Medical Malpractice Litigation Research Articles

The Medical Legal Environment in Neurosurgery: An Informative Overview of the Stages of Litigation and Distinct Challenges

Medical malpractice litigation is something that every neurosurgeon encounters in his or her career and causes significant strife to amateur physicians attempting to navigate the medicolegal process. Neurosurgery in particular is one of the highest risk specialties for litigation. This calls to order the importance of a clear understanding of the medicolegal proceedings that may follow after a complaint has been filed. This report describes the steps to be taken by the physician in the instance that litigation is expected or considered a possibility. We describe the elements that comprise a medical malpractice claim, details of the lawsuit process including hospital peer review and expert witness selection, and how to communicate appropriately with the patients and their families in an empathetic way. It is imperative to gain an appropriate understanding of the entirety of the malpractice claim process to ease the anxiety of litigation for the physician and decrease the amount of avoidable complications.

Medical malpractice in heart transplantation from 1994 to 2019.

Heart transplantation is a unique clinical intervention because it involves two separate parties, the donor and the recipient. This increases the potential for the legal liability of heart teams involved with heart transplantation, but there is no research that exists to date that analyzes the etiology of medical malpractice litigations relating to heart transplantation. The Westlaw legal database was queried for all medical malpractice litigations concerning heart transplantation from 1994 to 2019 in the United States. Individual litigations were reviewed for inclusion, resulting in 41 included cases, and then analyzed for legal and clinical data. Statistical analyses were performed with the Fisher exact test and Mann-Whitney U tests. The mean age of patients involved in these litigations was 38.88 years, with female patients being younger on average. Female patients received a significantly larger average award than male counterparts (p = .03). Alleged failure to diagnose was significantly associated with settlements (p = .047). An alleged failure to obtain informed consent as presented by the plaintiff was significantly associated with defendant verdicts (p = .03). Incidence of stroke and infection were each significantly associated with nondefendant verdicts (p = .02 and p = .02). There should be an emphasis on documenting informed consent from all involved parties in heart transplantation to limit litigations filed against clinicians. As technologies and growing donor pools increase the prevalence of heart transplantation, clinicians would be well-served to be aware of legally tenable practices that will allow them to adopt a higher transplant volume without simultaneously adopting added legal exposure.

Does the law require reinterpretation and return of revised genomic results?

Does the law require reinterpretation and return of revised genomic results?

Medical Malpractice System in the United States of America: Lesson to Learn for Indonesia

A system that serves the liability and settlement of medical malpractice disputes or commonly referred to as medical malpractice system has been established in many countries to respond the rise of medical malpractice claims against doctors. Medical malpractice system in the United States of America (the USA) has been relatively well developed as compared to other countries. Beside adopting pretrial screening process in medical malpractice litigation, various methods of alternative to litigation have been developed in the USA. This paper aims to explore the development of the medical malpractice system in the USA and to see the possibility for Indonesia to learn. This normative legal research relies on the secondary data especially which were collected from online sources. It is found that there are some initiatives in the USA that can be adopted by Indonesia for improving its medical malpractice system, especially the establishment of pretrial screening panel. It is expected that pretrial screening process can eliminate meritless claims which later may reduce unnecessary legal actions against doctors.

Commentary on: Characterization of Medical Malpractice Litigation After Rhinoplasty in the United States.

Commentary on: Characterization of Medical Malpractice Litigation After Rhinoplasty in the United States.

Chaotic dynamics in the presence of medical malpractice litigation: A topological proof via linked twist maps for two evolutionary game theoretic contexts

In the present work we reconsider the evolutionary game theoretic models by Antoci et al. (2016, 2018) describing the dynamic outcomes arising from the interactions between patients and physicians, whose behavior is subject to clinical and legal risks. In particular, Antoci et al. (2016) analyzed the case of positive defensive medicine, while Antoci et al. (2018) dealt with the case of negative defensive medicine. We show that, when the models admit a nonisochronous center, it is possible to prove the existence of chaotic dynamics for the Poincaré map associated with those systems via the method of Linked Twist Maps (LTMs). To such aim we exploit in both frameworks, using a similar rationale, the periodic dependence on time of a model parameter influencing the position of the center and describing some risk associated with certain medical interventions, whose seasonal variation is empirically grounded. We also recall the ecological interpretation of the same model proposed by Harvie et al. (2007) and connected with intraspecific competition and environmental carrying capacity in predator-prey settings. In this case, it is sensible to assume a seasonal variation both for the carrying capacities and for the intrinsic growth rates of the two populations. Although such parameters influence the shape of the orbits, but do not affect the center position, we show that it is still possible to prove the existence of chaotic dynamics for the associated Poincaré map via the LTMs technique dealing with a different geometrical configuration for orbits in the phase plane.

The status of medical malpractice litigations in Saudi Arabia: Analysis of the annual report.

Context:Medical malpractice is a leading cause of morbidity and mortality worldwide. Analyzing the current number of lawsuits and comparing it to previous years will help assess the status of medical malpractice litigations in Saudi Arabia.Subjects and Methods:A review and analysis of the annual statistics book of the Medico-Legal Committees (MLCs) in Saudi Arabia over the years (1437–1439 H) was conducted.Results:Over the 3-year study period, the total number of lawsuits was 3,684. The percentage of increase of malpractice lawsuits from 1437 until 1439 Hijri (2016–2018) was 26% (1,097–1,379 lawsuits). Obstetrics and Gynecology consistently had the highest number lawsuits compared to other specialties (25.6%), followed by dentistry (13.5%). Similarly, the rate of compensation after a lawsuit was highest in Obstetrics and Gynecology claims (62.7%), followed by dentistry (60%). The private healthcare sector consistently showed the highest number of lawsuits when compared to other healthcare providers, with a 73% increase over 3 years. The Ministry of Health showed an overall reduction in the number of lawsuits by 6.6% over the course of the study period.Conclusions:The number of lawsuits in Saudi Arabia is increasing rapidly. Understanding the reason for this is very important especially given the high rates of lawsuits for certain specialties and healthcare sectors. A root cause analysis cannot be conducted without a detailed reporting system for malpractice lawsuits; the development of which would help in research and the generation of solutions in this field.

Commentary on: Characterization of Medical Malpractice Litigation After Rhinoplasty in the United States.

Commentary on: Characterization of Medical Malpractice Litigation After Rhinoplasty in the United States.

An Analysis of Medical Malpractice Litigations in Coronary Artery Bypass Grafting from 1994-2019

BackgroundCardiothoracic surgery is one of the more highly litigated medical specialties, and coronary artery bypass grafting (CABG) constitutes a substantial portion of cardiothoracic surgery cases. Therefore, understanding litigations relating to CABG would be of benefit to surgeons working to uphold the standards of care that their patients seek and minimize their own legal liability. This study analyzed CABG litigations to identify predictive factors of litigation and verdict type. MethodsThis study utilized the Westlaw legal database to compile litigations from 1994-2019 across the United States, and resulted in 307 total litigations. After individual screening, 211 litigations met the criteria for inclusion, and were analyzed for demographic, clinical, chronological, and verdict characteristics. ResultsLitigations were present in 33 US states, with California, New York, and Florida having the most litigations. Defendant verdicts were reached in 67.78% of litigations, followed by 20.38% of plaintiff verdicts, and 11.85% of settlements. Plaintiff verdicts were associated with the incidence of myocardial infarction during hospitalization. The winter season had the most litigations (42.18%), and the most defendant verdicts (37.76%). Patient mortality occurred in 47.39% of litigations. The most common alleged reason for litigation was a procedural error (55.45%). ConclusionsDefendant verdicts were significantly associated with an alleged reason of procedural errors, an alleged reason of a failure to monitor, and congestive heart failure present in patients. The common nature of defendant verdicts, and the significantly greater occurrence of defendant verdicts during the highly litigated winter season, suggest that surgeons frequently satisfy the legal standard of care.

Malpractice litigation: The unmeasured complication

We read with great interest the article by Palaniappan and colleagues1 on their study using the Westlaw legal database to examine medical malpractice litigations involving aortic dissections in the United States over a 25-year period. With up to 20% of cardiothoracic surgeons facing a medical malpractice claim annually,2 it behooves us to understand the factors associated with litigation.3

A Reliability Check on Expert Witness Testimony in Medical Malpractice Litigation: Mandatory Medical Simulation

A Reliability Check on Expert Witness Testimony in Medical Malpractice Litigation: Mandatory Medical Simulation

Medical Safety in Ningen Dock and Health Checkup: Learning from Medical Malpractice Litigations

Medical Safety in Ningen Dock and Health Checkup: Learning from Medical Malpractice Litigations

The, Of, For, In The Use of Amicable Settlement for Resolving Medical Malparctice in Indonesia

Massive publicity on alleged medical malpractice cases has created hostile environment within the health care setting in Indonesia. The unexpected practice of defensive medicine would be possible in response to the rise of medical malpractice litigation. Although it has many negative implications, litigating medical malpractice dispute is preferable for many injured patients. Dispute resolution mechanisms should be introduced and promoted in Indonesia as an alternative to the litigation process with hope of providing redress to victims of medical malpractice in a more amicable manner. This paper aims at exploring the use of amicable settlement method for resolving medical malpractice disputes in Indonesia.

Characterization of Medical Malpractice Litigation After Rhinoplasty in the United States.

When complications following rhinoplasty occur or when the desired outcome is not achieved, patients may seek litigation on the premise that there was a violation in the standard of care. Knowledge of malpractice claims can inform rhinoplasty surgeons on how to minimize risk of future litigation as well as improve patient satisfaction. The aims of this study were to identify motives for seeking medical malpractice litigation after rhinoplasty, and to examine outcomes of malpractice litigation after rhinoplasty in the United States. The Westlaw legal database was reviewed for all available court decisions related to malpractice after rhinoplasty. Data collected and analyzed included plaintiff gender, location, specialty of defendant(s), plaintiff allegation, and adjudicated case outcomes. Twenty-three cases were identified between 1960 and 2018, located in 12 US states; 70% of the plaintiffs were female. Otolaryngologists were cited in 11 cases, whereas 12 cases involved a plastic surgeon. All cases alleged negligence. Cases involved "technical" errors (69.6%), "unsatisfactory" outcomes (39.1%), inadequate follow-up or aftercare (30.4%), issues with the informed consent process (21.7%), unexpectedly extensive surgery (8.7%), improper medication administration (4.3%), and failure to recognize symptoms (4.3%). Twenty of the 23 adjudicated cases (86.9%) were ruled in favor of the surgeon. The main contributing factor in cases alleging malpractice was poor aesthetic outcome/disfigurement (60.7%). Malpractice litigation after rhinoplasty favored the surgeon in the majority of the adjudicated cases reviewed. The principal reason for litigating was dissatisfaction with aesthetic outcomes. Rhinoplasty surgeons may mitigate possible litigation by developing a positive doctor-patient relationship, clearly understanding the patient's surgical expectations, and obtaining detailed informed consent while maintaining frequent and caring communication with the patient.

Relative Prevalence and Characteristics of Malpractice Litigation Involving Radiology Trainees.

To assess the prevalence and characteristics of medical malpractice litigation involving radiology trainees. Using a LexisNexis legal database keyword search, we identified all state and federal lawsuits between 2009 and 2018 yielding formal appellate and lower court opinions (precedent setting "complex litigation") potentially involving physician trainees. Available judicial records were systematically reviewed to identify malpractice matters with material trainee involvement. Cases were categorized by criteria including specialty and location. Incidence rates were calculated for all specialties. Radiology lawsuits were characterized further. Initial LexisNexis Boolean database search yielded 8,935 potentially relevant cases with 580 confirmed as malpractice materially involving physician trainees. Annual cases trended downward (high 70, low 37). Most originated in New York (195 of 580; 33.6%), Ohio (41; 7.1%), and Pennsylvania (34; 5.9%) and involved surgery (204; 35.2%), obstetrics and gynecology (114; 19.7%), and medicine (105; 18.1%). The case incidence rate for all trainees was 0.63 per 1,000 trainee years. Of 309 cases with known outcomes, defendant physicians prevailed in 238 (77.0%). Radiology trainees represented only 23 cases (4.0%), corresponding to an incidence rate ratio of 0.79 (confidence interval 0.52-1.20). Radiology litigation most frequently involved alleged missed diagnoses (14 of 23; 60.8%) and procedural complications (7; 30.4%). Defendant radiologists prevailed in 9 of the 13 cases with known outcomes (69.2%). Complex medical malpractice litigation involving physician trainees is infrequent and decreasing over time. Lawsuits involving radiology trainees are uncommon, less likely than for many nonradiology trainees, and typically involve alleged missed diagnoses or procedural complications. Defendant radiologists usually prevail.

Medical malpractice litigation related to choking accidents in older people in Japan.

To analyse malpractice litigation cases in Japan and identify the factors related to choking accidents in older people. Choking while eating is common in older people and has potentially severe consequences. This study analysed court decisions related to choking accidents occurring in Japan between 2000 and 2015 that involved the death of an older person or permanent severe choking-related injury. A database of court decisions (n=23) was constructed according to patient and caregiver characteristics, and nursing services. An analysis was performed on caregiver liability, and to identify factors related to choking accidents. The court ruled that the caregiver was liable in 10 of the 23 cases. Liability was related to appropriate food choices, failure to monitor of eating or the non-performance of resuscitation after an accident. Prior knowledge of aspiration (P<.001), inappropriate assistance during the meal (P<.001), and inappropriate emergency treatment (P=.028) were more likely to be present in cases in which caregivers were judged liable than in those in which they were not. Lack of appropriate assistance during the meal was the factor most strongly associated with a court ruling of caregiver liability for choking accidents in older people.

What Practitioners can Teach Academics About Tort Litigation – The Plaintiff’s Perspective in Medical Malpractice Litigation

Abstract Although medical errors are a leading cause of injury and death in the United States, only a small fraction of claims result in litigation, and the number of paid claims continues to decline. There are many reasons for the relatively small number of medical errors that result in medical malpractice litigation, including the prohibitive cost of procuring medical experts, caps on recovery, the long timeline of a med mal case from intake to verdict or settlement, and the outsized success rate of defendant doctors at trial. This article explores all of these topics, as well as common causes of action and notable plaintiff types.

Overview of medical malpractice in neurosurgery.

Annually, 20% of all practicing neurosurgeons in the United States are faced with medical malpractice litigation. The average indemnity paid in a closed neurosurgical civil claim is $439,146, the highest of all medical specialties. The majority of claims result from dissatisfaction following spinal surgery, although claims after cranial surgery tend to be costlier. On a societal scale, the increasing prevalence of medical malpractice claims is a catalyst for the practice of defensive medicine, resulting in record-level healthcare costs. Outside of the obvious financial strains, malpractice claims have also been linked to professional disenchantment and career changes for afflicted physicians. Unfortunately, neurosurgical residents receive minimal practical education regarding these matters and are often unprepared and vulnerable to these setbacks in the earlier stages of their careers. In this article, the authors aim to provide neurosurgical residents and junior attendings with an introductory guide to the fundamentals of medical malpractice lawsuits and the implications for neurosurgeons as an adjunct to more formal residency education.

Damned if you monitor, damned if you don't: medical malpractice and intraoperative neuromonitoring for spinal surgery.

The aim of this study was to identify trends in medical malpractice litigation related to intraoperative neuromonitoring. The Westlaw Edge legal research service was queried for malpractice litigation related to neuromonitoring in spine surgery. Cases were reviewed to determine if the plaintiff's assertion of negligence was due to either failure to use neuromonitoring or negligent monitoring. Comparative statistics and a detailed qualitative analysis of the resulting cases were performed. Twenty-six cases related to neuromonitoring were identified. Spinal fusion was the procedure in question in all cases, and defendants were nearly evenly divided between orthopedic surgeons and neurosurgeons. Defense verdicts were most common (54%), followed by settlements (27%) and plaintiff verdicts (19%). Settlements resulted in a mean $7,575,000 damage award, while plaintiff verdicts resulted in a mean $4,180,213 damage award. The basis for litigation was failure to monitor in 54% of the cases and negligent monitoring in 46%. There were no significant differences in case outcomes between the two allegations of negligence. The use and interpretation of intraoperative neuromonitoring findings can be the basis for a medical malpractice litigation. Spine surgeons can face malpractice risks by not monitoring when required by the standard of care and by interpreting or reacting to neuromonitoring findings inappropriately.

Determinants of brain tumor malpractice litigation outcome and indemnity payments: a 29-year nationwide analysis.

Medical malpractice litigation is a significant challenge in neurosurgery, with more than 25% of a neurosurgeon's career on average spent with an open malpractice claim. While earlier research has elucidated characteristics of litigation related to brain tumor treatment, factors impacting outcome and indemnity payment amount are incompletely understood. The authors identified all medical malpractice cases related to brain tumors from 1988 to 2017 in VerdictSearch, a database of 200,000 cases from all 50 states. The outcome for each case was dichotomized from the perspective of the defendant physician as favorable (defendant victory) or unfavorable (plaintiff victory or settlement). Indemnity payments were recorded for cases that resulted in settlement or plaintiff victory. Univariate regression was used to assess the association between case characteristics and case outcome as well as indemnity payment amount. Subsequently, significant variables were used to generate multivariate models for each outcome. Statistical significance was maintained at p < 0.05. A total of 113 cases were analyzed, resulting most commonly in defendant (physician) victory (46.9%), followed by settlement and plaintiff victory (both 26.5%). The most common specialty of the primary defendant was neurosurgery (35.4%), and the most common allegation was improper diagnosis (59.3%). Indemnity payments totaled $191,621,392, with neurosurgical defendants accounting for $109,000,314 (56.9%). The average payments for cases with a plaintiff victory ($3,333,654) and for settlements ($3,051,832) did not significantly differ (p = 0.941). The highest rates of unfavorable outcomes were observed among radiologists (63.6%) and neurosurgeons (57.5%) (p = 0.042). On multivariate regression, severe disability was associated with a lower odds of favorable case outcome (OR 0.21, p = 0.023), while older plaintiff age (> 65 years) predicted higher odds of favorable outcome (OR 5.75, p = 0.047). For 60 cases resulting in indemnity payment, higher payments were associated on univariate analysis with neurosurgeon defendants (β-coefficient = 2.33, p = 0.017), whether the plaintiff underwent surgery (β-coefficient = 2.11, p = 0.012), and the plaintiff experiencing severe disability (β-coefficient = 4.30, p = 0.005). Following multivariate regression, only medical outcome was predictive of increased indemnity payments, including moderate disability (β-coefficient = 4.98, p = 0.007), severe disability (β-coefficient = 6.96, p = 0.001), and death (β-coefficient = 3.23, p = 0.027). Neurosurgeons were the most common defendants for brain tumor malpractice litigation, averaging more than $3 million per claim paid. Older plaintiff age was associated with case outcome in favor of the physician. Additionally, medical outcome was predictive of both case outcome and indemnity payment amount.