301,06). Rejection of liability increased from 50% in the period 1994 to 1998 versus 72% in 2004 to 2006 (p = 0.023). Factors associated with recognition were patient employment (p = 0.005) and patient death (p = 0.01). Factors associated with an increase in financial compensation are delay in imaging (p = 0.033), delay in diagnosis (p = 0.009), and relaparotomy with repair in the initial hospital (p = 0.028).

CONCLUSIONS

The Dutch arbitration system for medical liability after BDI is associated with a short time to resolution and high rejection rates, and payments to BDI patients are low.

Physicians' liability in ophthalmology practice

PURPOSE

The aims of this paper are to point out the importance of coherence in established guidelines in daily practice, highlight the value of signed patient informed consent forms and stress the value of a good understanding of the law, while focusing on issues related to malpractice in ophthalmology.

METHODS

Search of the current relevant literature.

RESULTS

The most common causes of medical litigation in ophthalmology are related to LASIK surgery, cataract surgery, glaucoma care, radial keratotomy for myopia reduction and failure to diagnose binocular vision anomalies in children and adults in a timely fashion. The litigation raised in most cases is driven by unfavourable outcomes and not by malpractice.

CONCLUSION

Maintenance of high standards in daily practice, with continuous training and clear communication along with the appropriate documentation of any procedure carried out, may improve the professional safety of practising eye specialists in the event of medical litigation. Although the use of patient informed consent varies substantially among European countries, it may serve as useful evidence in the physician's defence.

Physicians' liability in interventional radiology and endovascular therapy

INTRODUCTION/OBJECTIVE

Modern practice in Radiology has rapidly changed over the last decades incorporating invasive techniques. Additionally, litigation in medical practice has arisen as an important issue. This article aims to highlight issues related to malpractice in interventional radiology and endovascular therapy in order to point out the importance of the written informed consent.

METHODS AND MATERIAL

Search of relevant literature from the Pubmed.

RESULTS

The role of radiologist has been greatly transformed over the last decades. He is not only entitled to participate in the diagnosis but also he undertakes therapeutic procedures, either alone or as a member of a team. Thus the radiologist is now more exposed to actions that maximize litigation risk. Adequate communication and a written consent form seem to be mandatory before any invasive radiological procedure. Patient should know in detail the benefits and the risks of the scheduled procedure and whether the proposed therapy is a new form of treatment or part of a randomized trial.

DISCUSSIONS AND CONCLUSION

Interventional radiologist or physician is exposed to high litigation risk. This certainly requires an urgent adaptation of his practice and attitude to the new reality. Written patient's informed consent remains an integral part of the communication between physicians and patients, and importantly is offering professional protection along these lines.

Litigation for pneumothorax as a complication of fine-needle aspiration of the breast

Background

Pneumothorax is a rare but recognized complication of diagnostic needle aspiration of the breast. Two recent court cases alleging negligence have reached opposing opinions on very similar findings.

Methods

A Medline literature search was carried out.

Results

The reported incidence of pneumothorax after diagnostic aspiration of the breast in seven series varied between three in 100 and one in 10 000, but the weight of evidence tended towards the latter rate. Two studies reported that the complication is more common in the hands of trainees. It is not always possible to maintain the aspirating needle parallel or tangential to the chest wall. Pleural puncture may be more common than is apparent, and is most common in the tail of the breast in a thin woman.

Conclusion

It is important that breast clinicians are aware of the risk of pneumothorax but, provided proper care has been taken, this complication is not the result of a negligent act.

Impaired quality of life 5 years after bile duct injury during laparoscopic cholecystectomy: a prospective analysis

OBJECTIVE

To assess the impact of bile duct injury (BDI) sustained during laparoscopic cholecystectomy on physical and mental quality of life (QOL).

SUMMARY BACKGROUND DATA

The incidence of BDI during laparoscopic cholecystectomy has decreased but remains as high as 1.4%. Data on the long-term outcome of treatment in these patients are scarce, and QOL after BDI is unknown.

METHODS

One hundred six consecutive patients (75 women, median age 44 +/- 14 years) were referred between 1990 and 1996 for treatment of BDI sustained during laparoscopic cholecystectomy. Outcome was evaluated according to the type of treatment used (endoscopic or surgical) and the type of injury. Objective outcome (interventions, hospital admissions, laboratory data) was evaluated, a questionnaire was filled out, and a QOL survey was performed (using the SF-36). Risk factors for a worse outcome were calculated.

RESULTS

Median follow-up time was 70 months (range 37-110). The objective outcome of endoscopic treatment (n = 69) was excellent (94%). The result of surgical treatment (n = 31) depended on the timing of reconstruction (overall success 84%; in case of delayed hepaticojejunostomy 94%). Five patients underwent interventional radiology with a good outcome. Despite this excellent objective outcome, QOL appeared to be both physically and mentally reduced compared with controls (P <.05) and was not dependent on the type of treatment used or the severity of the injury. The duration of the treatment was independently prognostic for a worse mental QOL.

CONCLUSIONS

Despite the excellent functional outcome after repair, the occurrence of a BDI has a great impact on the patient's physical and mental QOL, even at long-term follow-up.