Anesthesia Malpractice Claims Research Articles

Awareness during anesthesia: a closed claims analysis.

Awareness during general anesthesia is a frightening experience, which may result in serious emotional injury and post-traumatic stress disorder. We performed an in-depth analysis of cases from the database of the American Society of Anesthesiologists Closed Claims Project to explore the contribution of intraoperative awareness to professional liability in anesthesia. The database of the Closed Claims Project is composed of closed US malpractice claims that have been collected in a standardized manner. All claims for intraoperative awareness were reviewed by the reviewers to identify patterns of causation and standard of care. Logistic regression analysis was used to identify independent patient and anesthetic factors associated with claims for recall during general anesthesia compared to other general anesthesia malpractice claims. Awareness claims accounted for 79 (1.9%) of 4,183 claims in the database, including 18 claims for awake paralysis, i.e., the inadvertent paralysis of an awake patient, and 61 claims for recall during general anesthesia, ie., recall of events while receiving general anesthesia. The majority of awareness claims involved women (77%), younger than 60 yr of age (89%), American Society of Anesthesiologists physical class I-II (68%), who underwent elective surgery (87%). Most (94%) claims for awake paralysis represented substandard care involving errors in labeling and administration, whereas care was substandard in only 43% of the claims for recall during general anesthesia (P < 0.001). Claims for recall during general anesthesia were more likely to involve women (odds ratio [OR] = 3.08, 95% confidence interval [CI] = 1.58, 6.06) and anesthetic techniques using intraoperative opioids (OR = 2.12, 95% CI = 1.20, 3.74), intraoperative muscle relaxants (OR = 2.28, 95% CI = 1.22, 4.25), and no volatile anesthetic (OR = 3.20, 95% CI = 1.88, 5.46). Deficiencies in labeling and vigilance were common causes for awake paralysis. Claims for recall during general anesthesia were more likely in women and with nitrous-narcotic-relaxant techniques.

Learning and memory during general anesthesia: an update.

Learning and memory during general anesthesia: an update.

Variation in Expert Opinion in Medical Malpractice Review

Background : Expert opinion in medical malpractice is a form of implicit assessment, based on unstated individual opinion. This contrasts with explicit assessment processes, which are characterized by criteria specified and stated before the assessment. Although sources of bias that might hinder the objectivity of expert witnesses have been identified, the effect of the implicit nature of expert review has not been firmly established. Metbods : Pairs of anesthesiologist-reviewers independently assessed the appropriateness of care in anesthesia malpractice claims. With potential sources of bias eliminated or held constant, the level of agreement was measured. Results : Thirty anesthesiologists reviewed 103 claims. Reviewers agreed on 62% of claims and disagreed on 38%. They agreed that care was appropriate in 27% and less than appropriate in 32%. Chance-corrected levels of agreement were in the poor-good range (kappa = 0.37 ; 95% CI = 0.23 to 0.51). Conclusions : Divergent opinion stemming from the implicit nature of expert review may be common among objective medical experts reviewing malpractice claims.

Variation in Expert Opinion in Medical Malpractice Review

Expert opinion in medical malpractice is a form of implicit assessment, based on unstated individual opinion. This contrasts with explicit assessment processes, which are characterized by criteria specified and stated before the assessment. Although sources of bias that might hinder the objectivity of expert witnesses have been identified, the effect of the implicit nature of expert review has not been firmly established. Pairs of anesthesiologist-reviewers independently assessed the appropriateness of care in anesthesia malpractice claims. With potential sources of bias eliminated or held constant, the level of agreement was measured. Thirty anesthesiologists reviewed 103 claims. Reviewers agreed on 62% of claims and disagreed on 38%. They agreed that care was appropriate in 27% and less than appropriate in 32%. Chance-corrected levels of agreement were in the poor-good range (kappa = 0.37; 95% CI = 0.23 to 0.51). Divergent opinion stemming from the implicit nature of expert review may be common among objective medical experts reviewing malpractice claims.

The Medical Malpractice System

Letters1 June 1993The Medical Malpractice SystemKaren L. Posner, MD, Frederick W. Cheney, MD, and Robert A. Caplan, MDKaren L. Posner, MDSearch for more papers by this author, Frederick W. Cheney, MDSearch for more papers by this author, and Robert A. Caplan, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-118-11-199306010-00025 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Taragin and coworkers [1] investigated the medical malpractice tort system through use of closed claims data from the Medical Inter-Insurance Exchange of New Jersey. They presented the conclusion that physician care in malpractice cases is usually defensible and suggested that unjustified payments are probably uncommon. Their findings are generally consistent with the American Society of Anesthesiologists' study of 1004 closed anesthesia malpractice claims [2]. Their study, however, differed from ours and others [3] in one important aspect: In their study the standard of care assessment was not associated with severity of injury. In contrast, we found that ...

A Comparison of Obstetric and Nonobstetric Anesthesia Malpractice Claims

CHADWICK, H. S.; POSNER, KAREN; CAPLAN, ROBERT A.; WARD, RICHARD J.; CHENEY, FREDERICK W. Author Information

A Comparison of Obstetric and Nonobstetric Anesthesia Malpractice Claims

Malpractice claims filed against anesthesiologists for care involving obstetric (OB) anesthesia (n = 190) were taken from the American Society of Anesthesiologists' Closed Claims Database and compared to claims not involving OB cases (n = 1351). The most common complications in the OB claims were (percentage of all OB claims): maternal death (22%), newborn brain damage (20%), and headache (12%). In contrast, the most common complications in the nonobstetric (non-OB) group were (percentage of all non-OB claims): death (39%), nerve damage (16%), and brain damage (13%). The group of OB claims contained a proportionately greater number of minor injuries, such as headache, backache, pain during anesthesia, and emotional injury (32%) compared to the non-OB claims (4%). Complications due to aspiration and convulsions were more common among the OB cases. The standard of care was judged to have been met in 46% of OB and 39% of non-OB claims. This difference is not statistically significant. Claims involving general anesthesia were more frequently associated with severe injuries and resulted in higher payments than did claims involving regional anesthesia. Payments were made in a similar proportion of OB and non-OB claims (53 and 59%, respectively). For cases in which payments were made, the median payment for OB claims was significantly greater ($203,000) than for non-OB claims ($85,000; P less than or equal to 0.05).