Factors influencing judicial decisions on medical disputes in plastic surgery.

Abstract

Recently, more lawsuits have been filed by patients against their plastic surgeons, often leading to social and financial losses for the physicians involved. The authors sought to determine the factors that influence judicial decisions against plastic surgeons. Data from 98 malpractice claims filed between January 1 2000 and December 31 2008 were obtained from a state court of justice in Brazil. The authors selected 39 closed cases for this study. The following parameters were reviewed for each case: date of decision, complaint(s), conclusions of expert report, presence/absence of informed consent, medical records, and judicial decision. The chi-square test, Cramer's V coefficient, Fisher's exact test, and Cochran-Armitage test were utilized to compare data. Significance was defined as P ≤ .05. Most lawsuits pertained to breast surgery (32%), abdominoplasty (24%), rhinoplasty (22%), and liposuction (22%). The most common complaints were scars and resulting contour (48.9%), general dissatisfaction (25.6%), and complications (25.2%). In all cases with medical records considered of "good quality" by the judge (n = 17), the surgeon was acquitted. There was a significant correlation between decisions favoring the surgeon and the presence of written informed consent documentation. "Not guilty" verdicts also were associated with expert report conclusions favoring the physician. Surgeons were found guilty of malpractice in cases that failed to meet at least 2 of these 3 conditions (good-quality medical record, informed consent, expert report favoring the surgeon). Factors that heavily influenced judicial decisions were the quality of medical records, informed consent, and expert report conclusions.