Medical Malpractice Litigation Research Articles

QLTI-15. MEDICAL MALPRACTICE AND GLIOMA

Abstract BACKGROUND Medical malpractice affects the practice of medicine in every field and specialty. It is a particular concern in high risk specialties including neurological surgery, which has the greatest risk of malpractice litigation. Treatment of glioma patients is complex and requires diagnosis based on presentation and imaging, followed by the decision of resection versus biopsy to confirm diagnosis and potentially improve prognosis. The possibility of a complication accompanies every procedure and patients generally also go on to receive chemotherapy and radiation. Interdisciplinary care is a hallmark. We explored medical malpractice litigation pertaining to gliomas with a focus on outcomes and the role of the defendants as well as the liabilities prompting litigation. METHODS WestLaw Precision, an established legal database, was queried for all cases relevant to “glioma” occurring since 2000. Cases and settlements, in particular, were considered. Keywords included “glioma” and “medical malpractice” with the date range including all cases after January 1, 2000. Cases were identified and analyzed for variables of interest. RESULTS Fourteen relevant cases were identified and reviewed. There were three plaintiff verdicts, one settlement and ten defense verdicts in favor of the defense. Two cases involved minors, while all others concerned adults. Both cases pertaining to the care of minors with gliomas resulted in findings for the defense. The majority of cases centered on failure to diagnose occurring before surgery or treatment. Defendants included neurosurgeons, pathologists, radiologists, nurses and hospital systems. Although the number of cases considered here is small, jury verdicts in favor of plaintiffs resulted in far higher payouts compared with settlements. CONCLUSIONS Medical malpractice allegations relating to glioma treatment are shown to be rare and infrequent. The majority of cases alleged a failure to appropriately diagnose, before surgery or treatment took place. The great majority of cases reported within WestLaw Precision resulted in jury verdicts for the defense.

Doctor-patient communication as prevention of medical malpractice litigation

Introduction: By medical malpractice we mean the flow of complaints that affects hospitals and that, more and more often, concerns shortcomings in the care relationship and defects compromise the therapeutic alliance. Methodology: Review of the literature concerning doctor-patient communication and the correlation between complaints and the quality of patient communication. Results: international experiences have provided numerous concrete elements to enhance a plan for improving doctor-patient communication. Discussion: the enhancement of the communication and relational performance of health professionals should be pursued as an index of quality, ethics and legitimacy of care. An internal training programme on relational skills, directly in the healthcare teams, is proposed. Conclusions: in addition to verbal communication between doctor and patient, written forms also play a crucial role, both as a pact of care and in the courts.

Medical Malpractice Litigation Following Revision Total Hip and Knee Joint Arthroplasty: A Review of Reported Legal Claims in the U.S. in the Past 20 Years

IntroductionThe increasing incidence of primary total hip (THA) and knee (TKA) arthroplasty has been accompanied by a subsequent rise in revision surgeries. Revision total joint arthroplasty (TJA) is associated with major litigation risk, primarily due to procedural and post-surgical errors. However, the understanding of the causes and outcomes of revision TJA malpractice cases remains unstudied. This study aimed to analyze litigated malpractice claims against orthopaedic surgeons performing revision TJA using a national legal database. MethodsA database was queried for a nationwide analysis of medical malpractice litigation in revision TJA from 2000 to 2023. Data on the time, duration, and locations of the litigations, allegations of surgical negligence, the damages cited, the outcomes of the trials, and indemnities were collected. ResultsOf 110 TJA malpractice cases identified over two decades, 32 cases involving revision THA and TKA surgeries were included in the final analysis. The cases were equally divided between THA and TKA, spanning 16 states, with the highest proportions in New York, Connecticut, and Louisiana. “Procedural error” (28%; n = 9) was the most frequently cited negligence, followed by “post-surgical error” (25%; n = 8) and “failure to treat” (19%; n = 6). The most common damages were “continued pain/mobility limitations” (28%; n = 9) and “infections” (19%; n = 6). Most cases resulted in a verdict for the defense (63%; n = 20). The average indemnity was $5,713,635, with considerable variability. ConclusionThis study presents the leading causes of litigated malpractice claims over the past two decades in the United States in revision TJA as perceived procedural and post-surgical errors, with the most common damages reported being “persistent pain/mobility limitations” and “infections.” Given the rising incidence of revision TJA, orthopaedic surgeons may utilize these trends to better inform patients about the potential risks and outcomes of surgery and mitigate litigation risks.

Inductive and Deductive Reasoning in Byrom vs. Johns Hopkins Bayview Hospital

The status quo that results from medical malpractice litigation is 85,000 medical malpractice lawsuits filed per year, of which 66% are potentially frivolous. There are also 3 million claims but only 85,000 are represented. There is something wrong with this status quo, which prompts questions about traditional decision-making Traditional decision-making is inductive reasoning. Deductive reasoning is hypothesis testing. The objective evidence and the burden of proof are the same in both; except hypothesis testing has a greater level of confidence. The differences are examined in detail. Of the parties involved in dispute resolution, medical experts are essential, medical experts are doctors. Doctors are familiar with hypothesis testing and threats to validity. Doctors, who are medical experts, are duty-bound to be objective. Hypothesis testing best satisfies this duty. Nothing prohibits medical experts from using hypothesis testing when they review a case to arrive at an opinion; although, until now, none do. Yet, as doctors, it is expected of them and they can never be prohibited from doing so. In the final analysis, traditional decision-making subjectively infers a departure from the standard of care; however, hypothesis testing objectively proves it.

Physicians' Knowledge, Attitude and Practice Regarding Medical Errors: Cross Sectional Study in Governmental Hospitals in Cairo

Abstract Background Medical errors are inevitable events in almost all healthcare settings and represent a major source of morbidity and mortality throughout the world. In Egypt, medical error is one of the most distressing issues facing the physicians due to absence of settled laws regarding medical malpractice litigations and unjustified social media which flare up any medical error without scientific criticism of the case. This study aimed to assess physicians’ knowledge and attitude toward medical errors and their reported incidence of medical errors and their leading factors. Methods This cross-sectional study was conducted on physicians working in governmental hospitals in Cairo, with duration of work experience equal or more than two years. An online self-administered structured questionnaire was used for data collection. Results The study included 580 physicians, with different specialties. There was no significant difference either in knowledge or practice score between the respondent physicians according to their personal characteristics. Diagnostic errors were the most common errors reported by the participants (either missed diagnosis 73.4%, delayed diagnosis 71.3% or wrong diagnosis 58.4%); followed by failure of communication (between medical staff 53.4% and with the patient 47.5%). Incidence of infection or contamination was the most reported surgical error (32.5%) and inadequate preoperative assessment and/or preparation of patient was the most common anesthetic error (27.7%). Regarding the resulting damage from the errors, 7.8% of the participants reported incidence of patient’s death, 4.7% of them reported incidence of severe physical damage, 26.6% reported by mild-to - moderate physical damage and 31.7% of them reported financial damage. Most of them reported defensive medicine practices. Conclusions Participants’ knowledge about medical responsibility was insufficient. Although most of them reported incidence of medical errors, they recommended establishment of guiding system helping them to disclose incidence of errors and taking actions to prevent them in the future.

Malpractice rates are lower for women physicians compared to men physicians

Background Previous literature has shown that women physicians are less likely to be involved in medical malpractice litigation than male physicians. Methods This study sought to examine the differences in malpractice experience by provider gender by using closed medical malpractice claims from 2011 through 2020. Results We found that after adjusting for the number of claims and dollar losses per full time equivalents worked, female physicians experienced fewer and less costly claims than male physicians ( p < .001). Specific specialties had a significant relationship between claim frequency and provider gender, which included general surgery ( p = .01), obstetrics ( p = .001), gynecology ( p = .04), internal medicine and family general practice ( p < .001). Conclusion The results from this analysis support the prior findings that male physicians experience a higher rate of malpractice claims. Therefore, there is an opportunity to learn how women providers achieve lower malpractice risk to inform clinical practice recommendations.

Risk factor analysis of medical litigation outcomes in obstetrics and gynecology: A retrospective cohort study of 344 claims in Japan

AimMedical errors are critical in obstetrics and gynecology (OB/GYN) and contribute to high litigation risks. However, few studies have examined system and diagnostic errors as potential preventable problems. This study aimed to enhance medical safety and reduce litigation by identifying and addressing key contributory factors. MethodsWe retrospectively searched the national Japanese malpractice claims database for OB/GYN cases between 1961 and 2017. We evaluated provider characteristics and background information of the patients (plaintiffs). The main outcome was litigation (acceptance or rejection) in the final judgment. Using multivariable logistic regression models, we assessed the associations between medical malpractice variables (system and diagnostic errors, facility size, situation, place, time, and clinical outcomes) and litigation outcomes (acceptance). ResultsOverall, 344 malpractice claims were analyzed. Among these, 277 (80.5 %) were obstetric, and 67 (19.5 %) were gynecological. Of the obstetric cases, 193 were perinatal, and 84 were maternal. Malpractice claims were accepted (OB-GYN losses) in 185 cases (53.8 %). In multivariable analyses, system errors (odds ratio 97.4, 95 % confidence interval 35.2–270.0), diagnostic errors (odds ratio 4.5, 95 % confidence interval 1.8–11.3), and clinic (odds ratio 2.7, 95 % confidence interval 1.2–4.8) had a significant statistical association with accepted claims. ConclusionSystem errors, diagnostic errors, and clinics were significantly associated with acceptance claims. These findings underscore the necessity of addressing modifiable factors at the physician level and within the healthcare management system to enhance patient safety and reduce litigation risks, thereby ensuring a safer and more reliable healthcare environment for patients and medical professionals.

Medical Malpractice Litigation Trends Following Primary Total Hip and Knee Joint Arthroplasty: An Updated Nationwide Analysis

BackgroundTotal joint arthroplasty (TJA) is the most common procedure associated with malpractice claims within orthopaedic surgery. Although prior research has assessed prevalent causes and outcomes of TJA-related lawsuits before 2018, the dynamic healthcare environment demands regular re-evaluations. This study aimed to provide an updated analysis of the predominant causes and outcomes of TJA-related malpractice lawsuits and analyze the outcomes of subsequent appeals following initial jury verdicts. MethodsA legal database was queried for cases between 2018 and 2022 involving primary hip and knee TJA in the United States. Cases were listed as original rulings or appeals and reviewed for the alleged negligence, damages incurred, demographics, and verdicts. Appeals were further assessed for appellant details, preliminary judgment, and outcomes. The findings were compared to previous litigation data using descriptive statistics. ResultsThe final cohort comprised 59 cases: 33 (56%) total knee arthroplasty (TKA) and 26 (44%) total hip arthroplasty (THA). The TKA cases primarily cited pain (24%), while the THA cases cited nerve injuries (31%). Negligence largely stemmed from procedural error (47%), postsurgical error (27%), and failure to inform (14%). Case outcomes were in favor of the defense in 66% of cases. Overall, 90% of primary verdicts led to appeals, with 71% by the plaintiff. Initial rulings were upheld in 87% of plaintiff appeals, whereas 53% of defendant appeals retained the initial judgment. ConclusionsThe primary cause of litigation shifted from infection to ongoing/worsening pain in TKA cases over time. While nerve injury TKA cases have decreased, it remains the most cited damage after THA. Defense verdicts are common, but there is an increasing number of verdicts against defendants. Plaintiffs are more likely to appeal, but are less successful in appellate courts. These findings allow surgeons and policymakers to address emerging litigation trends in TJA to mitigate risks and improve the overall quality of TJA.

Legal and ethical facets of robotic surgery: a suggestion for a guideline

Surgical negligence being a branch of medical negligence is considered a widely extended topic in the territory of Sri Lanka. The central focus of this paper is the use of robotic systems in the performance of surgical procedures and its legal and ethical facets. ‘Robotic Surgery’ is a novel form of technology that is efficient and productive and mostly preferred in sophisticated health systems and used in different fields of medicine namely cardiology, urology, oncology etc. In this method, the robots assist the surgeon in the performance of the surgery. The assistance given by a surgical robot is useful due to the efficiency, fewer incisions, less bleeding, and the lower possibility of infections. However, there are risks as well. If the risk and the injury were a result of the surgeon’s fault, this gives rise to medical malpractice litigation. If the injury is a consequence of the malfunctioning of the surgical robot, it will create a defective product liability on the side of the manufacturer of the robotic system. If the hospital has undertaken the specific surgical venture without sufficient resources, expertise, and institutional stability, that will lead to the hospital's liability. Even, the liability of an error caused by robotic surgery can be imposed in different ways; the ultimate accused will be the health sector. The author’s attempt in this paper is to discuss the legal and ethical implications of a surgeon-patient relationship in the performance of robotic surgery and thereby recommend a guideline to address legal and ethical issues relevant to robotic surgical procedures.

Medical malpractice litigation and daylight saving time.

Daylight saving time (DST) constitutes a natural quasi-experiment to examine the influence of mild sleep loss and circadian misalignment. We investigated the acute effects of spring transition into DST and the chronic effects of DST (compared to standard time) on medical malpractice claims in the United States over 3 decades. We analyzed 288,432 malpractice claims from the National Practitioner Data Bank. To investigate the acute effects of spring DST transition, we compared medical malpractice incidents/decisions 1 week before spring DST transition, 1 week following spring DST transition, and the rest of the year. To investigate the chronic effects of DST months, we compared medical malpractice incidents/decisions averaged across the 7-8 months of DST vs the 4-5 months of standard time. With regard to acute effects, spring DST transitions were significantly associated with higher payment decisions but not associated with the severity of medical incidents. With regard to chronic effects, the 7-8 DST months were associated with higher average payments and worse severity of incidents than the 4-5 standard time months. The mild sleep loss and circadian misalignment associated with DST may influence the incidence of medical errors and decisions on medical malpractice payments both acutely and chronically. Gao C, Lage C, Scullin MK. Medical malpractice litigation and daylight saving time. J Clin Sleep Med. 2024;20(6):933-940.

Medical Malpractice Litigation Following Hindfoot Arthrodesis

Given high patient expectations in the setting of complex surgeries, orthopedic surgeons are at risk of being subject to malpractice claims which can impose significant economic and psychological burden. This study investigates malpractice claims against orthopedic surgeons and podiatrists performing hindfoot arthrodesis and determine factors associated with plaintiff verdicts and settlements using the Westlaw legal database. The database was queried for all cases involving hindfoot arthrodesis using the terms “malpractice” and either “ankle fusion,” “arthrodesis,” “subtalar fusion,” “tibiotalar fusion,” “tibiotalocalcaneal fusion,” “TTC fusion,” or “tibiofibular fusion” from 1987 to 2023. Data regarding patient demographics, causes cited for litigation, case outcomes, and indemnity settlements were collected. Cases were excluded if the defendant was not an orthopedic surgeon or a podiatrist, the procedure involved was not a hindfoot arthrodesis, or if the patient was a minor. Forty-five cases of hindfoot arthrodesis met the inclusion criteria. The mean plaintiff age was 51.5 ± 13.8 years with 51.1% male. Thirty-three cases (73%) were in favor of the defendant, with an average inflation-adjusted payout of $853,863 (±456,179). The most alleged category of negligence was procedural/intraoperative error (75%) followed by postsurgical error (38%) and failure to inform (31%). The most common specific damages included functional/ROM limitation (49%), need for additional surgery (47%), continuing/worsened pain (27%), and nonunion/malunion (29%). Given the frequency of hindfoot arthrodesis performed, this study highlights the importance of effective communication with patients concerning potential postoperative complications, prognosis of their injury, and risks and benefits associated with each treatment modality.

An Analysis of Medical Malpractice Litigation Involving Orbital Fractures.

Orbital fractures frequently require operative management by a plastic and reconstructive surgeon. Due to the proximity to the globe and complexity of the reconstruction, orbital fractures, and related procedures have the potential to be a source of medical litigation. The aim of the present study was to review orbital fracture malpractice litigation, including case outcomes and compensatory damages. The Westlaw and Lexis Nexis databases were queried for jury verdicts and settlements related to orbital fracture malpractice lawsuits. The Boolean terms included "orbit! /10 fracture," "orbit! & fracture," and "ocular & fracture" for both databases. Cases were included if they were state or federal cases related to both orbital fracture and medical malpractice involving surgical or medical mismanagement or misdiagnosis of orbital fracture. A total of 49 cases from 1994 to 2018 met inclusion criteria between the databases. The most common legal complaint was the defendant's failure to make a diagnosis either by not ordering the proper radiological tests or by not interpreting radiological tests correctly, seen in 35% of cases. In 57% of the cases, the defendant was a surgeon, 46% of which involved a plastic surgeon specifically. Cases were resolved in favor of the defendant 49% of the time. Most cases (57%) resulted in a monetary outcome of $0. However, cases that were decided in favor of the plaintiff had significant compensatory damages with the majority being over $100,000, and 1 case as high as $8 million. Although almost half of the orbital fracture malpractice cases resulted in an outcome favoring the defendant, significant monetary consequences against the defendant were possible in cases when the plaintiff prevailed.

110 Trends and Risk Factors for Medical Malpractice Litigation in Open Cranial Neurosurgery

INTRODUCTION: Neurosurgery is the most litigious specialty amongst all specialties across medicine. Understanding the reasons for malpractice claims can help inform neurosurgeons improve care and mitigate litigation risk. METHODS: The Westlaw Edge and LexisNexis databases were searched for cases involving medical malpractice claims due to cranial surgery between the years 1985-2023. Data collected included case date, verdict ruling, jurisdiction, sustained injuries, and awards or settlement amounts. RESULTS: Of 1546 cases reviewed, 317 were identified as malpractice claims resulting from cranial surgery. The primary causes for litigation were perioperative complications (n=115), delayed or denied treatment (n = 95), insufficient follow-up care (n = 51), inappropriate procedure selection (n = 39), and inadequate informed consent (n = 8). Tumor surgery had the highest number of claims (n = 81), followed by vascular (n = 59), trauma (n = 54), infection (n = 43), functional/epilepsy (n = 28), and other/not defined (n = 56). Regarding verdict ruling, 39.4% (n = 125) ruled in favour of the defendant; 20.5% (n = 65) in favour of the plaintiff; 2.2% of verdicts resulted in mixed ruling (n = 7); in 10.7% (n = 34) of claims were resolved in an out-of-court settlement; and in 27.1% (n = 86) the verdict was not available. The subspecialty with the highest proportion of plaintiff verdicts was tumor 29.2%, (n = 19), and tumor also had the highest proportion of defendant verdicts 26.40%, (n = 33). The average verdict amount awarded to plaintiffs was $5,592,703, while the average settlement amount was $2,751,807. CONCLUSIONS: The authors highlight several risk factors for medical malpractice claims across cranial neurosurgery. These results suggest that litigation may be mitigated with accurate and timely diagnosis, timely referrals and coordinated care.

An Updated Analysis of Body Contouring Malpractice Cases.

Body contouring procedures are commonly performed in the United States for patients seeking to sculpt specific areas of their bodies. The aim of this study was to provide an updated analysis of the factors that influence medical malpractice litigation surrounding body contouring surgery. The following terms were used to search the Westlaw Campus Legal research Database for cases with earliest documentation after January 2013: ("contouring" OR "abdominoplasty" OR "liposuction" OR "tummy tuck" OR "body lift" OR "thigh lift" OR "arm lift" OR "brachioplasty" OR "thighplasty" OR "lipectomy" OR "panniculectomy") AND "surgery" AND "medical malpractice." Cases were only included if there was a complaint of medical malpractice subsequent to a body contouring procedure, and details of the cases were provided. Information was collected on the location of the lawsuit, the earliest year of available case documentation, patient demographics, procedure(s) performed, alleged injury, specialty involvement, and verdicts. A total of 32 cases were included in the study. Most of the patients involved in the cases were women (n = 30, 93.8%) and alive (n = 28, 87.5%). New York state had the most cases (n = 7, 21.9%). Abdominoplasty (56.3%), liposuction (53.1%), and buttock augmentations (15.6%) were the most common procedures. Plastic surgeons were involved in 93.8% (n = 30) of the cases, and anesthesia, emergency medicine, dermatology, and oncology were also involved. Claims of malpractice most often discussed negligent technique (71.9%) and poor postoperative management (62.5%). Common postoperative complications were infection/sepsis (40.6%), scarring (31.3%), and emotional distress/prolonged pain (31.3%). One available ruling was in favor of the plaintiff. Although many of the cases in this analysis cited negligent technique, none were founded in their argument. Because involvement in these cases can place a burden on attending physicians, clear expectations of postoperative infections, scarring, and prolonged pain should be addressed during the informed consent process.

Analysis of reasons for medical malpractice litigation due to anterior cervical discectomy and fusion

BackgroundAnterior cervical discectomy and fusions (ACDF) are among the most common cervical spine operations, with over 137,000 surgeries performed annually. Understanding reasons underlying malpractice pertaining to ACDF may inform physicians of practices to improve delivery of patient care and mitigate malpractice. The aim of our study was to analyze the causes and outcomes for lawsuits pertaining to ACDF. MethodsThe Westlaw Edge and Verdict Search databases were queried for malpractice claims utilizing the keywords “anterior cervical discectomy and fusion” and “ACDF”. Inclusion criteria was based on relevance of case grievance(s) to ACDF. Data collected included date of case hearing, plaintiff demographics, defendant specialty, verdict ruling, location of filed claim, monetary award, and sustained injuries. ResultsFifty cases were included in this study after excluding 1933 cases. Of the 50 cases, 34 (68%) resulted in a defendant outcome, 8 (16%) resulted in a plaintiff outcome, and 8 (16%) resulted in settlement. Plaintiff verdicts resulted in an average monetary payment of $9.70 million, while settlements resulted in an average payment of $2.06 million. Reasons for litigation were divided into 10 categories, most commonly improper postoperative management (20%), hardware failure (18%), intraoperative error (14%), off-label use of implants (14%), and insufficient informed consent (12%). ConclusionsMalpractice claims due to ACDF are associated with higher frequencies of plaintiff verdicts and higher monetary costs compared to other spinal surgery procedures. There does not appear to be supporting evidence that spinal cord neuromonitoring is mandatory for ACDF procedures from a medicolegal standpoint.

Letter to the Editor Regarding “Medical Malpractice Litigation after Spine Surgery in Beijing Between 2013 and 2018”

Letter to the Editor Regarding “Medical Malpractice Litigation after Spine Surgery in Beijing Between 2013 and 2018”

Never events in plastic surgery: An analysis of surgical burns and medical malpractice litigation

IntroductionBurns and fires in the operating room are a known risk and their prevention has contributed to many additional safety measures. Despite these safeguards, burn injuries contribute significantly to the medical malpractice landscape. The aim of the present study is to analyze malpractice litigation related to burn and fire injuries in plastic and reconstructive surgery, identify mechanisms of injury, and develop strategies for prevention. MethodsThe Westlaw and LexisNexis databases were queried for jury verdicts and settlements in malpractice lawsuits related to burn and fire injuries that occurred during plastic surgery procedures. The Boolean terms included “burn & injury & plastic”, “fire & injury & “plastic surg!”” in Westlaw, and “burn & injury & “plastic surg!””, “fire & injury & “plastic surg!”” in LexisNexis. ResultsA total of 46 cases met the inclusion criteria for this study. Overheated surgical instruments and cautery devices were the most common mechanisms for litigation. Plastic surgeons were defendants in 40 (87%) cases. Of the included cases, 43% were ruled in favor of the defendant, while 33% were ruled in favor of the plaintiff. Mishandling of cautery devices 6 (13%), heated surgical instruments 6 (13%), and topical acids 2 (4%) were the most common types of errors encountered. ConclusionNever events causing burn injury in plastic and reconstructive surgery are ultimately caused by human error or neglect. The misuse of overheated surgical instruments and cauterizing devices should be the focus for improving patient safety and reducing the risk of medical malpractice. Forcing functions and additional safeguards should be considered to minimize the risk of costly litigation and unnecessary severe harm to patients.

Why Medical Error is Killing You (And Everyone Else)

In 2000, the infamous report To Err is Human rocked society with its focus on the pervasive danger of medical error. More than two decades later, medical error rates remain high and pose a consistent danger to patients. Today, medical error ranks as the fourth leading cause of death behind heart disease, cancer, and COVID-19. Medical error reflects the vulnerabilities of the healthcare process and may be diagnostic in nature. A large concern in responding to medical error is an overemphasis on blame and the idea that good physicians do not make mistakes. Our perspective on how to address medical error is flawed. The successful reduction of error will require rethinking how we respond to error and creating a culture of openness and transparency. Changing how we address error benefits all patients but is particularly important for racial and ethnic minorities, women, and the LGBTQ+ population, whose healthcare needs have historically been overlooked. This Article reviews what we know about medical error and the disproportionate effects of harm it can cause. I consider issues leading to the persistence of medical error and emphasize the need to improve patient safety, address harm to vulnerable communities, and decrease medical malpractice litigation. Successfully addressing error requires a multi-pronged approach that embraces different disciplines. First, the healthcare industry should emphasize restorative justice strategies and institute legal safeguards, such as increased protections for apologies and information disclosure from healthcare institutions. Second, communication theory and high reliability organizations offer model methodologies to both address and prevent harm from medical error. Third, error response should shift away from a culture of blame and instead emphasize developing a Just Culture that encourages the acceptance of responsibility under collective accountability. Finally, the healthcare field should work to be more patient focused, with patients at the center of care and decision-making. Medical error presents a real and deep concern for patients and their families. Reducing the widespread effects of medical error will require a multidisciplinary approach extending to fields far beyond medicine, and even the law, to see real change.

Analysis of reasons for medical malpractice litigation due to spinal cord stimulator

Study designRetrospective cohort study. IntroductionMalpractice claims analysis is performed by several specialties to improve quality of patient care and to identify areas where physicians can improve their practice to mitigate the incidence of committing malpractice. The Food and Drug Administration has flagged over 80,000 injuries caused by spinal cord stimulator (SCS), making them the 3rd most flagged medical device. This study analyzed malpractice claims due to SCS by querying two legal databases widely used in medicolegal research. MethodsWestlaw Edge and VerdictSearch were queried for malpractice cases filed between the years 2000 and 2022 using the keywords “spinal cord stimulator.” Case inclusion criteria was defined as a plaintiff's basis of litigation resting on a claim of medical malpractice due to SCS. Additional data collected included date of case hearing, plaintiff sex and age, defendant specialty, verdict ruling, location of the filed claim, payment or settlement amount, and sustained injuries. ResultOf the 1773 reviewed cases, 45 cases were included and categorized as battery or implantable pulse generator malfunction (35.56 %), lead complications (28.89 %), surgical complications (20.00 %), and miscellaneous (15.56 %). Four (8.89 %) cases resulted in settlement, 11 (24.44 %) in a plaintiff verdict, and 30 (68.00 %) resulted in a defendant verdict. Claims filed due to infection related to SCS were more likely to result in a defendant verdict (p = .047), whereas claims filed due to neurological deficit were more likely to result in a plaintiff verdict (p = .020). The average settlement amount for the 4 cases is $1,975,309.61. ConclusionOur findings suggest obtaining adequate neuroimaging preoperatively with MRIs, disclosing neurological risks specifically paralysis on informed consent, and evaluating radiography intraoperative and postoperatively with anterior-posterior (AP) and lateral x-ray films to ensure proper SCS placement are practices that may mitigate malpractice due to SCS. Battery defects and lead complications were the most common grounds for SCS-related malpractice claims.

Medical malpractice litigation following humeral fractures in the United States

Background The purpose of this study is to characterize malpractice claims against orthopedic surgeons treating humeral fractures and determine factors associated with plaintiff verdicts and settlements. Methods The Westlaw legal database was queried for all cases involving humeral fractures. Patient demographics, causes cited for litigation, case outcomes, and indemnity payments were collected to determine common factors that lead plaintiffs to pursue legal action. Results Fifty-seven cases were identified that met inclusion criteria. The mean plaintiff age was 52.5 years with 61% female. The most common category of negligence was treatment error, which occurred in 29 claims (51%). The most common types of damages incurred were functional limitation (40%), nerve injury (32%), and malunion/nonunion (26%). Overall, 42 cases (74%) resulted in a defense verdict. Four cases (7%) resulted in settlements and 11 cases (19%) resulted in plaintiff verdicts. Cases that resulted in plaintiff verdicts or settlements were treated with intramedullary nails more often than those with defense verdicts (27% vs. 4.8%, p = 0.036). Discussion These findings highlight the importance of effective communication with patients regarding treatment modalities, risks and benefits, and prognosis of their injury. Level of evidence IV; Case Series using Large Database; Epidemiology Study