Malpractice Lawsuits Research Articles

Inferior Vena Cava Filter Litigation Review: An Analysis of Medicolegal Cases Pertaining to Inferior Vena Cava Filters

PurposeTo identify and analyze all medical malpractice and product liability lawsuits pertaining to inferior vena cava (IVC) filters published within a well-recognized legal research database. Materials and MethodsLexisNexis, a legal research database, was used to retrieve cases that mentioned harm from IVC filters, or lack thereof, as the cause for legal action. A total of 672 cases were analyzed for type of case (medical malpractice or product liability), filter model implanted, filter complications, court decisions, and settlement payments if any. ResultsOf 95 analyzed cases, 20 (21.1%) were medical malpractice cases and 75 (78.9%) were product liability cases. C.R. Bard was the manufacturer associated with the most lawsuits (n = 41, 48.8%). The most litigious filters were the G2 filter from C.R. Bard (n = 17, 20.2%) and Greenfield filter from Boston Scientific (n = 17). The most common complications were IVC penetration (n = 26, 29.9%), filter migration (n = 26, 29.9%), filter fracture (n = 23, 26.4%), and tilt (n = 16, 18.4%). The number of product liability cases has increased from accounting for 25.0% (2 of 8) of filter lawsuits between 2000 and 2010 to 83.9% (73 of 87) during 2011–2020. Of the 20 medical malpractice claims, 9 (45%) were filed for failure to place a filter. One physician was found liable for filter-related complications by a state court in 2014. ConclusionsThe majority of recent IVC filter–related lawsuits are filed against manufacturers on the basis of product liability claims, with the main litigious filters being the G2 and Greenfield filters. Most cases resulted in rulings for physicians or manufacturers. Some were filed against physicians for filter-related complications or for failure to place an IVC filter.

Medical Malpractice Lawsuits Involving Trainees in Obstetrics and Gynecology in the USA.

Background: While the liability risks for obstetrics and gynecology (ob/gyn) physicians are widely recognized, little is known about how trainees have been involved in ob/gyn lawsuits. Objectives: To characterize involvement of trainees in malpractice lawsuits related to ob/gyn. Methods: The legal database Westlaw was utilized to collect ob/gyn-related malpractice lawsuits involving trainees reported from 1986 to 2020 in the USA. Outcome: Forty-six malpractice cases involving ob/gyn trainees were identified, including 34 cases related to obstetrics and 12 to gynecology. There were 11 cases alleging lack of informed consent, including 7 cases alleging lack of consent for trainee involvement. Of the 34 obstetrics cases, 27 related to procedural complications, 17 to treatment, 13 to diagnosis, and 4 to informed consent. Of these, 17 were decided in favor of the physician, 6 resulted in findings of negligence, 9 had unknown outcomes, and 3 ended in settlement. For the 6 cases ending in a finding of negligence, the mean award was $2,174,472 compared to $685,000 for those that were settled. Of the 12 gynecology cases, 8 related to procedural complications, 7 to informed consent, 3 to diagnosis, and 2 to treatment. Of these, 6 were decided in favor of the physician, 3 resulted in findings of negligence, and 3 had unknown outcomes. For the cases ending in a finding of negligence, the mean award was $465,000. Conclusions and Outlook: This review of malpractice cases highlights types of situations in which trainees are sued and reveals the importance of designing curriculum around faculty training and supervision regarding trainee involvement in patient care.

Malpractice Litigation: The Elephant in the Reading Room.

Seven percent of radiologists in the United States are sued each year for alleged medical malpractice [1], with radiologists on average spending 10% of their professional careers with looming malpractice claims [2]. The implications are manifold. Malpractice lawsuits are strongly associated with not only physician burnout—which is now endemic—but also depression and suicide [3]. And as medical expenditures continue to soar, the costs of defensive medicine, and particularly defensive imaging [4], cannot be ignored.

EVALUATION OF ORAL AND MAXILLOFACIAL SURGEONS' AND RESEARCH ASISSTANTS’ ATTITUDES OF DEFENSIVE DENTISTRY

Objective
 The concept of defensive medicine practices can
 be described as the physicians primarily aiming to
 protect themselves from possible legal actions in
 clinical decision processes. At the point reached
 today, the increase in legal processes dealing with
 health practices causes physicians to use defensive
 medical practices more frequently in their clinical
 practice. The aim of this study is to investigate the
 defensive dentistry attitudes of oral and maxillofacial
 surgeons (OMFS) and research assistants and the
 factors affecting these attitudes.
 Materials and Methods
 146 OMFS specialists/research assistants working
 in various institutions were contacted between
 January-February 2021, and 63 dentists (43.1%),
 who responded by filling out the survey and met
 the inclusion criteria, were included in the study.
 The participants' age, gender, institution or private
 establishment where they operate, time spent
 in the physician-patient relationship, history of
 malpractice lawsuits, thoughts on whether they
 will face malpractice lawsuits in the next 10 years,
 and their level of knowledge on defensive dentistry
 were recorded. Inclusion criteria for the study were
 determined as having served at least 1 year in the
 field of OMFS and still being in a patient-physician
 relationship in this field.
 Results
 It was concluded that 47.6% of the physicians
 participating in the study applied defensive dentistry
 at a very high level, 41.3% at a high level, and
 11.1% at a moderate level, while the mean defensive
 dentistry score was found as 46.25 ±7.42. It has been
 determined that the mean defensive dentistry scores
 vary depending on the institution, litigation history and
 the anticipation of litigation in the next 10 years.
 Conclusion
 OMFS specialists and research assistants commonly
 practice defensive dentistry. On the other hand, it has
 been determined that OMFS specialists and research
 assistants do not have sufficient knowledge about
 the concept of defensive dentistry, therefore we think
 that including training on the concept of defensive
 dentistry in graduate or post-graduate programs
 would be beneficial.

Obstetric hemorrhage and surgical emergencies training workshops on fresh cadavers and simulators result in high application in daily practices and decreased patient referral.

Objective:In this study, we aimed to evaluate the effects of obstetric emergencies workshops combining theoretical lectures, simulation trainers and fresh cadaver models on daily practices and referrals of obstetrics and gynecology specialists.Materials and Methods:This is a prospective observational study involving obstetrics and gynecology specialists attending the Turkish Society of Obstetrics and Gynecology endorsed obstetrics hemorrhage management courses held in 2018 and 2019. The training course is an annually organized two-day course, one day allotted to theoretical lectures and the other day to practical training on both simulators and fresh cadavers. Trainees participating in the course was surveyed with an anonymous questionnaire on their motivation to attend the course and their juridical history of obstetric patient management. Attendees were asked to disclose whether they had ever independently performed the procedures stated in the questionnaire or not, before commencing the course and 1 year after attending the course.Results:Among the attendees 22% (n=32) had at least one obstetrical malpractice lawsuit and 36.1% (n=52) were accused of Health Care Complaints Comission. The main motivation of the attendees for taking this course was Professional development followed by reducing maternal mortality and morbidity and avoiding malpractice. One year after the course, attendees applying uterine devascularization surgery increased by 36.1% (52/144), uterine compression sutures increased by 52.7% (76/144), and ability to apply uterine balloon tamponade increased by 59.7% (86/144). Besides improvement in other obstetric surgical skills an indirect effect seen that the attandees operated on high-risk cases increased in placenta previa (15.3%), placenta acreata spectrum (30.5%), operative deliveries (27.7%), peripartum hysterectomy (24.9%) and relaparotomy for postpartum hemorrhage (34.7%).Conclusion:Opportunities of attending well organized fresh cadaveric workshops on managing postpartum hemorrhage and other obstetric surgeries, can quickly adapt to daily practice, restore the professional confidence of obstetric and gynecology specialists, and eventually decrease patient referral.

Adverse events in anesthesia: Analysis of claims against anesthetists affiliated to an insurance fund in Colombia. Cross-sectional study

Introduction: Prevention, identification, analysis and reduction of adverse events (AEs) are all activities designed to increase safety of care in the clinical setting. Closed claims reviews are a strategy that allows to identify patient safety issues. This study analyzes adverse events resulting in malpractice lawsuits against anesthesiologist affiliated to an insurance fund in Colombia between 2013-2019.
 Objective: To analyze adverse events in closed medicolegal lawsuits against anesthesiologist affiliated to an insurance fund between 2013-2019.
 Methods: Cross-sectional observational study. Convenience sampling was used, including all closed claims in which anesthesiologist affiliated to an insurance fund in Colombia were sued during the observation period. Variables associated with the occurrence of AEs were analyzed.
 Results: Overall, 71 claims were analyzed, of which 33.5% were due to anesthesia-related AEs. Adverse events were found more frequently among ASA I-II patients (78.9%), and in surgical procedures (95.8%). The highest number of adverse events occurred in plastic surgery (29.6%); the event with the highest proportion was patient death (43.7%). Flaws in clinical records and failure to comply with the standards were found in a substantial number of cases.
 Conclusions: When compared with a previously published study in the same population, an increase in ethical, disciplinary and administrative claims was found, driven by events not directly related to anesthesia. Most of the anesthesia-related events occurred in the operating theater during surgical procedures in patients and procedures categorized as low risk, and most of them were preventable.

Trial and Error: Learning From Malpractice Claims in Childhood Surgery

IntroductionThe purpose of this study was to analyze a nationwide database of malpractice lawsuits involving pediatric surgical patients to identify contributing factors in liability claims. MethodsUsing the CRICO (Controlled Risk Insurance Company Strategies’ Comparative Benchmarking System) database, malpractice claims involving patients ≤18 y old were reviewed from 2008 to 2017. Data were analyzed using descriptive statistics and logistic regression. ResultsOf the 844 claims, 76% of the patients were older than age 5. While the average total indemnity paid was $544,325, cases with claimants <1-year-old accounted for 24% of the total indemnity paid, with an average of $1,135,240 per claimant. The most frequently named responsible services were Orthopedics (34%), General Surgery (15%), and Otolaryngology (11%). Fracture or dislocation, appendectomy, skin/breast surgery, arthroscopy, and tonsillectomy/adenoidectomy were among the frequently involved procedures for the cohort of cases. The most common contributing factors for the top procedures involve issues surrounding patient assessment, technical performance, and communication. Cases with a contributing factor of failure to appreciate and reconcile relevant sign/symptom/test results were associated with a higher likelihood of payment (OR 6.6, P < 0.05). Issues surrounding the selection of therapy also led to an increased likelihood of an indemnity payment (OR 2.8, P < 0.05). ConclusionsMalpractice claims related to pediatric surgical procedures involve a wide range of specialties. Patient evaluations, technical performance, and communication are modifiable factors to improve surgical care in children. The contributing factors assigned to each procedure may represent an opportunity for focused improvement to improve patient outcomes.

10. Do Plastic Surgery Residents Get Sued? An Analysis of Malpractice Lawsuits

Background: Residents may be implicated in malpractice lawsuits. Our study aims to examine medical malpractice lawsuits involving plastic surgery trainees. Methods: Using the LexisNexis legal database, jury verdicts and settlements from all appellate state and federal cases between February 1988 and 2020 were queried, and a non-representative sample of over 300 cases was compiled, each of which were manually reviewed by 2 authors (A.G. and S.J.). Results: During a 30-year period, 22 malpractice cases involving plastic surgery trainees were identified. Of these cases, 15 (68.2%) involved claims in which a trainee was directly named as a defendant. A total of 18 (81.8%) cases were due to procedural-related adverse outcomes, while 4 (18.2%) cases were associated with clinical or diagnostic-related adverse outcomes. Of the procedure-related cases, 5 (27.8%) occurred when the trainee was the lead surgeon. Allegations raised by plaintiffs included lack of informed consent of procedure complications (12, 54.5%), procedural error (11, 50%), failure to supervise a trainee (11, 50%), inexperience of the trainee (8, 36.4%), incorrect diagnosis or treatment (5, 22.7%), a delay in evaluation (3 cases, 13.6%), lack of informed consent of resident being involved (3, 13.6%), lack of follow-up care (3, 13.6%), and prolonged operative time (1, 4.5%). The median time from injury to lawsuit resolution was 3.5 years (interquartile range [IQR], 3-5 years). Verdicts were ruled in favor of the defense in 9 (40.9%) cases and for the plaintiff in 6 (27.3%) cases. A settlement was made in 7 (31.8%) cases. The median payout for plaintiff-won cases was $5,100,000 (IQR $1,530,000-$17,500,000), and the median settlement was $2,500,000 (IQR $262,500-$4,410,000).?? Conclusion: Procedural error, improper informed consent, improper trainee supervision, and resident inexperience were the most common allegations proposed by patients in cases involving plastic surgery trainees. These factors can lead to an enduring financial and psychological burden early on in a physician’s career, as well as poor health outcomes. Highlighting these issues during medical education may decrease physician malpractice risk, lower the incidence of burnout, and ultimately improve patient satisfaction and outcomes.

Court rules technician not covered by employer's insurance in malpractice lawsuit

Pharmacists and pharmacy technicians are humans, and humans make mistakes. Human errors can be reduced though system improvements, but they cannot be completely avoided. This is why health care institutions have departments of “risk management” rather than departments of “risk elimination.”

MP10-20 MEDICAL MALPRACTICE LAWSUITS INVOLVING UROLOGY TRAINEES

You have accessJournal of UrologyCME1 May 2022MP10-20 MEDICAL MALPRACTICE LAWSUITS INVOLVING UROLOGY TRAINEES Roei Golan, Manish Kuchakulla, Arjun Watane, Raghuram Reddy, Ravi Parikh, and Ranjith Ramasamy Roei GolanRoei Golan More articles by this author , Manish KuchakullaManish Kuchakulla More articles by this author , Arjun WataneArjun Watane More articles by this author , Raghuram ReddyRaghuram Reddy More articles by this author , Ravi ParikhRavi Parikh More articles by this author , and Ranjith RamasamyRanjith Ramasamy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002532.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Malpractice suits are lengthy and may cause a heavy psychological burden on young physicians at the inception of their careers. Our objective was to distinguish the various characteristics of medical malpractice lawsuits involving trainees to prevent future litigation. METHODS: LexisNexis, an online legal research database containing legal records from the United States, was retrospectively reviewed for malpractice cases involving urology interns, residents, or fellows from January 1, 1988, to December 31, 2020. RESULTS: A total of 16 cases were included, of which 7 (43.8%) involved urological allegations while 9 (56.2%) involved non-urological allegations. 5 of the cases consisting of non-urological adverse outcomes led to mortality. Procedural error was claimed in 12 (75%) cases, negligence in 7 (43.8%), delayed evaluation in 6 (37.5%), lack of informed consent of procedure or complications in 4 (25%), failure to pursue treatment in 4 (25%), inexperienced trainee in 2 (12.5%), failure to supervise trainee in 2 (12.5%), lack of informed consent of trainee involvement in 1 (6.2%), incorrect diagnosis in 1 (6.2%), and prolonged operative time in 1 (6.2%) case. The average time from medical injury to verdict date was around 5 years. The median time was 4.4 years (IQR 3.9 - 5.2 years), with a maximum time of 11.9 years and a minimum time of 1.8 years. Five (31.2%) cases led to the jury rendering a defense verdict, and 6 (37.5%) cases resulted in payout for the plaintiff (median $728,491; IQR $439,245 - $1,350,000). The other 5 (31.2%) cases resolved in a settlement (median $490,000; IQR $397,500 - $525,000). Payouts, whether through verdict or settlement, occurred in 11 (68.8%) cases. CONCLUSIONS: The cases reported in this study highlight the importance of perioperative care, communication skills between attending physicians, trainees, and patients, providing detailed informed consent, careful documentation, and acknowledging mistakes. Future research should focus on strengthening training programs' execution of malpractice prevention amongst trainees. In addition to mitigating malpractice lawsuit risk, malpractice education may benefit the healthcare system and most importantly, the patients and their families. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e155 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roei Golan More articles by this author Manish Kuchakulla More articles by this author Arjun Watane More articles by this author Raghuram Reddy More articles by this author Ravi Parikh More articles by this author Ranjith Ramasamy More articles by this author Expand All Advertisement PDF DownloadLoading ...

Charting Practices to Protect Against Malpractice: Case Reviews and Learning Points.

IntroductionMedical documentation issues play a role in 10–20% of medical malpractice lawsuits. Inaccurate, incomplete, or generic records undermine a physician’s defense and make a plaintiff’s lawyer more likely to take on a case. Despite the frequency of documentation errors in malpractice suits, physicians receive very little education or feedback on their documentation. Our objective in this case series was to evaluate malpractice cases related to documentation to help improve physicians’ documentation and minimize their liability risks.MethodsWe used Thomson Reuters Westlaw legal database to identify malpractice cases related to documentation. Common issues related to documentation and themes in the cases were identified and highlighted.ResultsWe classified cases into the following categories: incomplete documentation; inaccurate text; transcription errors; judgmental language; and alteration of documentation. By evaluating real cases, physicians can better understand common errors of other practitioners and avoid these in their own practice.ConclusionEmergency physicians can reduce their liability risks by relying less on forms and templates and making a habit of documenting discussions with the patients, recording others’ involvement in patient care (chaperones, consultants, trainees, etc.), addressing others’ notes (triage staff, nurses, residents, etc.), paying attention to accuracy of transcribed or dictated information, avoiding judgmental language, and refraining from altering patient charts.

VISION-RELATED MALPRACTICE INVOLVING PRISONERS: Analysis of the Westlaw Database.

To characterize vision-related malpractice litigation involving prisoners. Retrospective legal database review using the Westlaw database was performed to identify vision-related malpractice lawsuits involving prisoners in the United States from 1914 to 2020. Main outcomes and measurements were allegations of malpractice, verdicts, and settlements. Sixty-four vision-related malpractice lawsuits involving prisoners were identified. Mean defendant age was 49 years (range, 28-74 years). Fifty-seven percent of the defendants were ophthalmologists and 43% were optometrists. The cases were most commonly from the South and Midwest (n = 19 [30%] for each). Allegations of malpractice included inadequate medical care or treatment refusal (n = 21 [33%]), failure to treat fully leading to continued suffering (n = 18 [28%]), and delay in treatment or referral (n = 17 [27%]). Retina-related diagnoses were most common (n = 18 [28%]). Forty-six (72%) cases were closed, 14 (22%) were open, and four (6.3%) were partially closed. Only two (3.1%) cases were decided in favor of the plaintiff. The most common reason for an unsuccessful suit was lack of deliberate indifference by the eye care professional (n = 21 [46%]). The most common reasons for vision-related malpractice brought forth by prisoners were inadequate or incomplete eye care and treatment refusal. Retina was the most commonly involved subspecialty. However, the success rate of these suits was extremely low.

Malpractice litigation following orthopaedic surgery of the hip: Frequency, reasons for lawsuit, and outcomes.

Medical malpractice litigation in the United States has resulted in the widespread adoption of defensive medicine practices. Orthopaedic surgery is among the specialties most likely to face a malpractice lawsuit, and hip-related surgeries are commonly involved. This study aimed to analyse malpractice litigation as it relates to hip surgery in the United States. The purpose of this study was to seek answers to the following questions: Has there been an increase or a decrease in the number of hip surgery malpractice cases in recent years? What are the most common reasons for a patient to pursue litigation? Which surgical complications are most likely to result in a lawsuit? What trends do we see in terms of outcomes? The Westlaw legal database was queried for all relevant cases from 2008 to 2018. A retrospective review of cases was conducted and descriptive analyses were performed in order to identify factors associated with hip surgery malpractice litigation. A total of 82 cases were analysed. There was a downtrend in the number of cases per year. Total hip arthroplasty (47 cases, 57.3%) was the procedure most often involved. Procedural error was noted as a reason for litigation in 71 (86.6%) cases. Neurological injury (22 cases, 26.8%), malpositioned hardware (15 cases, 18.3%) and leg length discrepancy (8 cases, 9.8%) were the most common complications listed. The majority of cases resulted in a verdict in favour of the defendant orthopaedic surgeon (48 cases, 58.5%). The mean payout for a plaintiff verdict (20 cases, 24.4%) was $1,647,981 (range, $1,852-$7,000,000) and the mean payout for a settlement (13 cases, 15.9%) was $657,823 (range, $49,000-$3,000,000) (p = 0.063). The study concluded that, within the 10-year period, there was a significant downtrend in hip surgery malpractice cases filed per year. Orthopaedic surgeons were found liable in the minority of cases. As expected, verdicts in favour of plaintiffs resulted in seemingly higher payouts than settlements.

To Use or Not Use Intraoperative Neuromonitoring: Utilization of Neuromonitoring During Spine Surgeries and Associated Conflicts of Interest, a Cross-Sectional Survey Study.

Introduction:There are no universal guidelines that dictate the indications for the use of intraoperative neuromonitoring (IONM) in spine surgery resulting in its variable use. The choice to use IONM has been both cited in malpractice lawsuits and insurance claims, but no data exist regarding surgeons' rationale for making this choice. The goal of this study was to assess (1) the use of certain IONM modalities during common spine surgeries, (2) surgeons' rationale for use of IONM, and (3) IONM practices and potential conflicts of interest associated with its use.Methods:Respondents were asked to select each IONM modality they used during 20 different surgical scenarios within the spine followed by rating the importance of several reasons when selecting to use IONM. Finally, the occurrence of conflicts of interest, out-of-network billing, and cost were assessed.Results:Approximately one-half (47%) of respondents who perform anterior cervical diskectomy and fusion/total disk arthroplasty for radiculopathy use IONM, opposed to 76% for myelopathy. The presence of cord compression and/or neurologic symptoms increased IONM use by approximately 30% during trauma cases. Medicolegal was the reason of highest importance when choosing to use IONM (7.4 ± 2.9; mean ± SD), followed by surgeon reassurance (6.2 ± 2.7; P < 0.0001 versus medicolegal) and belief it affects patient outcomes (5.2 ± 3.0; P = 0.004 versus reassurance).Conclusions:Although there is increasing use of IONM, this has not translated to an absolute requirement for every spine surgery. Surgeons are faced with opposing influences of the medicolegal system and insurance payers. Future guidelines on using IONM should not be absolute, but rather should consider the risks of each procedure, along with how patients and surgeons value these risks, in addition to the costs. The findings of this study should help to serve as a guide to surgeons, payers, and courts as contemporary, common practices for the use of IONM during spinal surgical scenarios.

The Incidental Findings Coordinator: How a Radiology Nurse can Add Value and Promote Patient Safety

A radiology incidental finding or “incidentaloma” is an important, unexpected finding on imaging that requires clinical or imaging follow-up. Although recommendations for the follow up of incidentalomas are common, actual follow-through is often suboptimal. This gap may lead to patient harm and expose hospitals to malpractice lawsuits. Nevertheless, there is no universal consensus on how to ensure proper follow up. Coordination of incidentaloma follow-up is a unique role through which a radiology nurse can strengthen interdepartmental communication and improve patient outcomes. Our institution employs a hybrid system that uses software to track follow-up recommendations and a radiology nurse to communicate with the relevant parties. The broad skill set of radiology nurses makes them particularly well-suited for this role.

Expert witness testimony in medical malpractice litigation: Minutiae and methods – In credence and credibility

Most medical cases have favorable health outcomes. There are, however, some cases that do not culminate in the most favorable ones. In the latter instance, situations may even escalate to the point of a medical malpractice lawsuit against the medically abiding physician or surgeon. Given the above scenario, the present review offers accessible information regarding the minutiae of expert witnesses and entailing testimonies. This paper describes the intricacies of expert testimonies, presents a scenario that makes these testimonies double-edged instruments, and scrutinizes two legal records as consequential options to consider. In our first research statement, we zoom into the eligibility of expert witnesses and intricacies of its processes. We, thereafter, present a reasonable grasp of the contents and characteristics of these testimonies. In our second research statement, we propose a strategy to safeguard the defendant clinician's stance in expert testimonies that may present as double-edged instruments. In our third research statement, we weigh the pros and cons of two legal records such as a Memorandum of Settlement and a Consent Terms document. The present research is designed to explore details about expert testimonies in malpractice cases. A strategy to protect the defendant's actions would be to request the testimony in confidence as a proactive measure to prevent the case from being abruptly withdrawn. A Consent Terms document would be more preferable to a Memorandum of Settlement because this document hinders further escalation into appellant courts in a legal landscape.

Medical Malpractice Lawsuits Involving Urology Trainees

ObjectiveTo distinguish the various characteristics of medical malpractice lawsuits involving trainees to prevent future litigation. MethodsLexisNexis, an online legal research database containing legal records from the United States, was retrospectively reviewed for malpractice cases involving urology interns, residents, or fellows from January 1, 1988 to December 31, 2020. ResultsA total of 16 cases were included, of which 7 (43.8%) involved urological allegations while 9 (56.2%) involved non-urological allegations. 5 of the cases consisting of non-urological adverse outcomes led to mortality. Procedural error was claimed in 12 (75.0%) cases, negligence in 7 (43.8%), delayed evaluation in 6 (37.5%), lack of informed consent of procedure or complications in 5 (31.2.%), failure to pursue treatment in 4 (25.0%), inexperienced trainee in 2 (12.5%), failure to supervise trainee in 2, lack of informed consent of trainee involvement in 1, incorrect diagnosis in 1, and prolonged operative time in 1 case. ConclusionMalpractice education, careful supervision, awareness during perioperative care, and detailed communication between patients and physicians should be highlighted in training programs to improve patient outcomes and mitigate risk of future malpractice.

Medical Malpractice Litigation Involving Arteriovenous Malformations of the Central Nervous System

To comprehensively analyze malpractice claims relating to arteriovenous malformations. Westlaw and LexisNexis databases were cross-referenced to obtain a comprehensive list of medical malpractice lawsuits related to arteriovenous malformations. The initial search yielded 147 results, of which 78 were considered eligible for analysis. Plaintiff age was reported in 16 cases (mean age 30.9 ± 19.9 years). In 53 cases, the location of the lesions was reported: 38 (90.9%) were intracranial, and 15 (28.3%) were spinal. The main complaints were medical error (34 cases, 43.6%), failure to diagnose (33 cases, 42.3%), failure to treat (20, 25.6%), misdiagnosis (7 cases, 9.0%), lack of informed consent (7 cases, 9.0%), and other causes (11 cases, 14.1%). The medical specialties most commonly involved were neurosurgery (22 cases, 34.4%), radiology (16 cases, 25.0%), and neurology (10 cases, 15.6%). Neurosurgeons were more frequently sued than neurologists (P= 0.01) but not radiologists (P= 0.25). The court rulings included in favor of the defendant in 23 cases (29.5%), in favor of the plaintiff in 6 cases (7.7%), a settlement in 27 cases (34.6%), mediation in 1 case (1.3%), and unknown/other in 21 cases (26.9%). Rulings in favor of the defendant (P= 0.0005) or settlements (P < 0.0001) were more frequent than rulings in favor of the plaintiff, but there was no difference in rulings in favor of the defendant compared with settlements (P= 0.69). While the courts rule in favor of defendants more than plaintiffs, the time and psychological demands of litigation place a high burden on physicians.

Quality of Health Services on Outpatient Satisfaction Levels: A Literature Review

The aims of the study is to determine the Service Quality on Outpatient Satisfaction Level. Patient satisfaction is a critical metric that is frequently used to assess the quality of health care services. Clinical outcomes, patient retention, and medical malpractice lawsuits are all affected by patient satisfaction. Patients are satisfied when they receive services that fulfill their expectations; they then opt to rate the services and behave based on their satisfaction. Service quality comprises five dimensions: reliability, responsiveness, assurance, empathy, and concrete value. Institutions must take numerous steps to ensure reliable services, including continual education and training of staff

Fear Not: Utilizing Simulation for Medical Malpractice Education.

INTRODUCTIONMedical malpractice payouts across specialties totaled over $4.03 billion USD in 2019. It is estimated that over 72% of Emergency Medicine (EM) physicians will be involved in a medical malpractice lawsuit by age 55. The majority of EM residencies do not include adequate education on medicolegal risk mitigation and litigation. The purpose of the study is implementation of an innovative interprofessional simulation to target this education gap.METHODSAn anonymous pre- and post-survey was distributed to participating EM providers electronically. The surveys evaluated baseline medicolegal knowledge, self-rated deposition comfort and concern regarding malpractice litigation. The simulation event involved an interactive lecture on basic tenets of medical malpractice and state legal statutes from medicolegal experts. Resident physician volunteers acted as defendant physicians during simulated depositions using a redacted, closed malpractice case.RESULTSEighty EM providers attended the event over two days. All attendees completed the pre-survey (80/80), and 66.3% (53/80) completed the post-survey. The majority incorrectly answered 4 of 5 medicolegal questions. The mean comfort level regarding being deposed is 1.53 ± 0.94 on a 1-5 Likert scale (extremely uncomfortable to extremely comfortable); the mean level of concern/fear of malpractice litigation is 3.38 ± 0.95 on a 1-5 Likert scale (not at all to extremely concerned). There was a statistically significant increase in deposition comfort level post-event (1.83, P < .01).CONCLUSIONThe majority of EM physicians are inexperienced and concerned regarding litigation. After participating in an educational event and observing a simulated deposition, physicians reported an increased comfort level regarding being deposed in the future.