Litigation in musculoskeletal oncology

Abstract

Musculoskeletal tumours lend themselves to being mismanaged. There is still a residual but unjustifiable feeling among orthopaedic surgeons that the removal of a lump is a relatively straightforward procedure. Unfortunately, if that lump happens to be a sarcoma and it is managed inappropriately the consequences can be disastrous both for the patient and the surgeon involved. A review of the National Health Service Litigation Authority’s (NHSLA) figures for the ten years between 2003 and 2012 show that 69 cases were brought. Fortunately, 44 of these were successfully defended but 25 were lost or settled, with damages per case ranging between £3000 and £951 350 and total costs per case of between £7000 and £1 104 826. The total cost to the NHSLA over this period for lost or settled cases was £2 912 541, a mean figure of £116 502 per case. Why were these cases lost? The commonest reason was that there was a failure or delay in the diagnostic process (16 cases). There was a failure to perform the appropriate tests in three cases, a failure or delay in treatment in four, and inappropriate treatment in the other two. What was the effect on the patient? There were three resultant amputations, eight cases each of additional pain, suffering and progression of the tumour, an additional or unnecessary operation in one, and five other assorted outcomes. There were three …