Indemnity Payments Research Articles

The Effect of the Payment of Diya by the Institutions on the Acquittal of the Debtor's Liability

Most of well-known jurists of the Ahl al-Bayt and Hanafi schools have officially recognized the responsibility of the wise man in pure unintended murder and have agreed with the guarantee of the wise man. Just as in the era of the issuance of the Ahadith, the inclusion of ruling of the responsibility of the wise has been definite; But today's conditions of the society seems completely different from the conditions of the era when those Ahadith were issued; Because in the era of issuing the Ahadith, tribial affiliations and tribal relations prevailed in the societies of that day, especially in the Arabian Peninsula, and support and compensation were done through the tribal system, but today, the tribal system and tribal relations have been dismantled, and compensation and protection are done through commitments and contracts. Today, in many societies, the guarantee of the wise is totally removed, so there will not be any ruling. In such societies, compensation for damages must be done through commitments and contracts with institutions such as insurance, but in societies where guarantee of the wise is still in effect, if the wise shows disobedience to the payment of indemnity and its performance by institutions such as insurance, in some cases the wise will be acquitted of responsibility, and in some cases due to negligence of the divine duty, the wise will be punished even though compensation has been done by the institutions. Based on this, the present article tries to discuss and investigate the possibility of replacing institutions such as insurance instead of the wise institution in Ahl al-Bayt jurisprudence and Hanafi jurisprudence.

Examining Nursing Medical Malpractice Cases Related to Medications.

The aim of this study was to analyze medication-related nursing medical malpractice cases to gain insights regarding how malpractice risk can be reduced. The criminal prosecution and verdict of nurse RaDonda Vaught focused attention on the potential medicolegal risk for nurses related to medications. Medication-related medical malpractice cases involving nurses were obtained from a national database. Various attributes of these cases were examined, including contributing factors, injury severity, and case outcomes. Authors identified 231 nursing medication-related medical malpractice cases closed from 2017 to 2021. The most frequent adverse events involved medication administration. Not following policies or protocols was the most common contributing factor. Opioids and epinephrine were the medications most frequently involved in the cases. Indemnity payments were made in 56.3% of the cases, with an average indemnity payment of $366 002. Nursing medication-related medical malpractice cases are relatively uncommon, which may reassure nurses regarding medicolegal risk. Medications and contributing factors involved in the cases suggest patient safety interventions including education related to policies, procedures, and protocols.

Strategies for litigation avoidance in spine surgery

Medicolegal cases frequently arise within the realm of orthopaedic and neurological surgery, with a notable presence within the field of spine surgery. Despite new protocols and technological advancements created for the purpose of minimizing the risk of litigation, the rate of medicolegal cases still remains high in the United States. Understanding the basis of malpractice claims offers insight into strategies for surgeons to avoid litigation. Surgeons should emphasize these strategies in the perioperative care setting as this period represents the largest percentage of malpractice claims. Cases that directly involve surgical management, while less frequent, do tend to result in larger indemnity payments.

Defining the process of malpractice claims and indemnity payments

Medical malpractice is defined as an omission or act that deviates significantly from the norms of medical practice and leads to harm or injury to the patient. The key legal elements of medical malpractice are 1) the presence of a patient-doctor relationship, 2) failure to meet a standard-of-care, 3) evidence of injury relating directly from sub-standard care, and 4) harm relating to that injury. If a patient feels as though they have been a victim of a medical error, the first step in the process of beginning a claim is that the patient/plaintiff will consult with an attorney who specializes in malpractice. If the case is determined to be valid, a suit can be filed to initiate a pre-discovery and deposition process. During the discovery process, information is gathered through interrogatories, requests for disclosure, requests for production, requests for admission, expert reports, and depositions. The pre-trial process generally culminates in a deposition. This step involves a formal proceeding whereby the physician provides a recorded testimony under oath, which may be used in the future if the suit is brought to court. Following this process, suits can be dropped, settled, or end in the pursuit of a trial. When a defendant is found liable in a medical malpractice case, the plaintiff is entitled to indemnity payments in proportion to the harm and damages associated with the malpractice case. Indemnity payments are expected to cover various damages, including economic, non-economic, and less often punitive damages. Economic damages include tangible medical costs, like medical bills, future medical care, lost wages, and future lost wages associated with the injury or disability resulting from the malpractice event.

Factors influencing United States cattle producers use of livestock risk protection

AbstractUnited States cattle producers have various government‐sponsored programs to protect against weather and disease related risks, but livestock risk protection (LRP) insurance is the only program that protects against price risk. However, adoption of LRP insurance is low even though cattle price declines are the primary cause of economic loss, and LRP premium subsidies have recently been increased. Therefore, the objective of this study is to explore how informational nudges about receiving an indemnity payment, LRP contract characteristics, and individual risk preferences affect the use of LRP. Producer survey results were estimated using a Cragg model to determine the factors affecting producers’ likelihood of purchasing LRP and the number of head they would insure. Producers were more likely to purchase 100% LRP coverage and would also insure more head at 100% coverage when compared to lower coverage levels. We found providing information on the probability of receiving an indemnity did not impact LRP purchasing decisions. However, counter to expectations, producers were more likely to buy LRP when the randomly provided cattle prices in the survey were successively increasing each month, and if participants considered themselves more willing to take risks in their cattle operation. Results provide insights into behavioral factors affecting LRP participation which could help inform future insurance policies.

Legal Outcomes of Litigation After Iatrogenic Genitourinary Trauma

INTRODUCTIONTo evaluate plaintiff and defendant characteristics associated with iatrogenic genitourinary trauma litigation and outcomes of closed claims. METHODSLexisNexis was queried in April 2023 using terms related to genitourinary organs and injury, and manually reviewed for iatrogenic cases. Case details including defendant, organ involvement, and legal outcome were obtained. Multinomial regression analysis was performed to identify factors associated with outcome. RESULTS410 cases involving 611 defendants were identified, with the ureter the most commonly affected organ (202/410, 49.3%). Most cases involved adult plaintiffs (380, 92.7%) and resulted in favor of the defense (227, 55.4%). Injuries resulted most frequently from gynecologic surgeries (179, 43.7%). Defendants were most commonly obstetricians/gynecologists (243/611, 39.8%) and urologists (168, 27.5%). Penile (OR 6.3 [95% CI 2.5-16.1]) and urethral (OR 4.8 [2.0-11.7]) injuries were associated with greater odds of a plaintiff verdict relative to ureter injury. A plaintiff verdict was also more likely when defendants were academic hospitals compared to individual practitioners (OR 4.3 [1.9-9.9]). In cases ruling in favor of the plaintiff, indemnity payments were larger when the defendants were comprised of individual practitioners compared to a hospital or medical group (median $549,613 vs. $250,000, p < 0.001). CONCLUSIONUrologists may be involved in medical malpractice lawsuits for iatrogenic injury even when they are uninvolved in the index procedure. Most cases that reach litigation result in defense verdicts regardless of the genitourinary organ injured. Defendant characteristics associated with plaintiff verdicts are more nuanced, and providers should be aware of potential downstream effects of litigation.

Assessment of Claimant, Clinical, and Financial Characteristics of Teleradiology Medical Malpractice Cases.

Background The increasing use of teleradiology has been accompanied by concerns relating to risk management and patient safety. Purpose To compare characteristics of teleradiology and nonteleradiology radiology malpractice cases and identify contributing factors underlying these cases. Materials and Methods In this retrospective analysis, a national database of medical malpractice cases was queried to identify cases involving telemedicine that closed between January 2010 and March 2022. Teleradiology malpractice cases were identified based on manual review of cases in which telemedicine was coded as one of the contributing factors. These cases were compared with nonteleradiology cases that closed during the same time period in which radiology had been determined to be the primary responsible clinical service. Claimant, clinical, and financial characteristics of the cases were recorded, and continuous or categorical data were compared using the Wilcoxon rank-sum test or Fisher exact test, respectively. Results This study included 135 teleradiology and 3474 radiology malpractices cases. The death of a patient occurred more frequently in teleradiology cases (48 of 135 [35.6%]) than in radiology cases (685 of 3474 [19.7%]; P < .001). Cerebrovascular disease was a more common final diagnosis in the teleradiology cases (13 of 135 [9.6%]) compared with the radiology cases (124 of 3474 [3.6%]; P = .002). Problems with communication among providers was a more frequent contributing factor in the teleradiology cases (35 of 135 [25.9%]) than in the radiology cases (439 of 3474 [12.6%]; P < .001). Teleradiology cases were more likely to close with indemnity payment (79 of 135 [58.5%]) than the radiology cases (1416 of 3474 [40.8%]; P < .001) and had a higher median indemnity payment than the radiology cases ($339 230 [IQR, $120 790-$731 615] vs $214 063 [IQR, $66 620-$585 424]; P = .01). Conclusion Compared with radiology cases, teleradiology cases had higher clinical and financial severity and were more likely to involve issues with communication. © RSNA, 2024 See also the editorial by Mezrich in this issue.

Аналогия летописному «призванию варягов» в Житии св. Ансгара

The author of the article draws attention to the story in the Life of St Ansgar about the military campaign of the Swedes against the Curonians, which took place in 854. The Life was written by Ansgar's pupil and successor Rimbert before 876. His information, confirmed by archaeological data, is reliable. The description of the campaign indicates that the Swedes plundered a Curonian city (most likely Grobinya) and besieged another one, Apuole, for a long time. The siege ended with negotiations and recognition of the Swedish dominance by the Curonians. They agreed to the payment of a one-time indemnity and a permanent tribute in the future. The author of the article suggests these events can serve as a historical background for the events described in the ancient Rus’ian story about the ‘calling-in of the Varangians’ which also tells about the interaction of alien Scandinavians with local peoples (‘tribes’) in the middle of the 9th century. The story is not preserved in ancient Rus’ian chronicles in its original form, and the author follows its reconstruction according to the textual investigations of A.A. Shakhmatov. The author emphasizes that in the chronicle, just like in the Life, the main expression of dominance was the right to collect tribute on an ongoing basis. Like in the Life, the chronicle stated that the population agreed to pay tribute for the sake of ‘peace’ and the author stresses the importance of this concept in archaic perceptions of power and justice. Tributary relations were interpreted and presented by the participants of the events themselves as contractual. At the same time, according to the story of the Life, the establishment of the power of the Swedes over the Curonians was the result of the usage of force, and this casts doubt on the idyllic story of the chronicle about the voluntary ‘calling-in’ of the Varangians by autochthonous peoples. The Life written in the 9th century offers a much more plausible picture of the subjugation of the local population to the Scandinavians than the legendary chronicle story, written no earlier than the beginning of the 11th century. On the whole, the author writes about a similar historical situation described in the Life of Ansgar and the chronicle story (the penetration of the Scandinavians into the Circum-Baltic space), and about analogies in the descriptions of this situation in the life and chronicle (one model of legitimization of relations between the Scandinavians and autochthonous residents using the concept of “peace”).

An analysis of medical malpractice claims against medical oncologists from a national database: Implications for safer practice.

Malpractice claims data include valuable information about patient safety. We used mixed methods to analyze claims against medical oncologists (MO) from 2008 to 2019 using a national database. MO claims were compared to a group of other internal medicine subspecialties (OIMS). Logistic regression was used to examine correlates of closing with an indemnity payment. A subset of claims against MO were thematically analyzed using a validated safety incident taxonomy as a framework. 456 claims against MO were compared with 5771 claims against OIMS. MO claims closed with indemnity payments 29.8% of the time versus OIMS 30.3% (p = 0.87). Median MO and OIMS indemnity payments were similar ($190,591 vs. $233,432; p = 0.20). Correlates of MO claims closing with payment included patient assessment, communication among providers, and safety and security as contributing factors. Thematic analysis identified provider cognitive error, adverse drug events and relational problems as the most common safety incidents. MO malpractice claims have similar outcomes to OIMS. We demonstrate the proof-of-concept of applying a safety incident taxonomy to medical malpractice. Finding ways to reduce patient exposure to provider cognitive errors, adverse drug reactions, and communication breakdowns should be strategic priorities for safer cancer care.

Determinants of Poultry Egg Farmers’ Participation in Livestock Insurance in Rivers State, Nigeria

Poultry farming is exposed to several hazards caused by epidemic diseases, climate change and marketing among others which lead to losses of revenue. Yet, majority of poultry farmers do not neither shared nor transferred their hazards rightly. In the light of this, this study examined the determinants of poultry egg farmers’ participation in livestock insurance in Rivers State, Nigeria. Primary data were obtained with the aid of questionnaire and interview schedules from 120 farmers drawn through multistage sampling procedure. Descriptive statistics and Probit regression model were used to analyze the data. Results shows the mean age of the poultry egg farmers to be 45.21 years, years spent in formal education mean of 14.87 years, mean household size of five (5), and stock size of 1721 birds were obtained. 60.8% were aware of livestock insurance and about 35% of the farmers insured their farms. Probit regression result shows that access to credit facilities, stock size and household size were statistically significant determining the poultry egg farmers’ participation in livestock insurance scheme. Poor agricultural extension service delivery and delay in indemnity payment among others were constraints encountered in participating livestock insurance. The study recommends that extension agents in collaboration with the insurance company providers should educate poultry farmers on livestock insurance role in risk management. Also, insurance companies should endeavor to keep terms of contractual arrangements not to delay in indemnity payment to the farmers.

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

Investigation of Malpractice Claims Concerning Orthopedic Surgeons in Sari, North of Iran, 2015-2020

Introduction: Treatment failure and claims against physicians may have many negative consequences. Orthopedic surgeons have always been among the most used specialists. Therefore, the investigation of causes and the process of these claims can help reduce the negative effects of medical malpractice on physicians and society. Materials and methods: This retrospective study investigated all medical orthopedic negligence cases in Sari, Iran, from March 2015 to March 2020. Data were collected using a researcher-made checklist and analyzed in SPSS software (V-21). Results: Out of 57 finalized cases investigated in this study, surgeons were found liable in 23 (40%) cases. The mean ± SD age of patients was 41 ± 19.3. Moreover, the level of education had a positive correlation with the surgeon’s liability. The most common cause of complaint was reduced Range of motion (ROM) and the most common type of complained surgery was “open reduction &amp; internal fixation” (ORIF). None of the surgeons were found liable due to surgical site infection or device failure. The mean ± SD time for the file processing was 11.1 ± 10.1 months. The mean indemnity payment was 320 million Iranian Rials (9.7% of indemnity for death in Iran). Conclusion: The most effective way to reduce medical complaint cases is to increase the knowledge and skill levels of physicians. The lack of a blinded arbitration system in both organizations could lead to bias in the case assessment process. Moreover, considering the long processing time of the claims, it is recommended that new technologies should be used to reduce the time and increase the accuracy of the final verdict. The absence of a ‘no-fault’ compensation program is a significant flaw in Iran violating patients’ rights. Also, more studies are needed to evaluate justice and equality in Iranian medical commissions.

Characterizing Malpractice Cases Involving Emergency Department Advanced Practice Providers, Physicians in Training, and Attending Physicians.

To evaluate available characteristics and financial costs of malpractice cases among Advanced Practice Providers (Nurse Practitioners and Physician Assistants), trainees (medical students, residents, fellows) and attending physicians. A retrospective analysis of claims occurring in the emergency department from January 1, 2010 to December 31, 2019 contained in the Candello database. Cases were classified according to the provider type(s) involved: Nurse Practitioner (NP), Physician Assistant (PA), trainee, or cases which did not identify an extender as being substantially involved in the adverse event that resulted in the case ("no extender"). There were 5,854 cases identified with a total gross indemnity paid of $1,007,879,346. Of these cases, 193 (3.3%) involved an NP, 513 (8.8%) involved a PA, 535 (9.1%) involved a trainee, and 4,568 (78.0%) were no extender. Cases where a trainee was involved account for the highest average gross indemnity paid whereas no extender cases are the lowest. NP and PA cases differed by contributing factors compared to no extender cases: Clinical Judgment (NP 89.1% vs no extender 76.8%, p<0.0001; PA 84.6% vs no extender, p < .0001), Documentation (NP 23.3% vs no extender 17.8%, p=0.0489; PA 25.9% vs no extender, p<0.0001) and Supervision (NP 22.3% vs no extender 1.8%, p<0.0001; PA 25.7% vs no extender p < 0.0001). Cases involving NPs and PAs had a lower percentage of high severity cases such as loss of limb or death (NP 45.6% vs no extender 50.2%, p=0.0004; PA 48.3% vs no extender, p < 0.0001). Advanced Practice Providers (APPs) and trainees comprise approximately 21% of malpractice cases and 33% of total gross indemnity paid in this large national emergency department dataset. Understanding differences in characteristics of malpractice claims that occur in emergency care settings can be used to help to mitigate provider risk.

(Анти)санкционные оговорки в международных коммерческих контрактах

The article provides analysis of sanctions clauses in international commercial contracts. Such clauses are intended to regulate actions of the parties in the event of sanctions and corresponding legal consequences. In comparison to classic force majeure clauses sanctions clauses have a number of advantages and may serve several interrelated purposes, including securing compliance by the parties with mandatory rules that impose restrictions on certain economic activity, adaptation of the contract to new circumstances in the event of economic sanctions, regulation of termination of the contract, as well as the distribution of risks and costs incurred by the parties in connection with this. The authors explore the structure of sanctions clauses and their provisions, which cause difficulties in practice, diverse approaches to determining the scope of sanctions clauses in the context of extraterritorial sanctions and blocking statutes, different threshold for sanctions risks that activate the clause, spectrum of options to secure adaptation of contract provisions depending on the specifics of the sanctions regimes, standards of due care and endeavours that are expected from parties in the context of sanctions, conditions for termination of contracts and possibilities for the distribution of costs incurred, including the payment of indemnity. The article also discusses validity of sanctions clauses, their relationship with overriding mandatory rules and norms preventing circumvention of the law, considers the risks of asymmetric and disparity provisions. Particular emphasis is placed on the relationship of sanctions clauses with other sections of international contracts, in particular applicable law and dispute resolution clauses.

Sustainability of poultry egg output and efficiency: a risk-mitigating perspective

IntroductionAgricultural insurance is crucial to reducing financial exposures and vulnerabilities, and managing the production risks of poultry farmers while also reducing hunger levels. Unfortunately, it has not been effective in developing countries, like Nigeria.MethodsThis study examined the outcome of agricultural insurance use on poultry egg output and efficiency in Oyo State, Nigeria. The multistage sampling technique was adopted to select 120 and 152 insured and uninsured poultry egg farmers, respectively. The data gathered, using a well-designed questionnaire, was analyzed by descriptive statistics, a logistic regression model, and a Stochastic Production Frontier.Results and DiscussionResults showed that the majority (about 74% and 77%) of uninsured and insured poultry egg farmers, respectively, were small-scale farmers who operated on low capital investment, making it difficult to take insurance policy. Educational level, farming size, access to credit facilities, previous mortality rate, sales challenges, and net farm income were significant variables affecting the level of use of insurance. The result of the stochastic production frontier showed that the use of insurance is not statistically significant to the poultry egg farmers’ production inefficiency. This study highlights the importance of formulating policies that promote private sector involvement, ensure prompt indemnity payment, and encourage uninsured farmers to adopt insurance policies, ultimately aiding affected farmers, improving production scale, and mitigating farm risks.

Constraints Hindering the Adoption of the Crop Insurance Scheme in Himachal Pradesh

The present study attempted to identify the significant constraints impeding the successful adoption of a crop insurance scheme in the state. It was based on the primary data collected from a sample of 360 farmers (180 insured and 180 non-insured). The findings revealed that non-adopters face the most difficulty in adopting the scheme due to delays in the payment of indemnity. At the same time, adopters had the most challenging time due to a lack of awareness. Moreover, the study successfully brought out various customized suggestions based on the experiences of farmers that can improve the implementation of schemes, particularly in the state. It included creating more awareness among the farmers, carrying out more crop-cutting experiments, increasing the indemnity level, providing assured compensation to the farmers, and providing insurance against wild animals, etc. Targeted policy interventions are needed to refine and update crop insurance products to make them more effective and valuable in various farming situations.

Medical Malpractice Litigation After Spine Surgery in Beijing Between 2013 and 2018

The aim of this study was to analyze the characteristics of alleged medical malpractice litigation involving spine surgery in Beijing between 2013 and2018. Two online legal databases, Wusong and Weike, were queried for court verdicts involving spine surgery from January 2013 to December 2018 in Beijing. For all included cases, data pertaining to defendants, plaintiffs, case outcomes, allegations, and verdicts were abstracted, and descriptive analyses were performed. A total of 186 legal cases were identified, and 122 cases were excluded because of irrelevance or insufficient information. Of the patients in the 64 cases included in this investigation, 40.6% were male. The mean age of the plaintiffs was 53.2 ± 18.6 years. The most common complaint addressed in this study is inadequate consent (53.1%; n= 34), followed by additional surgery required (40.2%; n= 26), being unsatisfied with the outcome of surgery (17.6%; n= 11), postoperative paralysis (15.6%; n= 10), and postoperative infection (15.6%; n= 10). The most common primary disease among all the cases is lumbar spinal stenosis (28.1%; n= 18), followed by spinal tumor (18.8%; n= 12), cervical spondylosis (17.2%; n= 11), vertebral fracture (14.1%; n= 9), deformity (12.5%; n= 8), and others (9.3%; n= 6). Spine surgeons successfully defended themselves in 13 cases (20.3%), which resulted in no indemnity payment. The remaining 51 cases (79.7%) were closed with an average verdict payout of U.S. $22,597, which was significantly lower than the average compensation claimed by the plaintiff (U.S. $11,3762) (P < 0.05). This study comprehensively summarized the medical alleged malpractice litigation after spine surgery in Beijing. Given the rapid growth rate of spine surgery and the burden of related alleged medical malpractice litigation, it is valuable for spine surgeons to understand the potential legal impact of spine surgery. The most common complaint addressed in this study is inadequate consent. The findings in the present study highlight that in China, spine surgeons should pay more attention to communication with patients and perform spine surgery based on abnormal imaging as opposed to what the history and physical examination dictate, which can help reduce the litigation rate and improve the patient experience.

PC27. Understanding Factors Associated with Paid Malpractice Claims in Plastic Surgery

PURPOSE: Few studies have investigated malpractice broadly in the field of plastic surgery. The purpose of this analysis was to characterize plastic surgery malpractice cases and examine factors influencing malpractice case outcomes, thereby identifying areas of patient safety concern. METHODS: The Candello database, which catalogs approximately 30% of all paid and unpaid malpractice claims in the United States, was utilized to obtain cases involving plastic surgery closed between 2009 and 2018. A total of 2674 cases were identified. A multivariable regression model was developed to analyze factors associated with a malpractice case closing with indemnity payment. RESULTS: A total of 716 (26.8%) of claims resulted in an indemnity payment. The clinical severity was determined to be high in 229 cases (8.6%). Emotional trauma (n=558, 20.9%) was the most frequently cited injury category. Major differences between procedure groups were not observed, with consistent severity of injury across categories. Poor surgical technique, problems with communication among providers, inadequate informed consent, and deficient documentation were significant factors predictive of malpractice cases closing with payment. Issues with technical performance resulting in a known complication and patient factors were protective against paid claims. CONCLUSION: Overall, both the financial and clinical severity of malpractice claims in plastic surgery were relatively low. Multiple factors were found to be associated with a case closing with an indemnity payment. Taken together, these data highlight the importance of the informed consent process and managing expectations in the clinical care of surgical patients.

Understanding Factors Associated with Paid Malpractice Claims in Plastic Surgery.

Few studies have investigated malpractice broadly in the field of plastic surgery. The purpose of this analysis was to characterize plastic surgery malpractice cases and examine factors influencing malpractice case outcomes, thereby identifying areas of patient safety concern. The Candello database, which catalogs approximately 30% of all paid and unpaid malpractice claims in the United States, was used to obtain cases involving plastic surgery closed between 2009 and 2018. A total of 2674 cases were identified. A multivariable regression model was developed to analyze factors associated with a malpractice case closing with indemnity payment. A total of 716 claims (26.8%) resulted in an indemnity payment. The clinical severity was determined to be high in 229 cases (8.6%). Emotional trauma [ n = 558 (20.9%)] was the most frequently cited injury category. Major differences between procedure groups were not observed, with consistent severity of injury across categories. Poor surgical technique, problems with communication among providers, inadequate informed consent, and deficient documentation were significant factors predictive of malpractice cases closing with payment. Issues with technical performance resulting in a known complication and patient factors were protective against paid claims. The financial and clinical severity of malpractice claims in plastic surgery were relatively low overall. Multiple factors were found to be associated with a case closing with an indemnity payment. These data highlight the importance of the informed consent process and managing expectations in the clinical care of surgical patients.

Factors Associated with Court Outcomes of Medical Malpractice Litigations Involving Breast Reductions: 1990 to 2020.

Up to 7.4% of physicians in the United States face the risk of undergoing medical malpractice litigation each year. Breast reduction operations are performed often, but specific factors of breast reduction malpractice litigation associated with the outcome and indemnity payments to plaintiffs are unknown. Using the Westlaw legal database, the authors analyzed plaintiff and defendant characteristics, alleged reasons for malpractice, case outcomes, and payments to plaintiffs among medical malpractice lawsuits involving breast reductions with final jury verdicts or settlements, using logistic regressions. Ninety-six malpractice litigations with jury verdicts or settlements involving breast reduction operations between 1990 and 2020 met the authors' inclusion/exclusion criteria. The average reported plaintiff age was 39 ± 15 years. A total of 28% ± 29.2%, 48% ± 50.0%, and 20% ± 20.8% cases occurred in the 1990 to 1999, 2000 to 2009, and 2010 to 2020 periods, respectively; 15% ± 15.6% of cases were held in New York. Most cases were in favor of defendants [ n = 65 (67.7%)]. Among 14 cases (14.6%) with nipple malpositioning as a sustained injury, eight of them (57.1%) were ruled in favor of plaintiffs. Nipple malpositioning had increased odds of plaintiff verdict or settlement versus defendant verdict (OR, 1.33; 95% CI, 1.03 to 1.74; P = 0.03). Median payments to plaintiffs were $221,348 (range, $4375 to $3,500,000) for plaintiff verdicts and $650,000 (range, $250,000 to $750,000) for settlements. Most breast reduction malpractice litigations were ruled in favor of defendants. Nipple positioning should be taken into high consideration by plastic surgeons performing breast reductions to avoid malpractice litigation and indemnity payments.