Litigation Cases Research Articles

226 Temporal Variation in Consent Litigation in General Surgery

Abstract Aim Issues with consent is one of the most common causes of litigation within General surgery. The guidance surrounding informed consent in surgery has changed following the Montgomery vs Lanarkshire Health Board (2015) court ruling. The aim of this study was to examine the time trends in medico-legal cases related to consent between 2011–2020. Method Data on the numbers of litigation cases in general surgery were obtained from NHS resolutions for the period of 2010–2020. Chi-squared analysis was performed using SPSS to compare the proportion of litigation cases that were due to consent before and after 2015. Results There were a total of 10,027 general surgery claims made between 2010–2020, of which 580 (5.8%) were related to issues with consent. The number and proportion of claims related to consent rose during the study period, with 208/2817 (3.76%) consent-related cases before 2015, versus 372/3267 (8.12%) after 2015; a 116% increase (p<0.001). Conclusions These data illustrate a significant rise in medico-legal claims related to consent in General surgery in the post-Montgomery era. This may be due to legal precedent being established following the Montgomery case, and the increased awareness of these issues as a result.

Domestic accountability through strategic litigation: Towards redress and reparations for Kenya's 2007-2008 post-election sexual and gender-based violence

There are a range of impediments in the pursuit of redress and reparations for sexual violence, more so in conflict and post-conflict situations. Often if accountability is sought through judicial institutions, it is through criminal proceedings. However, another option available is to file, simultaneously or alternatively, a civil and/or constitutional proceeding. In February 2013 six women and two men who were sexual and gender-based violence survivors of Kenya's 2007-8 postelection violence filed a constitutional petition. On 10 December 2020 the Kenyan High Court awarded four survivors Kes 4 million (approximately US $36 513) as general damages for the violation of their constitutional rights. This article, which is anchored on Kenya's human rights obligations, uses Kenya as a case study to examine the pursuit of domestic accountability through strategic litigation and the contribution made towards redress and reparation for survivors of sexual and gender-based violence from post-election violence. First, the author argues that the transitional justice approach in Kenya provided the foundation for the strategic litigation case. Therefore, the article provides an overview of key aspects of Kenya's transitional justice approach. Second, the author argues that to understand the significance of the strategic litigation, an understanding of the sexual and gender-based violence which necessitated the strategic litigation case is necessary. The article therefore examines Kenya's legacy of historical injustice and gross human rights abuses which played a role in the sexual and gender-based violence during post-election violence. Third, the author analyses the strategic litigation case, considering the key claims by the petitioners and the decision of the Court. Finally, the article discusses the lessons learnt and contribution made by this case. The author submits that, although imperfect, this strategic litigation was a valuable recognition and acknowledgment of sexual and gender-based violence survivors of post-election violence, contributed to reparation access and had an impact on domestic accountability as an option for redress and reparation.

A Study of Rent Fee Assessment on the Port Railway Station: The Litigation Case Study of a Korean Container Terminal

This study provides a systematic method for determining the proper rent fee of a port railway station with a litigation case study of Busan port container terminal. The Port Rail Station Operating Company (PRSOC) leases and operates the port railway station of the port authority (PA). The PA wants to receive a rent fee with the goal of recovering the investment cost, and the PRSOC wants to pay rent to the extent that it can generate an appropriate profit. In order to reasonably estimate the rent fee, this study attempted using a method of estimating the capacity-based demand of the rail station. A recent discussion of terminal rentals concerns what to rent. That is, will only the infrastructure be leased, or will the substructure and the superstructure be leased? Will the infrastructure, superstructure, and equipment be leased? Rail station capacity encounters a bottleneck when measuring railroad track capacity, i.e. RMGC capacity. In other words, arbitrary demand estimation leads to operating losses for PRSOC and may also cause losses to investors because investment costs cannot be recovered. In this study, data such as investment cost, operating cost, and sales required for the construction of the rail station were collected from the Ministry of Ocean and Fishery, PA, and PRSOC. Based on these data, a proper rent fee is proposed by analyzing the cash flow on the premise of operation for the next 30 years. This study adopts the discounted cashflow (DCF) method because DCF allows an objective and consistent comparison of rent fee levels from the PA and PRSOC perspectives. Using DCF, this study finds that the proper rent fee from the perspective of the PA is USD 397,045, while the PRSOC’s proper rent fee is USD 355,801. Thus, it is reasonable to set the standard for determining the proper rent fee by calculating and comparing the rent fee level from the perspective of PA’s investment cost recovery and PRSOC’s operating balance maintenance perspective. This study suggests that the DCF method should be applied to standardize the rent fee calculation system for the port railway station.

Review of Malpractice Litigation in the Diagnosis and Treatment of Venous & Lymphatic Disease

Malpractice claims involving nonthrombotic venous and lymphatic diseases and interventions have not been reported previously. We investigated common reasons for litigation, medical specialties involved, patient injuries, and case outcomes in malpractice litigation involving venous and lymphatic disease. Litigation cases entered into the Westlaw database from June 8th, 1984 to February 15th, 2018 were analyzed. Search terms included relevant words and phrases related to nonthrombotic venous, thoracic outlet syndrome, and lymphatic disease and treatment. Data on physician specialty, malpractice claims, and patient injuries jury outcomes, amount awarded to the plaintiff, and jury fees were collected and compared for each category. A total of 144 cases were identified. 41 cases involved varicose veins, 11 spider veins, 35 thoracic outlet syndrome (TOS), 17 other venous diseases, and 40 lymphatic diseases. Physician defendants were frequently vascular surgeons (23%) and general surgeons (15%). The majority of litigation claims involved "post-procedure complication" (77%), "lack of informed consent" (25%), "failure to diagnose & treat" (15%), and "intraoperative complications" (13%). The most common injuries were skin damage (27.8%), nerve damage (25%), and lymphedema (24%). Patient death occurred in 6% of cases. Out of venous malpractice cases with post-procedure complications, stab phlebectomy (27%) was the most common intervention followed by foam sclerotherapy (21%), rib resection (21%), laser spider vein removal (5%), and endovenous laser ablation therapy (EVLT)(3%). Of varicose vein cases, 15% included deep vein thrombosis or pulmonary embolism as post-procedure complications. In TOS rib resections, 65% of cases referenced nerve damage and 12% involved arterial injury. For lymphatic disease cases, general surgeons were frequently identified defendants (25%). Lymphedema (93%) and lymphangitis (7%) occurred as post-procedure complications after breast, gynecologic, orthopedic, and radiation procedures. A majority of complications occurred after breast cases (40%). Verdicts overall ruled in favor of the defendant in 71% (102/144) of cases and the plaintiff in 20% (29/144) of cases. Out of cases ruled in favor of the plaintiff, 31% were lymphatics, 24% varicose veins, and 24% TOS cases. Only 8% (12/144) of cases were settled and one outcome was unknown. The mean award was $820,193 (standard deviation SD $1,226,008, Range $12,853 - $6,500,000). The majority of venous and lymphatic litigation cases involve claims of post-procedure complications. Venous complications occurred after open and endovascular treatment of varicose veins, spider vein treatment, and surgical management of TOS. Lymphedema occurred after breast, oncology, and orthopedic procedures. These cases reflect opportunities for intervention to help potentially prevent litigation.

Pressure Ulcers from the Medico-Legal Perspective: A Case Report and Literature Review.

Introduction: The identification of professional liability profiles related to the development of pressure injuries is a very thorny issue from a medico-legal perspective. This is because no matter how strict the applied prevention protocols applied may be, the development of such injuries is largely dependent on endogenous factors. This paper aims to investigate the medico-legal issues related to this topic through the exposition of one case of medico-legal litigation and a traditional review of the literature. Methods: We performed a literature search using three databases (Pubmed, Scopus, and Web Of Science), restricting the search to the period between 2001 and 2021. We used “pressure ulcers” and “jurisprudence” as the main keywords. From an initial library of 236 articles, our selection resulted in 12 articles, which were included in the review. Results: We identified the ever-increasing expectations of patients and the concept of automatic attribution of responsibility when a pressure ulcer develops as the primary reasons for the increase in litigation over the past 20 years. The related corrective measures are numerous: a strict adherence to guidelines, an adequate documentation of preventive measures, a risk assessment, family involvement, and a successful collaboration between physicians and government institutions. Conclusions: The biological complexity of the pathogenetic development of pressure ulcers makes the subject very delicate from the medico-legal point of view. In principle, it is possible to state that a very large proportion of such injuries are preventable, but that there remains a percentage of them that cannot be prevented. In such cases, only a proper documentary demonstration of the adequacy of preventive measures can exclude liability profiles.

A Folklore Litigation in the Novel Agnaadi by Poomani

Nadar is a term used to describe the primitive manner of life of the human race. People's daily routines and customs are considered to be customs. An ethnic civilization is thought to have developed when customs alter over time and transform into cultural symbols. Every race still retains elements of its traditional dialects even after civilization has advanced. Poomani is regarded as one of the regional authors. He allows the writing to take on its own qualities by combining the aroma of the soil with the free-flowing energies of life. Through the short story ‘Aruppu’, he was introduced to the world of Tamil short stories. Poomani has the ability to write about rural life and aspects of ethnic culture. He wrote a book titled "Agnaadi" in 2012 after researching the history of the residents of Kalingal hamlet in Kovilpatti district. The book won the Sahitya Akademi Award in the year 2014 for its inventive ethnographic history and narrative. The word Agngnaadi means' mother'. It is a term used by certain ethnic groups. In that way, Poomani’s Agnaadi which has recorded rural life has also recorded folk liturgies. This article examines the novel Agnaadi as a case of folklore litigation.

Importance and Maintenance of Dental Records - Are Dentists Aware? A Survey Among Private Dental Practitioners

Introduction: Forensic expertise, including dental identification and expertise in civil litigation cases related to dental malpractice and injuries mostly count on dental records. Comparison of dental data obtained from the deceased person with dental data obtained by the dentist from the person’s file is a primary method of identification through dental evidence. Material and Methodology: In all, 180 dentists participated in an online survey. Questions covered general information on dentists, maintenance of dental records, and knowledge of legal requirements and forensic odontology. Results: 66.6% of dentists said that they update patient's data on every visit. 86.6% of dentists were aware of the use of Dental records in Forensic Odontology. 89.9% of dentists were not aware of how they should present the data when asked by the legal authority whereas only 10.1% of Dentists were aware of how they are supposed to provide the data. The percentage of dentists who knew how long are they legally mandated to keep patient records showed a significant difference (p<0.05) between Bachelors of Dental Surgery (BDS) and Masters of Dental Surgery (MDS) practitioners. Conclusion: Dentists being aware of forensic odontology, still lack the information about the legal aspects of it. Forensic odontology should be included in the curriculum as a separate subject to improve knowledge at the grassroots level. The focus should also be improved towards raising the awareness among private practitioners regarding the practical aspect of forensic odontology.

Analisis Perspektif Masyarakat Terhadap Cerai Gugat Di Kabupaten Bekasi

Divorce is the end of a marriage with the severance of the relationship between husband and wife due to the failure to carry out their respective roles in fostering a household. In the view of the community that divorce is a way out of household problems that must be avoided because it is a disgrace to the family. The purpose of writing this article is to analyze the community's perspective on the phenomenon of divorce and lawsuits that often occur in the community. The writing of this article uses a qualitative approach, case study method with data collection through interviews with informants, literature review, and documentation. The results of the study show that the perspective of the people who are respondents in this study is related to the case of litigation that occurs in the community, something that is not good and the result of the divorce is that there will be divisions in the family. In the view of society, a woman must carry out her obligations as a wife and according to her nature to create a harmonious family, as well as a husband who must carry out his obligations as the head of the household, because marriage must be maintained in order to maintain harmony and maintain its sacredness.

Transitional (in)Justice as Duration

This study demonstrates that the ‘transition’ in transitional jurisprudence is a collective imagination that plausibly lays upon the interaction between competing temporal narratives in ‘historical cases’—broadly understood as cases that involve the interplay between law’s temporality and historical process. The dominant view of transitional jurisprudence is inclined to consider transition as a series of discrete and fragmented events. This view, however, fails to bridge the gap between lived experience and law and policy’s mode of representation of past injustices. By contrast, this paper contends that transition should be perceived in pure temporality—transition as a flux or flow of time. This view enables legal actors to better engage in the multitude of temporalities in historical cases. This paper analyzes two issues. First, it juxtaposes the ontological perspective of time as duration and theory of adjudicative reasoning to construe ‘transition’ as a collective temporal imagination among legal actors. It manifests a theoretical basis for experiential time in law by extrapolating Postema’s legal time-mindfulness and Bergson’s duration. Second, it examines law’s distinctive virtue in micro-level agreement about the (temporal) sense of injustices. By focusing on the statutory limitation discussion in African-American Slave Descendants Litigation case in the United States, this study finds that law’s temporality is primarily contested due to the givenness of time. This article concludes that legal actors perceivably capture and disrupt persistent injustices at a micro-level by dislocating the present of atrocious lived experience.

보험회사의 채무부존재 확인의 소에 있어 확인의 이익에 관한 판례 평석

In case where there is a dispute between an insurance company and an insured as to whether an insurance company should pay insurance proceeds and/or as to how much insurance proceeds should be, a lawsuit for negative confirmation, claiming for a judgment to declare that the insurance company should not be held liable to pay any insurance proceeds, is the only possible form of a lawsuit that an insurance company can bring preemptively before a court. A plaintiff who wishes to bring such negative confirmation/declaration claim should have legal interest for such confirmation as it is legal requirement for a confirmation claim, and the Korean court has generally accepted that an insurance company has the legal interest to bring a negative confirmation/declaration claim as long as there is a dispute between an insurance company and an insured regarding insurance coverage and/or insurance proceeds. However, recently, in the above mentioned case, the Korean Supreme Court (en banc) had in-depth discussion as to whether the negative confirmation/declaration claim brought by an insurance company should be restricted or not. Especially, three supreme court judges made a dissenting opinion holding that an insurance company must show special circumstances on order to bring a negative confirmation/declaration claim, especially considering the public nature of insurance, legal obligation of an insurance company to provide protection for an insured, the equity that is required between the parties to an insurance contract and the possible abuse of negative confirmation lawsuit by an insurance company. Although it may be necessary to prevent the abuse of a lawsuit by an insurance company in order to protect an insured, it is difficult to accept the dissenting opinion because the right to bring a lawsuit is constitutional right of an insurance company, and if the court restricts the negative confirmation claim made by an insurance company by requiring additional conditions for “legal interest for confirmation” without a specific provision in a legislation, it could be considered as infringement of such constitutional right. As rightfully pointed out by the supplementary opinion to the majority opinion in this Supreme Court case, the negative confirmation/declaration lawsuit brought by an insurance company could also be beneficial to an insured as it will lead to a swift resolution of the dispute. Moreover, the special circumstance that the dissenting opinion mentioned seems very vague and abstract. So, if the Court requires the special circumstances for the negative confirmation claim, it will be too burdensome to both parties as there will be another dispute over the existence of such special circumstances. Currently, there are ways to control and suppress abusive and/or excessive litigation by an insurance company - (i) internal control system such as litigation management committee established within an insurance company and (ii) external control system such as public disclosure of litigation status of each insurance company and evaluation by the relevant authority. The recent statistics show that the number of litigation cases brought by an insurance company has gradually decreased over the years as a result of existing control systems.

Keep on Dancing: The Success and Failures of the Patent Dance as Shown by BPCIA Litigation Cases Filed after Sandoz v. Amgen

Keep on Dancing: The Success and Failures of the Patent Dance as Shown by BPCIA Litigation Cases Filed after Sandoz v. Amgen

중국 징벌적 손해배상제도의 입법현황과 사법실천의 동향

Changes and progress in social phenomena such as politics, economy, and culture have a lot of influence on the state's legislative policy. In China, the punitive compensation system, which was introduced to deter and prevent malicious illegal activities and to protect victims thicker since the end of the 20th century, has been widely expanded from food, medicine, and product accidents to intellectual property rights. The punitive damages system has been applied by individual legislation or judicial interpretation, but the first integrated civil law implemented in 2021 adopted punitive damages as one of the new rights relief methods. Among all civil cases, the proportion of litigation cases claiming punitive damages is insignificant at present. However, as the area to which the punitive compensation system can be applied is expanding significantly, related lawsuits are expected to increase significantly in the future. In order to implement the legislative purpose of the punitive compensation system and maintain a stable judicial order, above all, it is necessary to determine the multiple of compensation that can secure fairness and equity. As with the provisions of some laws, if the gap in the scope of the multiple of punitive compensation is excessively large, it is necessary to adjust it reasonably because the discretion of the judge may intervene. It is necessary to reasonably adjust this, and in order to secure the effectiveness of the system, a realistic alternative to increase the execution rate of the judgment should be prepared. We look forward to the accumulation of precedents while paying attention to China's continuous legislative efforts and changes in judicial practice.

A 40-Year Litigation Review of Transurethral Surgeries for Benign Prostatic Hyperplasia

ObjectiveTo describe litigation patterns of transurethral surgery in the treatment of benign prostatic hyperplasia including verdicts, types of lawsuits, plaintiff claims, and timing of the claims. MethodsData was gathered by searching for litigation cases between January 1, 1980 and December 1, 2021 in the Westlaw legal database using keywords for transurethral surgeries for benign prostatic hyperplasia. Extracted data included case type, general description of the plaintiffs and defendants, plaintiff claims, and whether the claim involved preoperative, perioperative, or postoperative management, verdict, and indemnity awards. ResultsThe Westlaw search yielded 44 unique cases after removing duplicate and irrelevant cases. The most common surgery resulting in a lawsuit was transurethral resection of the prostate (70%) and urologists were the most frequently named defendant (80%). The most common plaintiff claims were sexual dysfunction (36%), irritative lower urinary tract symptoms (32%), and lack of consent (27%). Among malpractice cases, the verdict was in favor of the defendant in most cases (71%) and among Eighth Amendment violation cases, the verdict was in favor of the defendant in every case. The average indemnity payment was $565,845 and the highest indemnity payment was $1,020,000. ConclusionComplications of transurethral surgeries and lack of consent are common reasons for patient's filing a lawsuit. Healthcare providers should ensure patient understanding of surgical risks and thoroughly document the conversation. Providers should be aware of the causes for litigation among transurethral surgeries for benign prostatic hyperplasia and of the possibility of Eighth Amendment violation lawsuits when treating prison inmates.

Legal implications of the climate-health crisis: A case study analysis of the role of public health in climate litigation.

BackgroundStrong scientific evidence affirms that climate change is now a public health emergency. Increasingly, climate litigation brought against governments and corporations utilizes international human rights, environmental and climate laws and policies to seek accountability for climate-destructive and health-harming actions. The health impacts of climate change make litigation an important means of pursuing justice and strategically challenging legal systems. Yet there is scant documentation in the literature of the role that public health has played in climate litigation and the legal weight public health narratives are given in such contexts. Therefore, we assessed to what extent courts of law have used public health harm in legal adjudication and sought to provide practical recommendations to address barriers to positioning legal arguments in public health-centric frames.MethodsWe reviewed legal databases to identify all publicly reported, documented, cases of climate litigation filed in any country or jurisdiction between 1990 and September 2020. For the 1641 cases identified, we quantified the frequency of cases where health concerns were explicitly or implicitly raised.FindingsCase numbers are trending upwards, notably in high income countries. Resolution remains pending in over half of cases as the majority were initiated in the past three years. Cases were primarily based in climate and human rights law and brought by a wide range of groups and individuals predominantly against governments. About half of the decided cases found in favour for the plaintiffs. Based on this, we selected the 65 cases that were directly linked to public health. We found economic forces and pricing of health risks play a key role, as courts are challenged by litigants to adjudicate on the responsibility for health impacts.ConclusionsWhile courts of law are receptive to public health science, significant legal reform is needed to enhance leveraging of public health evidence in legal judgements of climate litigation cases. The integration of a public health mandate into a new eco-centric legal paradigm will optimize its potential to promote human well-being—the core objective underpinning both international law, human rights, and public health. Existing legal doctrines and practices can be enhanced to increase the weight of public health arguments in climate legal action and consequently ensure legal rulings in climate litigation prioritize, protect and promote public health.

Children and Youth in Strategic Climate Litigation: Advancing Rights through Legal Argument and Legal Mobilization

AbstractChildren and young people constitute more than one quarter of all plaintiffs in rights-based strategic climate litigation cases filed globally up to 2021. This article examines the implications of this development for children's environmental rights inside and outside the courtroom, relying on the analysis of case documents, media coverage, and the broader literature on strategic climate litigation and children's rights. The article finds that children are well placed to make powerful arguments for intergenerational justice. Conversely, children's rights arguments that address their current-day grievances are under-utilized. More consistent inclusion of these types of claim could strengthen children's environmental rights, clarifying and enforcing legal obligations towards children in the context of the climate crisis as it unfolds. The involvement of children in strategic climate litigation, moreover, can advance the critical role of this demographic as stakeholder in climate solutions. However, the participation of children also raises ethical and practical dilemmas, which are currently poorly understood and only haphazardly addressed.

Thermal interactions among vertical geothermal borehole fields

Borehole heat exchanger applications are growing every day – so pronouncedly that many borehole fields will likely operate in dense installation areas in the foreseeable future. In these conditions, thermal interactions will have the potential to develop between neighboring fields, with detrimental effects for the performance and efficiency of such installations in the absence of appropriate designs strategies. Currently, scarce knowledge is accessible on thermal interaction effects among borehole heat exchanger fields and a few approaches allow to effectively consider such effects in the design of these heat exchangers. This paper expands the limited competence on thermal interaction effects among borehole heat exchanger fields and presents and validates a methodology to facilitate the design of such heat exchangers. With reference to a virtual operation of multiple vertical borehole fields in the Loop district of Chicago, USA, the work highlights significant thermal interactions among neighboring borehole fields, responsible for temperature drops of up to 5.9 °C during geothermal operations lasting 50 years. The proposed methodology allows correcting the design of borehole fields to avoid overexploitation of the geothermal resource and the occurrence of litigation cases between geothermal users, representing a powerful approach to cope with thermal interaction effects among geothermal boreholes at scale.

Current risk landscape of point-of-care ultrasound in pediatric emergency medicine in medical malpractice litigation

BackgroundPoint-of-care ultrasound (PoCUS) is expanding as a diagnostic tool in pediatric emergency medicine. Pediatricians are apprehensive to take on the risk of malpractice from incorrect interpretation of PoCUS imaging, therefore limiting its use. Although current studies provide reassurance to this concern, none look directly at the risk for pediatric emergency medicine physicians. Our study aims to evaluate the current medicolegal risk landscape posed by PoCUS in pediatric emergency medicine. MethodsA search of case law was performed utilizing the LexisNexis caselaw database for the period of January 2011 through December 2021. Initial search results were reviewed by the attorney co-authors for relevance to medical malpractice surrounding PoCUS. The remaining cases were reviewed by physician co-authors to ensure their relevance to both ultrasound and the acute care setting. Identified cases were then classified into categories as per the reason for the claim. ResultsNo cases of malpractice litigation were identified that directly related to PoCUS. Ten cases of ultrasound in the acute care setting were identified, 7 of which were in pediatric patients. The majority of these cases related to appendicitis or testicular torsion. Of these 10 cases, 2 cases claimed failure to consider the ultimate diagnosis, but ultrasound would have been an appropriate study had the diagnosis been considered. Of the 8 remaining cases, 6 were based on failure to perform or delay performing ultrasound, 1 claimed that improper ultrasound study was initially performed, and 1 case was based on an improper diagnosis made by ultrasound. DiscussionPoCUS does not appear to pose a significant risk of malpractice litigation in pediatric emergency medicine.

Litigation in the management of urinary stone disease.

ObjectiveTo present common technical and non‐technical issues leading to medicolegal litigation, illustrated by a series of 54 cases, with the aim of using these examples to prevent harm to patients and to prevent surgeons from having to experience the stress of litigation.MethodsA series of 78 medicolegal litigation cases reviewed by a single expert witness over 13 years from 2008 to 2021 was analysed by two reviewers. Twenty‐nine cases were identified as having a non‐technical learning point and 25 were identified as having a technical learning point. These are discussed using illustrative examples and the steps that could have avoided these issues are considered.ResultsAll major issues and themes are illustrated with cases demonstrating the errors that lead to litigation and the often‐simple steps that can be taken to avoid them. Out of 29 non‐technical issues, 13 involved consent issues (45%), eight involved delays in treatment (28%) and eight involved failure to provide adequate safeguarding advice (28%). Out of 25 technical issues, 13 cases involved intra‐operative problems (52%) including nine ureteric injuries, eight involved errors or omissions in the immediate preoperative period (32%) and four resulted from decisions around emergency decompression of the obstructed infected kidney. These emergency cases featured complications of amputation (two out of four) and death (one out of four). These decisions are complex and there are many subtleties to these cases, which are discussed in detail.ConclusionWe hope that this case series highlights the potentially catastrophic outcomes of even small errors of judgement, and allows careful stone surgeons to learn from the experiences of those unfortunate others without having to encounter these situations themselves.

Bony Apprehension Test for Identifying Bone Loss in Patients With Traumatic Anterior Shoulder Instability: A Validation Study

Background: The presence of bone loss has important implications for the surgical treatment of patients with recurrent shoulder instability. The bony apprehension test (BAT) is a physical examination maneuver that was designed to improve specificity from the anterior apprehension test (AAT) in detecting critical bone loss. Purpose: The purpose of this study was to compare the BAT with the AAT and relocation test based on their abilities to predict critical bone loss. Several well–described criteria were utilized to capture critical (≥25%) and subcritical (≥13.5%) glenoid defects, as well as Hill-Sachs defects (≥19%). The ability of the BAT to predict bipolar bone loss was also assessed, as indicated by engaging Hill-Sachs defects and off–track lesions. Study Design: Cohort study (diagnosis); Level of evidence, 1. Methods: The study cohort included patients ≥18 years of age who were scheduled to undergo arthroscopic stabilization for traumatic anterior shoulder instability. Notable exclusion criteria included multidirectional shoulder instability, connective tissue disorders, and workers’ compensation or litigation cases. Patients underwent physical examination immediately before surgery by the treating surgeon (ie, before the induction of anesthesia). Critical glenoid and humeral bone defects were measured on preoperative computed tomography scans. Hill-Sachs engagement and on- or off–track determination of bone loss were assessed arthroscopically and via computed tomography, respectively. Results: A total of 52 patients were included in the study. In cases of subcritical glenoid bone loss (≥13.5%) and critical Hill-Sachs defects (≥19%), the BAT had good and fair specificity (82% and 72%, respectively) but poor sensitivity (40% and 39%). The BAT also had poor sensitivity (0%), specificity (67%), and positive predictive value (0%) for higher percentages of glenoid bone loss (≥25%). When engaging Hill-Sachs lesions were assessed, the BAT had excellent specificity (94%) and positive predictive value (94%) but poor sensitivity (43%) and negative predictive value (44%). Furthermore, the BAT performed poorly at predicting off–track humeral lesions. The AAT demonstrated 100% sensitivity and 0% specificity in detecting all measures of bone loss. Conclusion: The BAT performed poorly at identifying subcritical and critical bone loss and was not found to have any clinical value. Future work is needed to identify a physical examination test that could complement advanced imaging for preoperative assessment of critical bone loss.

Proof of Foreign Nationality and Citizenship Deprivation: Pham and Competing Approaches to Proof in the British Courts

This paper analyses competing approaches to proof of foreign nationality in the British courts, in the context of challenges to deprivation of citizenship. I argue that prevalent British approaches to proof, as on display in the Pham litigation and subsequent cases, are in unproductive tension with a fundamental principle of nationality law, namely that it is for each state to determine under its law who are its nationals. Prevalent British approaches elide this principle, effectively wresting interpretive authority over foreign nationality law away from the relevant foreign state. I argue for approaches focused on direct ascertainment of foreign nationality, as opposed to its reconstruction according to British standards.