Plaintiff Verdict Research Articles

Medical Malpractice in Otolaryngology within the United States: A LexisNexis-Based Demographic Analysis.

Otolaryngologists are at a significantly greater risk of being sued than most other physicians. To date, there is a lack of studies characterizing trends in otolaryngology malpractice claims. To assess these trends and risk variables, this study examined malpractice claims against otolaryngologists. Retrospective database review. LexisNexis Jury Verdicts and Settlements. The LexisNexis legal database was used to locate jury verdicts and settlements related to medical malpractice in otolaryngology, from 2018 to 2024. The study did not include any claims covered by the Social Security Disability Insurance, Workers' Compensation, Healthcare Law, or Criminal Law and Procedure categories. Temporal trends were evaluated, and logistic regression was used to identify independent risk factors. Out of 903 items, 79 reported malpractice cases were included (mean age 44.5; 60.3% female). The most sued subspecialty was head and neck oncology (32.5%). Negligence (93.7%) was the primary cause of action. Of cases sent to the jury, 87.7% of them resulted in a verdict in favor of the defendant. The mean plaintiff verdict payout was $7,432,508.06 and the mean identified settlement amount was $1,562,500.00. Physical injury (62.0%) was the highest type of harm. Regional analysis indicated a higher percentage of cases from New York favored the defendant (21.1% vs 13.6%; P = .034). This study highlights key trends in otolaryngology malpractice claims, emphasizing the prevalence in cases of head and neck surgery, primarily attributed to negligence. By identifying trends and risk factors, otolaryngologists can get a better understanding of the dynamics surrounding malpractice.

The medicolegal challenges in spine care of professional athletes

Professional athletes are prone to spinal injuries, and the treatment of this distinct patient population involves additional medicolegal challenges that must be considered. Catastrophic complications and delay in treatment of complications are linked with plaintiff verdicts in legal claims. Clear communication, thorough informed consent, and prompt disclosure of errors or complications can mitigate litigation risks. Effective collaboration with the athletic team is important in optimizing a safe return to competitive play.

The increasing medicolegal cost in the care of high-level athletes

BackgroundMedical malpractice represents a significant economic cost in healthcare. Increasingly large damage claims by professional athletes against physicians have raised concerns about the medicolegal challenges in caring for high-level athletes. MethodsAn online proprietary legal research database was queried for lawsuits related to malpractice in the care of professional and amateur athletes from 1992-2023. Demographics of plaintiffs and defendants, details of lawsuit filings and damages claimed were recorded for all cases, settlements, and jury verdicts. Descriptive statistics, linear regression, as well as univariate analysis of demographic factors and damage claims in inflation-adjusted 2023 dollars was performed. ResultsEighty-eight lawsuits were recorded from 1992-2023. The sum of indemnities exceeded 186 million in 2023 inflation-adjusted United States Dollars. Football players were the most commonly represented athletes (n=26) and represented 49% of total financial awards. Fourteen cases (16%) involved treatment of the upper extremity. Professional and collegiate level of play was associated with higher damages in favor of plaintiffs when compared to other levels of play. No other demographic was associated with higher financial awards. Linear regression showed a significant positive trend with an increasing inflation-adjusted compensation for plaintiff verdicts in the last 30 years. ConclusionsThere is an increasing medicolegal financial risk associated with the care of athletes. This is higher in collegiate and professional levels of play. As physicians, insurers and institutions adjust to these financial risks, care must be taken to avoid ramifications on the availability and quality of care provided to athletes. Shoulder and elbow surgeons may consider additional preoperative counseling, legal waiver forms regarding malpractice claims and advocacy for medical malpractice reforms in the care of athletes with high earning potential to mitigate these increasing financial risks.

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.

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.

Medical malpractice and epidural hematomas: a retrospective analysis of 101 cases in the United States.

Neurosurgeons face particularly high rates of litigation compared to physicians in other fields. Malpractice claims are commonly seen after mismanagement of life-threatening medical emergencies, such as epidural haematomas. Due to the lack of legal analysis pertaining to this condition, the aim of this study is to identify risk factors associated with litigation in cases relating to the diagnosis and treatment of epidural haematomas. Westlaw Edge, an online database, was used to analyze malpractice cases related to epidural haematomas between 1986 and 2022. Information regarding plaintiff demographics, defendant specialty, reason for litigation, trial outcomes, and payouts for verdicts and settlements were recorded. Comparative analysis between cases that returned a jury verdict in favour of the plaintiff versus defendant was completed. A total of 101 cases were included in the analysis. Failure to diagnose was the most common reason for litigation (n = 64, 63.4%), followed by negligent care resulting in an epidural haematoma (n = 44, 43.6%). Spine surgery (n = 29, 28.7%), trauma (n = 28, 27.7%), and epidural injection/catheter/electrode placement (n = 21, 20.8%) were the primary causes of haematomas. Neurosurgeons (n = 18, 17.8%) and anesthesiologists (n = 17, 16.8%) were the two most common physician specialties cited as defendants. Most cases resulted in a jury verdict in favour of the defense (n = 54, 53.5%). For cases ending in plaintiff verdicts, the average payout was $3621590.45, while the average payment for settlements was $2432272.73. Failure to diagnose epidural haematomas is the most common reason for malpractice litigation, with neurosurgeons and anesthesiologists being the most common physician specialties to be named as defendants. More than half of all cases returned a jury verdict in favour of the defense and, on average, settlements proved to be more cost-effective than plaintiff verdicts.

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.

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.

Medical malpractice and cerebrospinal fluid shunts: An analysis of 36 cases.

Many physicians, particularly neurosurgeons, face malpractice claims during their career. The aim of this paper is to identify which factors increase the risk of litigation and influence legal outcomes relating to cerebrospinal fluid shunt management. Westlaw, an online legal database, was used to identify all medico-legal cases pertaining to cerebrospinal fluid shunts. Information regarding plaintiff demographics, defendant specialties, reasons for litigation, and trial outcomes were analysed. Thirty-six cases met criteria for inclusion. Most cases returned a defence verdict (44.4%), with delayed treatment or failure to appropriately treat patients with shunts the most common reason for litigation (66.7%). The average plaintiff verdict payout was $4,888,136.75 and average settlement $1,362,307.69. Delay or failure to treat resulted in the largest average payouts for plaintiff verdicts and settlements ($5,329,299.14 and $1,531,500.00, respectively).

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.

Thoracic Surgery Litigation: Analysis Using the Westlaw Legal Database

BackgroundIn the United States, medical malpractice bears a significant financial risk associated with surgery, particularly in the field of cardiothoracic surgery. Approximately 18.9% of cardiothoracic surgeons face litigation. We report an analysis of litigation in thoracic surgery. MethodsThe Westlaw legal database was used to identify thoracic surgery cases. Search terms were identified for various thoracic procedures. Case characteristics were analyzed. ResultsMedical malpractice in thoracic surgery results in a median payout of $1,183,000 million for plaintiff verdicts and a mean settlement award of $550,000. Outcomes of litigation are variable. Geographic location does not play a significant role in litigation. Thoracic surgeons in New York, California, Florida, and Illinois faced the most lawsuits. Intraoperative or procedural error and inadequate informed consent accounted for 52% of all cases. ConclusionsAttempts to increase patient understanding and education may be beneficial for reducing litigation. Analysis of why New York, California, and Illinois are highly litigious is warranted. Future analysis would also be useful to evaluate whether advances in techniques, such as robotic or thoracoscopic approaches, are associated with reduced incidence of litigation.

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

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.

Medical Malpractice Litigation Following Total Shoulder Arthroplasty: A Comprehensive Analysis Based on the Westlaw Legal Database.

Orthopedic surgery is one of the most common subspecialties subject to medical malpractice claims. Although Total Shoulder Arthroplasty (TSA) is associated with favorable patient outcomes and relatively low complication rates, surgeons performing this procedure may be subject to malpractice litigation leading to significant economic and psychological burden on the provider. The purpose of this study is to characterize and describe malpractice claims against orthopedic surgeons performing TSA utilizing the Westlaw legal database. The Westlaw Legal Database was queried for all cases related to TSA using the terms "malpractice" AND "shoulder replacement" OR "shoulder arthroplasty." Cases were excluded if the defendant was not an orthopedic surgeon, the procedure involved was not a TSA, or if the patient was a minor. Patient demographics, causes cited for litigation, case outcomes, and indemnity payments were analyzed to determine common factors that lead plaintiffs to pursue legal action. Thirty-five TSA cases were identified that met inclusion criteria. The mean plaintiff age was 55 years with 63.6% female. The most common category of negligence alleged was intraoperative error, which occurred in twenty-five claims (71%). The most common types of damages incurred were nerve injury (23%), functional limitation (20%), and infection (17%). Overall, twenty-seven cases (77%) resulted in a defense verdict. Four cases (11%) resulted in settlements and four cases (11%) resulted in plaintiff verdicts. The average inflation-adjusted monetary award in these cases was $1,619,919 (SD, $1,689,452). This study provides a comprehensive summary of malpractice claims and associated outcomes in TSA. Given the rapidly increasing rate of TSA in the United States and the burden of associated malpractice claims, understanding potential legal implications of TSA is of great value to orthopedic surgeons. Intraoperative error was the category of negligence cited most commonly in TSA malpractice claims. Nerve injury, functional limitation, and infection were the most commonly cited specific damages. These findings highlight the need for orthopedic surgeons to educate patients regarding potential postoperative complications while continuing to focus on minimizing their occurrence.

Analysis of the Reasons for Medical Malpractice Litigation Due to Facet Injections.

Introduction As the use of facet joint injections (FJI) increases, practitioners performing FJI may be at increased risk of legal liability.Malpractice claim analysis is performed by several specialties as it provides valuable insight into patient values and methods to mitigate the risk of malpractice litigation pertaining to a specific procedure or treatment. Malpractice analysis regarding FJI may provide clinicians with a better understanding of the reasons that lead to malpractice due to FJI, thereby allowing practitioners to improve the quality of care delivered to patients whilst mitigating the incidence of malpractice. The aim of our study was to analyze the reasons for malpractice litigation due to FJI by querying Westlaw and VerdictSearch, two well-established legal databases widely used in medicolegal research. Methods We queried the Westlaw Edge and VerdictSearchlegal databases utilizing the terms "facet injection" and "spine". Our database queries yielded 1026 results on Westlaw Edge and 545 results on VerdictSearch. Cases were reviewed and categorized by two independent reviewers based on the grievance(s) levied by the plaintiff. Discrepancies between reviewers were resolved by a third reviewer. Inclusion criteria for case relevance were defined as a basis of litigation resting on malpractice claims filed between the years 2000-2022 directly pertaining to FJI. Additional data collected included the date of the case hearing, verdict ruling, location of filed claim, payment or settlement amount, and sustained injuries. Results Of all 1571 cases reviewed, 1568 cases were excluded due to a basis of litigation unrelated to FJI. Of the three cases pertaining to FJI, the first case involved an alleged procedural error on the part of the anesthesiologist, whereby the anesthesiologist misplaced the needle during FJI, resulting in quadriplegia due to a cervical spine infarction. The plaintiff also contended that the pre-procedural timeout was improperly conducted as the practitioner utilized iohexol as the injected contrast material despite the patient's well-documented allergy to iohexol. The jury deemed both the practitioner and hospital negligent, and a plaintiff verdict was issued. The second case was filed under a basis of litigation alleging delayed diagnosis and treatment on the part of an emergency medicine physician. The court acquitted the physician, and a defense verdict was issued.The third case was filed under a basis of litigation of alleged deviation from the standard of care on the part of the anesthesiologist, whereby the anesthesiologist performing the FJI did not use fluoroscopy.The court affirmed fluoroscopy is not dictated as the standard of care for FJI and issued a defendant verdict. Conclusion This study provides insight into the risk of medical malpractice suits brought on by facet joint injection. Our findings suggest that despite the high prevalence of facet joint injections performed annually, there is limited legal liability associated with the procedure. Nevertheless, there are certain reasons a malpractice claim may be filed due to facet injection, including gross procedural error resulting in patient paralysis, delay in treatment or diagnosis, and deviation from the established standard of care.As such, treatment decisions regarding facet joint injection should not be influenced by medicolegal concerns and remain predicated on patient care needs and standard of care.

Allegations of Failure to Obtain Informed Consent in Otolaryngology: Evidenced-Based Recommendations for Sinus Surgeons.

Informed consent requires preoperative discussion of surgical risks, complications, and alternative treatment options. Allegations of incomplete informed consent are common in the field of otolaryngology. Analyze outcomes and case variables in cases of alleged informed consent failure involving otolaryngologists. A legal research database containing state and federal case records from across the United States was retrospectively reviewed for malpractice claims involving informed consent and otolaryngology. Among the 128 informed consent cases identified, 72.6% resulted in favorable verdicts for otolaryngologists. Functional endoscopic sinus surgery (FESS) was the most common source of informed consent litigation in the field of otolaryngology, with an incidence four-fold higher than the next most litigated procedure of uvulopalatopharyngoplasty (21.9% vs 5.4%). The top four factors cited in FESS-related cases were CSF leak (10), inadequate discussion of alternative therapies (4), diplopia (3), and meningitis (3). Cases resulting in a transient injury were significantly less likely to result in a payment from a plaintiff verdict or settlement (9.1%) as compared to payment-rates among cases involving permanent complications (34.6%) (p = 0.005). Failure to obtain informed consent is an important factor in medical malpractice litigation. This report identifies specific, actionable recommendations aimed at protecting sinus surgeons from liability and ensuring that patients are better informed.

Medical Malpractice Litigation Due to Off-Label Use of Bone Morphogenetic Protein.

Retrospective cohort study. To analyze the incidence and characteristics of malpractice lawsuits pertaining to the off-label use of Bone morphogenetic protein (BMP). BMP continues to be a popular alternative to the use of autologous bone graft during spinal fusion procedures. However, ~85% of BMP is used in an off-label manner, which may expose surgeons to claims of malpractice. Westlaw and VerdictSearch were queried for malpractice claims filed between 2000 and 2022 using the keywords "bone graft" and "spine." Case inclusion criteria were defined as a plaintiff's basis of litigation resting on a claim of medical malpractice due to off-label use of BMP. Additional collected data included the date of the case hearing, plaintiff's sex and age, defendants named in the lawsuit, verdict ruling, location of the filed claim, payment or settlement amount, sustained injuries, and additional allegations. Of 971 claims reviewed, 89 cases were due to off-label BMP use. The posterior approach was identified as the most common approach among the 89 cases. Of the 30 cases naming a surgeon defendant, 50% included allegations of insufficient informed consent. The most frequent adverse events were ectopic bone growth resulting in chronic pain or nerve damage. Zero cases involved heterotopic ossification, wound dehiscence, graft subsidence, hematoma, bladder retention, or retrograde ejaculation. A clear understanding that on-label BMP use is specific to single-level, anterior or anterolateral approaches between L2-S1 with vendor-specific cages is crucial for mitigating malpractice disputes. Though off-label use of BMP may incite litigation, the findings suggest court rulings are favorable for defendants as zero cases, resulting in plaintiff verdicts. Nevertheless, surgeons should balance the potential benefits of off-label use of BMP with the increased risk of litigation, and it may be advisable to disclose the use of BMP, whether on-label or off-label, in the informed consent.

An Analysis of Malpractice Litigation of Vascular Surgeons in Cases Involving Aortic Pathologies.

The aim of this study was to analyze malpractice claims for aortic pathologies and to assess if there has been a change in rate of malpractice lawsuits with evolution of endovascular therapy. Malpractice lawsuits were individually screened and compiled from the Westlaw database from 2000 to 2017 through use of relevant search terms. Data were collected of allegations, diagnoses, and outcomes of each case and compared. 268 unique cases were included in this study, with aneurysms (54%, n = 145) and dissection (35%, n = 94) making up the majority. There was a defendant verdict in 53% (n = 141), plaintiff verdict in 24% (n = 65), and settlements in 23% (n = 62) of lawsuits. Litigation was higher in the Midwest and Northeast. There was a gradual decline in litigation overall, however endovascular case numbers remained constant. There was negligible difference in the primary allegation underlying the litigation for various aortic pathologies, time to litigation and award between open and endovascular procedures. The proportion of litigation for clinical negligence in endovascular cases amongst all vascular surgical lawsuits is increasing. As novel methods of endovascular therapy emerge, it is imperative that physicians remain vigilant to legal considerations to minimize malpractice risk.

Hip and Knee Are the Most Litigated Orthopaedic Cases: A Nationwide 5-Year Analysis of Medical Malpractice Claims

BackgroundApproximately 80% of hip and knee surgeons will face malpractice litigation. Understanding contemporary reasons for litigation and legal outcomes in our field may help surgeons deliver more effective and satisfying care, while limiting their legal exposure. This study aimed to determine: 1) which orthopaedic subspecialties were most frequently litigated; 2) malpractice damages and negligence claimed; 3) the proportion of different case outcomes; and 4) factors associated with defense verdicts. MethodsA nationwide database was queried for all orthopaedic medical malpractice claims (2015 to 2020), obtaining 164 claims from 17 states. Variables included were as follows: case outcome, indemnity payment, damages, negligence claimed, treatment, and patient characteristics. A binary logistic regression determined if any collected variable increased the likelihood of a defense verdict. ResultsHip and knee cases were the highest-represented (n = 49, 29.9%; knee: n = 26, 15.9%; hip: n = 23, 14.0%), followed by the spine (n = 36; 22.0%), trauma (n = 29;17.7%), hand and wrist (n = 16; 9.8%), sports (n = 16; 9.1%), foot and ankle (n = 7; 4.3%), pediatric (n = 6; 3.7%), and shoulder (n = 6; 3.7%). Within hip and knee surgery, defense verdicts occurred in 38 cases (77.6%), while 9 (18.4%) resulted in plaintiff verdicts (mean payment: $4,866,929) and 2 (4.1%) resulted in settlements (mean settlement: $1,550,000). Nonreversible damages (eg, paralysis, amputation, and death; P < .001) were associated with a decreased likelihood of a defense outcome. ConclusionHip and knee cases were the highest-represented in orthopaedic malpractice litigation. Surgeons were more frequently found negligent when nonreversible damages occurred. Orthopaedic surgeons should be cognizant of litigation patterns while ensuring patient-centered high-quality care.

Medical Malpractice in Robotic Surgery: A Westlaw Database Analysis

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