Malpractice Claims Research Articles

Painful Convictions: Examining Pain Management Malpractice Claims From Incarcerated Patients, 2000–2020

We aim to characterize the legal landscape of incarcerated patients' pain management malpractice claims and to discuss the ethical and policy implications that result. The most common rationales for lawsuits were failure to completely treat (38 [46.3%]), failure to offer (34 [41.4%]), and delay of treatment (6 [7.3%]). In cases won by defendants, the most common rationale for verdicts was no deliberate indifference occurred (74 [86.6%]). We found that incarcerated individuals were often unsuccessful in litigating claims for inadequate pain management despite several cases pointing toward treatment strategies far below what would be ethically accepted as standard of care in the community setting.

Medical error analysis in dermatology according to the reports of the North Rhine Medical Association from 2004 to 2018.

Assessment of complaints addressed to the Expert Committee for Medical Malpractice Claims of the North Rhine Medical Association helps to identify quality assurance problems in dermatology. 333 dermatological reports (years 2004-2018) were allocated to three five-year intervals in order to show changes of total number of reports and with regard to indications, types of care, defined diagnosis categories, and therapeutic interventions. Statistical analysis was mainly descriptive (SPSS 27). Representative cases are explained in more detail. The number of dermatological reports fell from 119 in the first to 92 reports in the last five-year interval, along with a decline in treatment error rates (43% and 29%) despite an increasing number of procedures across disciplines. 104 reports dealt with (supposed) diagnostic errors, 156 with physical or pharmacological therapies, and 73 reports with surgery. The latter had a low treatment error rate (29%). In comparison to the number of dermatological treatments in Germany, patient allegations are raised only rarely indicating greater patient satisfaction and/or a lower risk potential in dermatology. Incorrect dosages or device settings, diagnostic errors, and deficits in obtaining informed consent are relevant sources of error as underlined by the presented case reports.

Solution Suggestions for Medical Malpractice Claims

Solution Suggestions for Medical Malpractice Claims

Endodontic malpractice litigations in the United States from 2000 to 2021

Background/purposeLittle is known regarding the outcomes and distinguishing characteristics of lawsuits related to endodontic procedures. This study used a verdict-based data from United States of America to analyze the factors associated with endodontic malpractice lawsuits and mitigate the risk of litigation. Materials and methodsThe LexisNexis legal database was used to search for endodontic malpractice cases from January 1, 2000 to December 31, 2021 using the terms “medical malpractice” and (I) “endodontist” (II) “endodontics” (III) “root canal” (IV) “dental pulp.” Each case was reviewed for reported medical characteristics and litigation outcomes. ResultsA total of 650 cases were initially identified, and 97 cases were included in the final analysis. Eighty-four (86.6%) of the 97 defendants were general practitioners; 42 cases favored the plaintiff, 53 (54.6%) favored the defendant, 1 was partial win/loss, and 1 was settled. The annual case mean was 4.41 ± 2.17 (Mean ± SD). The major allegations favored for the patients involving paresthesia, root perforation, rubber dam not use, wrong tooth therapy, and infections. Plaintiffs who claimed with post-procedural reasons had a significantly higher winning rate than non-post-procedural reasons (P < 0.05). ConclusionIn the present study, 54.6% of endodontic litigation favored the dentists in the US. The authors recommend that general practitioners refer complicated cases to endodontists and treat carefully to avoid paresthesia, canal perforation and infections. Clinicians should always diagnose and treat correctly, shared decision making with the patient, use rubber dam routinely, and timely management to prevent malpractice claims.

The nature of malpractice claims related to nerve damage after dental implants insertion in Israel during 2005-2020: A descriptive study.

Dental implant placement is a routine practice in dentistry, with a possible uncommon risk of neurosensory injury. The present study analyzed all dental implant claims involving sensory nerve disturbances between 2005 and 2020 in Israel. The study was conducted to understand implant risk management better and improve the patient's safety. All legal claims registered by Medical Consultant International (MCI) involving nerve damage claims between 2005 and 2020 were included in the study. The data included demographic details such as age, sex, event date, claim delivery date, and treatment settings. Information on the nerve damage included the damaged nerve, side of injury, and the number of implants performed in the same surgery. There were 218 claims regarding nerve damage out of 1154 claims for dental implant therapy. The mean age for nerve damage claims was 54.1± 11 years. There were more female than male claims (p= 0.02), with 87% of cases concerning damage to the inferior alveolar nerve (p< 0.0001), out of those molar areas being more frequently involved in nerve damage (64.3%, p< 0.0001). The left side was 1.4 times more frequent than the right side (p= 0.043). The risk for nerve injury was 7.4 times higher when placing multiple implants compared to single dental implant (p< 0.0001). Clinicians should be aware that placement of multiple implants, left-side implant placement, and patient gender may increase risk for a malpractice claim for neurosensory disturbances.

Should patients use online reviews to pick their doctors and hospitals?

AbstractWe compare the online reviews of 221 “Questionable” Illinois and Indiana physicians with multiple paid medical malpractice claims and disciplinary sanctions with matched control physicians with clean records. Across five prominent online rating services, we find small, mostly insignificant differences in star ratings and written reviews for Questionable versus control physicians. Only one rating service (Healthgrades) reports on paid medical malpractice claims and disciplinary actions and it misses more than 90% of these actions. We also evaluate the online ratings of 171 Illinois hospitals and find that their ratings are largely uncorrelated with the share of hospital‐affiliated physicians with paid medical malpractice claims and disciplinary sanctions. Online ratings have limited utility in helping patients avoid physicians with troubled medical malpractice and disciplinary records, and steering patients away from hospitals at which more physicians have paid medical malpractice claims and disciplinary sanctions.

The Application of Graph Theoretical Analysis to Complex Networks in Medical Malpractice in China: Qualitative Study.

Studies have shown that hospitals or physicians with multiple malpractice claims are more likely to be involved in new claims. This finding indicates that medical malpractice may be clustered by institutions. We aimed to identify the underlying mechanisms of medical malpractice that, in the long term, may contribute to developing interventions to reduce future claims and patient harm. This study extracted the semantic network in 6610 medical litigation records (unstructured data) obtained from a public judicial database in China. They represented the most serious cases of malpractice in the country. The medical malpractice network of China was presented as a knowledge graph based on the complex network theory; it uses the International Classification of Patient Safety from the World Health Organization as a reference. We found that the medical malpractice network of China was a scale-free network-the occurrence of medical malpractice in litigation cases was not random, but traceable. The results of the hub nodes revealed that orthopedics, obstetrics and gynecology, and the emergency department were the 3 most frequent specialties that incurred malpractice; inadequate informed consent work constituted the most errors. Nontechnical errors (eg, inadequate informed consent) showed a higher centrality than technical errors. Hospitals and medical boards could apply our approach to detect hub nodes that are likely to benefit from interventions; doing so could effectively control medical risks.

A Quality Improvement Initiative to Improve After-visit Summary Distribution in Orthopedic Outpatient Clinics.

We initiated a quality improvement (QI) initiative implementing concepts derived from the Institute for Healthcare Improvement (IHI) model, including plan-do-study-act cycles, to increase AVS distribution rates in a high-volume, fast-paced ambulatory pediatric orthopedic clinic. Interventions included staff education and training, trainee instruction, enlistment of electronic medical record superusers to enhance the distribution process, and provision of regular, transparent communication of individual and team performance. The impact of interventions was measured using a p-chart. There was a consistent improvement in the rate of AVS distribution with each intervention implemented. The distribution rate on project initiation was 81.9%, with a final rate of 95.7%. The most statistically significant shift occurred following the final intervention, which included sharing unblinded individual performance data. Our data demonstrate that a dedicated QI program using IHI methodology improved AVS distribution rates in a pediatric orthopedic clinic. Consistently distributing the AVS affords our patients and families a better opportunity to review pertinent visit information, education, medication changes, and upcoming appointments.

Medical Malpractice in Robotic Surgery: A Westlaw Database Analysis

INTRODUCTION: Malpractice claims involving robot-assisted surgical procedures have increased more than 250% in the past 7 years compared to the 7 years prior. We examined robotic surgery malpractice claims to identify trends in claimed liabilities, describe legal outcomes, and determine strategies to minimize future litigation. METHODS: The Westlaw legal database was queried retrospectively for US state and federal trials regarding robot-assisted surgical procedures from 2006 to 2013 and 2014 to 2021. Data abstracted from verdict reports included year, state, court type, defendant specialty, procedure performed, claimed injuries and liabilities, verdict, and damage amount awarded. RESULTS: Sixty-one cases across 25 states were identified, 16 cases between 2006 and 2013, and 45 from 2014 to 2021 (Fig. 1). Among those 45 cases, defendant verdicts predominated (n = 35, 77.8%), with only four plaintiff verdicts (8.9%) and six settlements (13.3%). Overall, 169 liabilities were claimed, most commonly negligent surgery (82.2%), misdiagnosis/failure to diagnose (46.7%), delayed treatment (35.6%), and lack of informed consent (31.1%). Thirteen cases resulted in indemnity payments (mean = $1,251,274), with damages ranging from $10,087 (infection and retained foreign body) to $5,008,922 (patient death). Hysterectomy (n = 19, 42.2%) was the most commonly litigated surgery, followed by prostatectomy (n = 5) and hernia repair (n = 4). The most litigated specialties were obstetrics/gynecology (48.9%), general surgery (28.9%), and urology (15.6%).CONCLUSION: Malpractice litigation in robot-assisted surgery is infrequent. As robotic procedures become more commonplace, surgeons must keep common liabilities in mind, as there are valuable and actionable lessons to be learned from these cases. Malpractice reform, continuing medical education activities, and improved informed consent protocols may help minimize future litigation.

Preserving Immunity for Reporters of Medical Child Abuse.

All American jurisdictions have laws protecting children from abuse and neglect. Mandated reporters, including health professionals, whether their suspicions ultimately are substantiated or unfounded, are entitled to immunity when their reports are entered in good faith. When harm takes the form of medical child abuse (MCA, also known as Munchausen syndrome by proxy or factitious disorder imposed on another), its origin is ambiguous, at least initially. Questions arise as to whether the caregiver intended to deceive medical professionals and if the condition improved when the child was separated from the caregiver. Clinicians may have an obligation to report MCA in difficult-to-diagnose cases or those where parents press for hospitalizations and procedures. Substantiated cases may lead to removal of children from homes and criminal prosecution of parents. This can result in backlash against the reporter by the parents, with claims of malpractice, official misconduct, intentional harm, fraud or conspiracy to commit fraud, defamation (libel or slander), or all of the above. This article examines case law regarding alleged departures from good-faith reporting of MCA and explores potential limitations to immunity provided to mandated reporters. The findings include no significant instances in which the immunity shield for good-faith reporting was pierced.

Artificial Intelligence in the American Healthcare Industry: Looking Forward to 2030

Artificial Intelligence in the American Healthcare Industry: Looking Forward to 2030

Trends and Developments in Medical Liability Claims in The Netherlands.

Recent data on number of claims, final judgement of claims and their costs are scarce. This study analyzes 15 years of malpractice claims in the Netherlands. All claims filed, and all claims closed by two insurance companies (which insure approximately 95% of all hospitals in the Netherlands) between 2007–2021 are included. Trends in number of claims, medical specialties involved, final judgements and costs from malpractice claims are analyzed, as well as the impact of COVID-19 on malpractice claims. In total, 20,726 claims were filed and 21,826 claims were closed. Since 2013, the number of claims filed decreased. Of all claims filed, 64% were aimed at surgical specialties and 18% at contemplative specialties. Of all claims closed, 24.49% were accepted, 19.26% were settled and 48.94% got rejected. The financial burden of all claims closed quadrupled between 2007 and 2021; this increase was caused by rare cases with excessively high costs. Since the COVID-19 pandemic, we observed a decrease in the number of claims filed, and the number of incidents reported. This study provides valuable insights into trends and developments in the number and costs of liability claims, which is the first step towards improving patient safety and preventing incidents and malpractice claims.

PO049 / #1078 THE MEDICAL-LEGAL AND ETHICAL ASPECTS OF NEUROMODULATORY INTERVENTIONS: E-POSTER VIEWING

Chronic pain is estimated to cost more health care dollars each year in the United States than heart disease, cancer, or diabetes. An estimated 100 million Americans are affected. Implanted devices such as intrathecal drug delivery systems (IDDS) and spinal cord stimulators (SCS) are among the modalities available for the treatment of intractable pain. Analyses of closed malpractice claims allow the study of both serious and rare complications and the awareness thereof facilitates improved patient safety.

Malpractice against shoulder surgeons: what the data say.

Thousands of orthopedic surgeons in the United State face medical malpractice claims annually; however, little is known regarding the common causes for litigation against shoulder surgeons. In addition, the current analysis does not take into consideration how surgical frequency affects the litigation likelihood. The purpose of our investigation was to identify the most common causes of litigation against shoulder surgeons in the United States adjusting for surgical frequency. The VerdictSearch database was used using the search terms "medical malpractice," "shoulder," and "NOT cancer." Results were queried, and all studies pertaining to orthopedic shoulder surgery included. Data gathered included cause of lawsuit, indemnity paid, type of surgery performed, results of the cases, verdict or settlement, and, if applicable, technical error. A query of a multisurgeon institutional database was conducted to determine how frequently surgeries were performed. Then the frequency of litigation was adjusted by the procedure frequency to determine which surgery has the greatest likelihood to be litigated relative to rotator cuff surgery. Forty-five cases were included in our study. After adjusting for the procedure frequency, the most likely procedure to be litigated, relative to rotator cuff repair, was manipulation under anesthesia (MUA), 251 times more likely to be litigated, and washout/lavage procedures, 17 times more likely to be litigated. Injection and total shoulder arthroplasty were 23 and 14 times less likely to be litigated relative to rotator cuff repair, respectively. In addition, the average age of the patients was 47 years, and 53% of the cases involved a male plaintiff. The most commonly litigated procedures were rotator cuff repair (42%), MUA (13%), and humeral open reduction and internal fixation (9%). The most commonly cited symptoms for litigation against shoulder surgeons were pain (60%) and loss of range of motion (40%). Of the 45 cases, 44% ended in physician loss, with the average indemnity paid via verdict being $1,118,714 vs. $416,875 for settlement. This study identifies that MUA and lavage/washout procedures are much more likely to be litigated relative to rotator cuff repair. Rotator cuff repair is actually one of the least likely procedures to be litigated. Furthermore, settlement may represent a method of decreasing the indemnity paid for malpractice cases for which surgeons are implicated.

The e-Autopsy/e-Biopsy: a systematic chart review to increase safety and diagnostic accuracy.

Solving diagnostic errors is difficult and progress on preventing those errors has been slow since the 2015 National Academy of Medicine report. There are several methods used to improve diagnostic and other errors including voluntary reporting; malpractice claims; patient complaints; physician surveys, random quality reviews and audits, and peer review data which usually evaluates single cases and not the systems that allowed the error. Additionally, manual review of charts is often labor intensive and reviewer dependent. In 2010 we developed an e-Autopsy/e-Biopsy (eA/eB) methodology to aggregate cases with quality/safety/diagnostic issues, focusing on a specific population of patients and conditions. By performing a hybrid review process (cases are first filtered using administrative data followed by standardized manual chart reviews) we can efficiently identify patterns of medical and diagnostic error leading to opportunities for system improvements that have improved care for future patients. We present a detailed methodology for eA/eB studies and describe results from three successful studies on different diagnoses (ectopic pregnancy, abdominal aortic aneurysms, and advanced colon cancer) that illustrate our eA/eB process and how it reveals insights into creating systems that reduce diagnostic and other errors. The eA/eB process is innovative and transferable to other healthcare organizations and settings to identify trends in diagnostic error and other quality issues resulting in improved systems of care.

The impact and prevention of systemic and diagnostic errors in surgical malpractice claims in Japan: a retrospective cohort study.

The Surgical Patient Safety System (SURPASS) has been proven to improve patient outcomes. However, few studies have evaluated the details of litigation and its prevention in terms of systemic and diagnostic errors as potentially preventable problems. The present study explored factors associated with accepted claims (surgeon-loss). We retrospectively searched the national Japanese malpractice claims database between 1961 and 2017. Using multivariable logistic regression models, we assessed the association between medical malpractice variables (systemic and diagnostic errors, facility size, time, place, and clinical outcomes) and litigation outcomes (acceptance). We evaluated whether or not the factors associated with litigation could have been prevented with the SURPASS checklist. We identified 339 malpractice claims made against general surgeons. There were 159 (56.3%) accepted claims, and the median compensation paid was 164,381 USD. In multivariable analyses, system (odds ratio, 27.2 95% confidence interval 13.8-53.5) and diagnostic errors (odds ratio 5.3, 95% confidence interval 2.7-10.5) had a significant statistical association with accepted claims. The SURPASS checklist may have prevented 7% and 10% of the accepted claims and systemic errors, respectively. It is unclear what proportion of accepted claims indicated that general surgeon loses should be prevented from performing surgery if the SURPASS checklist were used. In conclusion, systemic and diagnostic errors were associated with accepted claims. Surgical teams should adhere to the SURPASS checklist to enhance patient safety and reduce surgeon risk.

It’s Story Time: Unlocking the Learnings in Malpractice Settlements

Risk managers and the insurers with whom we work have the greatest opportunity in healthcare today to improve patient safety. Our most egregious mistakes become medical malpractice claims and lawsuits. Some of these go to trial where the outcome is public; however, the least defensible cases are settled without a trial. Almost every settlement includes a confidentiality or nondisclosure clause (NDC). Such clauses become “gag orders.” Providers who could learn from the mistake of a colleague do not, and the same mistake is repeated, often many times over. The stories of these settlements are a rich source of learning, and it’s time to tell them—anonymously. No naming names, no disclosure of settlement amounts, no “blame and shame.” Stories are powerful, attention-grabbing, and memorable. Telling them is a unique opportunity to link the prevention of patient harm to the healing mission of healthcare and acknowledge the common wish of every plaintiff that “this won’t happen to someone else.”

Assessing the value of precision medicine health technologies to detect and manage melanoma.

Assessing the value of precision medicine health technologies to detect and manage melanoma.

Informed Consent: A Process, Not a Form

Back to table of contents Previous article Next article Government & LegalFull AccessInformed Consent: A Process, Not a FormDenise Neal, B.S.N., M.J., C.P.H.R.M.ADenise NealSearch for more papers by this author, B.S.N., M.J., C.P.H.R.M.APublished Online:25 Aug 2022https://doi.org/10.1176/appi.pn.2022.09.9.25AbstractInformed consent is a collaborative, educational process and must be documented on an ongoing basis.iStock/fizkesInformed consent must be well understood and respected by those responsible for providing health care services to patients. The purpose of informed consent is to ensure patients have been provided with sufficient information to make an informed decision about their health care. The responsibility for obtaining informed consent rests with the psychiatrist providing the proposed medical care, treatment, or procedure, and this responsibility may not be delegated.Ongoing Collaboration Is KeyThe informed consent process is guided by federal and state statutes and regulations, case law, professional codes of ethics, Medicare Conditions of Participation, national accreditations standards (such as The Joint Commission and DNV), and provisions of medical staff bylaws. Age of consent by minors varies widely by state.Informed consent is an ongoing collaborative communication process between psychiatrists and patients. The signing of the consent form is validation that the process has occurred and an agreement has been reached. The communication process includes the following elements: a description of the indications for treatment; an explanation and purpose of the proposed treatment/procedure; the probable risks, benefits, and alternatives; and a description of the risks if patients do not consent to the proposed treatment/procedure/or alternatives.Risk Considerations for Effective Consent CommunicationDecisional capacity is the ability to understand and appreciate the nature and consequences of the decision. The determination of decisional capacity is made by a physician and must be documented at the time consent is obtained as this question will be brought up in any allegation of negligence involving informed consent. If the patient lacks decisional capacity, the patient’s legally authorized agent must consent.Patients determined to have decisional capacity have a fundamental right to decide whether to authorize or reject proposed medical care, treatment, procedures, or surgery. Patients with decisional capacity also have a right to change their mind and withdraw from previously authorized care and treatment.Documentation of the informed consent process is critical to defend a claim of medical malpractice and/or battery. To bring a claim for lack of informed consent, the patient must demonstrate that if adequate information had been provided, the patient would have elected to make a different decision. A battery claim may be brought for any unauthorized treatment or touching of the patient, even if the standard of care was followed and no harm occurred.The consent process is ongoing and may involve multiple discussions. Patients should be allowed to ask questions and receive answers in language they can understand. Each informed consent discussion should be documented. If patients refuse care or treatment, informed refusal must be documented, including that they had the opportunity to ask questions and to “teach back” what was discussed to verify their understanding. Documentation must also be maintained in the event patients decide to withdraw a previously provided consent.If applicable, obtain patients’ authorization when involving the family in care and treatment discussions. It is equally important to document the family’s involvement in decision-making and informed consent discussions.Bottom LinePatients have the right to make informed decisions regarding their health care. Informed consent is an ongoing process that includes a dialogue between the psychiatrist and each patient and allows for questions to be asked and answered. Documentation of the informed consent process is important to demonstrate informed consent was conducted in accordance with federal and state statutes and regulations, professional codes of ethics, and the standard of care. ■Risk management services are provided as an exclusive benefit to insureds of the APA-endorsed American Professional Agency Inc. liability insurance program. This information is provided as a risk management resource for Allied World policyholders and should not be construed as legal or clinical advice. This material may not be reproduced or distributed without the express, written permission of Allied World Assurance Company Holdings, Ltd, a Fairfax company (“Allied World”). Risk management services are provided by or arranged through AWAC Services Company, a member company of Allied World. © 2022 Allied World Assurance Company Holdings, Ltd. All Rights Reserved.Denise Neal, B.S.N., M.J., C.P.H.R.M., is a risk management consultant in the Risk Management Group of AWAC Services Company, a member company of Allied World. Risk management services are provided as an exclusive benefit to insureds of the APA-endorsed American Professional Agency Inc. liability insurance program. ISSUES NewArchived

Factors Associated with Malpractice Claim Payout: An Analysis of Closed Emergency Department Claims.

Factors Associated with Malpractice Claim Payout: An Analysis of Closed Emergency Department Claims.