Reasons For Litigation Research Articles

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.

An Analysis of Medical Malpractice Litigation due to Intravenous Steroid Treatment for Acute Spinal Cord Injury.

Retrospective cohort study. To evaluate the incidence of litigation due to using or foregoing methylprednisolone (MP), naloxone, or tirilazad for treatment of acute spinal cord injury (ASCI) through querying the Westlaw and VerdictSearch databases. There is historic controversy regarding the use of intravenous steroids for treatment of ASCI. Many highlight that MP continues to be used for ASCI treatment mainly as a defensive medicine tactic due to the fear of malpractice litigation. Westlaw and VerdictSearch were queried for cases involving steroid treatment for ASCI between the years 1998 and 2021. Collected data for each case included year of case hearing, verdict ruling, location of filed claim, and the plaintiff's basis of litigation. Cases were reviewed and categorized by two independent reviewers based on the grievance(s) levied by the plaintiff. Inclusion criteria for topic relevance was defined as a plaintiff's basis of litigation resting on a claim of medical malpractice due to the use, or lack thereof, of MP, naloxone, or tirilazad for treatment of ASCI. Upon review of 238 cases, case claims were grouped into five categories based on reason for litigation: Social Security benefits (171), lawsuit due to vaccination (25), medical malpractice unrelated to steroid use (16), fungal infections due to MP injections (4), and other (22). Zero cases were found to be related to lawsuits filed due to steroid use or lack thereof for ASCI treatment. Our findings suggest there is limited risk of malpractice litigation due to steroid use or lack thereof in the treatment of ASCI. As such, steroid-related treatment decisions for ASCI should be informed by evidence-based approaches to care not influenced by medicolegal concerns.

Distingsi Cerai Gugat Kalangan Tenaga Kerja Wanita Desa Mrican Kecamatan Jenangan Kabupaten Ponorogo: Analisis Teori Fenomenologis Edmund Husserl

This article reveals a problematic phenomenon that befell the families of female workers (TKW) in Mrican Village, Jenangan District, Ponorogo Regency, where the legal facts of divorce (the wife filed for divorce from her husband) increased, and even became commonplace. Based on data recorded by the media from January to November; in 2020 as many as 533 divorce case decisions (203 divorced divorces and 330 divorced divorces). This condition is interesting to study, especially in terms of the reasons and factors why a TKW sues for divorce from her husband, it does not stop there, the phenomenon is analyzed using the Phenomenological theory of Edmund Husserl, a phenomenological theory that emphasizes the integration of aspects of the system and sub-systems of society. In exploring the data, the researcher used a sociological qualitative approach and Edmund Husserl's phenomenological theory by using the interview as the main instrument. In this study, the informants used as primary sources include; Mrican Village community, Plaintiffs, Defendants, and Families. The collected data is then carried out in the analysis stages starting from data display, data reduction and data verification and conclusions. The results of the study revealed that 1) the tendency of the reasons for litigation among the TKW of Mrican Village, Jenangan District, Ponorogo Regency proposed by the plaintiff was a complete and irreconcilable reason between the two parties, namely the plaintiff and the defendant. Because the reasons come from both sides themselves. The causal factors that underlie the reasons for TKW in Mrican Village, Jenangan District, Ponorogo Regency in the Phenomenological Perspective of Edmund Husserl to file for divorce are the factors causing the lawsuit (economics, environment/social/lifestyle, and personal responsibility) and supporting factors for the lawsuit (education, family and technology).

11 A Twenty-one Year Review of Medical Malpractice Cases in Burn Care

IntroductionTraumatic injuries are a common source of medical litigation but no prior studies have reported on the trends of medical malpractice in burn care. As a result, it is unclear what factors increase the likelihood that a medical professional caring for a burn patient will be named in a lawsuit. By understanding what drives patient discontent and the motivations behind their malpractice claims, burn care practitioners can better care for patients and decrease their own risk of involvement in medical litigation.MethodsThe Westlaw legal research database contains state and federal court documents from over 40,000 databases across the United States and was queried for all cases of burn injuries and medical malpractice from 2000 to 2021. All mechanisms-of-injury (e.g. flame, scald, electrical, chemical, Stevens-Johnson, etc.) were included. Case information including injury circumstances, plaintiff/defendant occupation, defendant burn care experience, and burn demographics (TBSA, mechanism) were recorded when available. The primary outcome was the case ruling (plaintiff or defendant), and settlement amounts were recorded when available.ResultsForty of the 1,222 identified cases fit inclusion criteria. Twenty-seven percent (11/40) of cases involved treatment at a burn center and 82% of plaintiffs were men. The two most common mechanisms-of-injury were scald (38%) and flame burns (18%). The court ruled in favor of the plaintiff in 10% (4/40) of cases. When the court/jury ruled in favor of the plaintiff, the settlement amount ranged from $25,000 to $20,000,000. The most frequently sued medical specialty was Family Medicine (35%) and mid-level practitioners like physician assistants and nurse practitioners (35%). Physicians with a burn fellowship were named in only 5% (2/40) of cases. The most common claims were for burn depth misdiagnoses (7/40), deliberate indifference/treatments below standard-of-care (7/40), and delayed referrals to a burn specialist (6/40). All cases met American Burn Association transfer criteria. Patient mortality was the reason for litigation in 10% (4/40) of cases.ConclusionsThis study showed that most burn-specialized practitioners are not the subject of litigation. In fact, many patients filed malpractice claims because they were not referred to burn specialists. Based on case text analysis, all of the patients’ injuries fit American Burn Association transfer criteria and some lawsuits may have been avoidable.

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

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

Patterns of cataract surgery-related litigations in the United States from 2000-2020

ABSTRACT Background: Awareness of the outcomes of cataract surgery-related malpractice litigation in the United States allows for ophthalmologists to better understand how to improve patient care and reduce litigation. Methods: United States malpractice trials involving cataract surgery were searched in the LexisNexis legal database. Monetary amounts were inflation-adjusted to 2020 dollars. Results: Over the past 20 years, 482 cataract surgery litigations from 37 states were identified. New York (27.5%), Florida (8.9%), and California (8.3%) had the most cases. However, District of Columbia (11.63), New York (6.86), and Rhode Island (3.80) had the most cases per 1,000,000 residents. 48.5% of verdicts were for the defendant, 11.8% were for the plaintiff, and 30.5% were settled. Leading reasons for litigation were retinal detachment and endophthalmitis. The average amounts demanded, offered, and awarded were $1,224,061, $241,314, and $1,350,600, respectively. When comparing 2000-2010 and 2011-2020, amounts demanded (p=0.039) in the second decade significantly increased but amounts awarded (p=0.118) did not. Conclusions: Almost half of reviewed cataract-related malpractice litigation resulted in a defendant verdict. Settlements or plaintiff verdicts were costly with amounts awarded averaging above $1 million. Over the past decade, while plaintiffs are requesting significantly more, there was no significant increase in awarded amounts.

Litigation Arising From Minimally Invasive Cosmetic Procedures: A Review of the Literature.

Minimally invasive cosmetic procedures are on the rise. To meet this rising demand, increasing numbers of physicians and nonphysicians are performing these procedures. Understanding malpractice trends and reasons for litigation in cosmetic medicine is important to establish safeguards for patient care and minimize liability. Perform a comprehensive review of the literature on litigation associated with minimally invasive cosmetic procedures and discuss strategies to avoid facing a lawsuit. The authors searched PubMed databases using a variety of keywords to identify studies of lawsuits arising from minimally invasive cosmetic procedures through December 2020. A total of 12 studies of litigation meeting inclusion criteria were identified: botulinum toxin (1), soft tissue fillers (3), lasers (5), body contouring/liposuction (1), chemical peels/dermabrasion (1), and sclerotherapy (1). Principle factors associated with litigation included negligence, lack of informed consent, vicarious liability for action of delegates, lack of communication, poor cosmetic result, failure to inform of risks, inappropriate treatment or dose, and failure to recognize or treat injury. Understanding malpractice trends and reasons for litigation in minimally invasive cosmetic procedures can strengthen the patient-provider relationship, establish safeguards for patient care, and may minimize future risk of a lawsuit.

Malpractice Litigation Involving Chiropractic Spinal Manipulation

To evaluate the relationship between chiropractic spinal manipulation and medical malpractice using a legal database. The legal database VerdictSearch was queried using the terms "chiropractor" OR "spinal manipulation" under the classification of "Medical Malpractice" between 1988 and 2018. Cases with chiropractors as defendants were identified. Relevant medicolegal characteristics were obtained, including legal outcome (plaintiff/defense verdict, settlement), payment amount, nature of plaintiff claim, and type and location of alleged injury. Forty-eight cases involving chiropractic management in the United States were reported. Of these, 93.8% (n= 45) featured allegations involving spinal manipulation. The defense (practitioner) was victorious in 70.8% (n= 34) of cases, with a plaintiff (patient) victory in 20.8% (n= 10) (mean payment $658,487 ± $697,045) and settlement in 8.3% (n= 4) (mean payment $596,667 ± $402,534). Overaggressive manipulation was the most frequent allegation (33.3%; 16 cases). A majority of cases alleged neurological injury of the spine as the reason for litigation (66.7%, 32 cases) with 87.5% (28/32) requiring surgery. C5-C6 disc herniation was the most frequently alleged injury (32.4%, 11/34, 83.3% requiring surgery) followed by C6-C7 herniation (26.5%, 9/34, 88.9% requiring surgery). Claims also alleged 7 cases of stroke (14.6%) and 2 rib fractures (4.2%) from manipulation therapy. Litigation claims following chiropractic care predominately alleged neurological injury with consequent surgical management. Plaintiffs primarily alleged overaggressive treatment, though a majority of trials ended in defensive verdicts. Ongoing analysis of malpractice provides a unique lens through which to view this complicated topic.

Litigation for Health Technology Accessibility: A Tool for Inequality? Reflections Based on Case Study Analysis

INTRODUCTION The objective of this work is to analyze the characteristics of litigation for access to health’s goods and services in the Social Health Insurance (SHI) of Buenos Aires, Argentina. METHOD Descriptive study with analytical stage, performed in SHI, analyzing litigation done by beneficiaries along 15-years period to obtain goods or service from health managers. Variables explored were: Reason for litigation, delay time in case resolution, final result of judicial sentence, judges, lawyers and intervening professionals, income level of beneficiaries who started the litigation. RESULT 825 cases were analyzed during the study period according the method described. Demands increased 29.2 ±% per year. Medicines were the goods that most requested legal protection resources (32.5%). 51.9% of these litigations were due to medicines that have less than 24 months of registration by the National Regulatory Agency. The average delay for the final resolution of the procedure was 3.7 months. Judge's sentence was favorable to the beneficiaries in 97.4%. Although there are 27 judicial departments and many courts in each one; cases were concentrated in 47.4% only 2 very few courts. Litigation cases promoted by 112 out of the 15000 doctors that provides services to the SHI. In 73.7% of the cases, beneficiaries that litigated had a salary that exceed 4 times the minimum wage, and only 3.2% of them had low income. CONCLUSION We show how legal appeals might be working as an inverse strategy to the one desired, transferring collective resources belonging to the entire population, towards an specific demand from the most economically wealthy sector of society. As long as access to health care litigation maintains its current individualistic pattern, it will hardly be able to develop its full potential to guarantee effective respect for the collective right to access to goods that beneficiary the whole community.

Medical malpractice litigations involving aortic dissection.

Medical malpractice litigation arises when a discrepancy exists between a patient's expectation of acceptable medical care and the care the patient receives. Aortic dissection is a frequently misdiagnosed and often-fatal condition. The purpose of this study was to characterize trends of medical malpractice litigations arising from aortic dissection, investigate the etiology, and analyze predictive factors regarding the verdict. The Westlaw legal database was used to compile relevant litigations from 1994 to 2019 across the United States. Each litigation was screened individually for inclusion, and after inclusion, descriptive factors were compiled, including patient data, litigation data, verdict data, and clinical outcomes data. The Fisher exact test was used to evaluate the significance of association between parameters and verdict type. In total, 135 unique litigations met criteria for inclusion, with a defendant verdict in 57% (n=77), plaintiff verdict in 20% (n=27), and settlements in 23% (n=31). Plaintiffs most commonly cited a failure to diagnose as their reason for litigation in 64% (n=87). Patient mortality was associated with a lower average plaintiff award, $1,892,781 versus $5,944,983, and a lower average settlement, $1,230,923 versus $2,250,000, than their surviving counterparts. California, Illinois, and Pennsylvania had the most cases filed. An alleged failure to test, failure to refer, failure to consult, incidence of a stroke, and incidence of an autopsy diagnosis were significantly associated with defendant verdicts and a failure to diagnose was significantly associated with plaintiff verdicts (P<.05). Plaintiffs frequently cited a failure to timely diagnose, order diagnostic tests, and interpret diagnostic tests as reasons for litigations. Defendant verdicts were common, suggesting judicially acceptable standards of care are commonly satisfied.

PROCEDURE FOR FORENSIC EXAMINATION: PRACTICAL ASPECTSIN CORRECTING REGISTRY ERRORS

The authors of the article investigated registry errors that are contained in the Unified State Register of Real Estate. The main causes and sources of registry errors, as well as possible solutions are shown. It was found that registry errors are a cause of violation of civil rights and, consequently, a reason for litigation. To identify the characteristics of the subject of the study, the forensic procedure was taken as a basis. The objects of research were land plots, their boundaries, configuration and location, as well as capital construction objects, which are located within the boundaries of the studied plots. The forensic procedure was analyzed in the process of determining the location of the boundaries

Reasons for Litigation in Arthroplasty Infections and Lessons Learned.

Infections complicate a minority of orthopaedic arthroplasties but are the leading cause of malpractice claims. The basis for the claims is unclear. The objective of this study was to identify the main deviations from current recommendations by reviewing patient files recorded by a major French medical liability-specialized insurance company for private practitioners (MACSF [Mutuelle d'Assurance du Corps de Santé Français]) and to analyze legal claims and outcomes of litigation. All claims data for periprosthetic joint infections were analyzed retrospectively from 2010 to 2014. Treatment strategies were compared with therapeutic guidelines published by medical societies. Forty-five claims for periprosthetic joint infection were recorded; 82% of patients were men and the mean patient age was 63 years. Twenty-one patients (47%) had a knee arthroplasty, 21 had a hip arthroplasty, 2 had a shoulder arthroplasty, and 1 had an ankle arthroplasty. Twenty-three infections (51%) occurred within 1 month postoperatively. Staphylococcus aureus was isolated from intraoperative samples in 36% of the cases (including 25% of these with methicillin-resistant strains), and coagulase-negative staphylococci were isolated in 51% (44% methicillin-resistant strains) of the cases. Treatment lasted for a median of 9.5 months (range, 1.5 to 96 months), with a median of 6 months (range, 1.5 to 20 months) of antibiotics and 3 surgical procedures (range, 0 to 7 surgical procedures). A total of 18% of patients had antibiotic-related side effects, 2% of patients died, and 76% of patients had persistent sequelae. An infectious disease specialist's advice was required for 56% of the patients. Discordances with therapeutic guidelines were found in 76% of the patient files, including delay in diagnosis (44%) and inadequate medical treatment (18%) or medico-surgical treatment (13%). Late diagnosis of early postoperative infections appears to be the major cause of inappropriate management and malpractice litigation. Discordance with current guidelines was identified. Early consultation with an infectious disease specialist may help to reduce malpractice claims. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The medicolegal landscape of spine surgery: how do surgeons fare?

Background ContextBecause of the limited and confidential nature of most legal data, scarce literature is available to physicians about reasons for litigation in spine surgery. To optimally compensate patients while protecting physicians, further understanding of the medicolegal landscape is needed for high-risk procedures such as spine surgery. Based on these, surgeons can explore ways to better protect both their patients and themselves. PurposeTo characterize the current medicolegal environment of spine surgery by analyzing a recent dataset of malpractice litigation. Study DesignA retrospective study. Patient SampleAll malpractice cases involving spine surgery available to public query between the years of 2010 and 2014. Outcome MeasuresCase outcome for spine surgery malpractice cases between the years of 2010 and 2014. MethodsWestlawNext was used to analyze spine surgery malpractice cases at the state and federal level between the years 2010 and 2014. WestlawNext is a subscription-based, legal search engine that contains publicly available federal and state court records. All monetary values were inflation adjusted for 2016. One hundred three malpractice cases were categorized by case descriptors and outcome measures. Claims were categorized as either intraoperative complaints or preoperative complaints. ResultsRulings in favor of the defendant (surgeon) were noted in 75% (77 of 103) of the cases. Lack of informed consent was cited in 34% of cases. For the 26 cases won by the plaintiff, the average amount in settlement was $2,384,775 versus $3,945,456 in cases brought before a jury. Cases involving consent averaged a compensation of $2,029,884, whereas cases involving only intraoperative complaints averaged a compensation of $3,667,530. A significant correlation was seen between increased compensation for plaintiffs and cases involving orthopedic surgeons (p=.020) or nerve injury (p=.005). Wrong-level surgery may be associated with lower plaintiff compensation (p=.055). The length of cases resulting in defense verdicts averaged 5.51 years, which was significantly longer than the 4.34 years average length of settlements or verdicts in favor of plaintiffs (p=.016). ConclusionsSpine surgeons successfully defended themselves in 75% of lawsuits, although the cases won by physicians lingered significantly longer than those settled. Better understanding of these cases may help surgeons to minimize litigation. More than one third of cases involved a claim of insufficient informed consent. Surgeons can protect themselves and optimize care of patients through clear and documented patient communication, education, and intraoperative vigilance to avoid preventable complications.

How to interpret skeletal radiographs in adult trauma

Musculoskeletal injuries, including fractures and dislocations, account for more than 60% of diagnoses in the emergency department in England.1 Interpreting a radiograph is a crucial part of diagnosis and management and a vital skill for junior doctors. It relies on good anatomical knowledge, an understanding of radiographic views, and a systematic approach. In this article we aim to enable you to develop these skills and boost your confidence. For the patient with a fracture or dislocation, a good outcome depends on sound radiographic interpretation. A missed or delayed diagnosis increases long term morbidity and is the commonest reason for litigation.2 The importance of accurate and early radiographic interpretation is well illustrated by the relatively common neck of femur fracture (fig 1).⇓ Non-displaced fractures are stable and usually fixed by cannulated screw pinning, whereas displaced fractures are unstable and require pinning in younger patients and hemiarthroplasty in older patients. A missed non-displaced fracture can progress to a displaced fracture that requires more complex surgical management and has much greater morbidity. Fig 1 The importance of correctly identifying fractures, exemplified by a case involving the femoral neck. An ambulatory 74 year old woman presented to the emergency department with left hip pain after a fall. Review the anteroposterior views of the left hip. The first radiograph (a) shows normal appearances of the left hip in a younger woman for comparison. Radiograph (b) shows a subcapital neck of femur fracture. Note the cortical discontinuity superolaterally. An irregular sclerotic band running diagonally across the neck represents impaction. This fracture is suitable for pinning, but was missed at initial presentation. The patient re-presented with the inability to bear weight and a shortened, externally rotated left leg. In (c) the follow-up radiograph shows how the fracture in (b) has progressed in displacement; it …

Protecting the airway and the physician: Aspects of litigation arising from tracheotomy.

In recent decades, medical malpractice costs have increased and have led to a change in the way physicians practice medicine. Tracheotomies are cases in which complications have a high risk of morbidity and mortality and the potential for litigation. The Westlaw legal database was used to gather data on 43 jury verdicts and settlements from 1987 to 2013. Various factors included outcome, defendant specialty, and the reason for litigation. Median settlements were $500,000 and median verdict awards were $2,000,000. Postoperative negligence was alleged most often (81%) followed by intraoperative negligence (27.9%) and permanent injury (18.6%). Otolaryngologists were named as defendants most often (25.6%), with nurses named second most often. Pediatric cases had significantly higher awards and were more often named in favor of the plaintiff. An awareness of tracheotomy malpractice litigation has the potential to both help physicians avoid future litigation and improve patient safety.

Reason for Lawsuit in Spinal Cord Injury Affects Final Outcome.

Retrospective cohort study. To review past cases and analyze them to determine whether reason for lawsuit led to a defense versus plaintiff verdict when patients sustain spinal cord injury. Secondary objectives included analyzing demographic factors and monetary awards for plaintiff verdicts and settlements. Evaluating malpractice cases could provide valuable information for the physician who has been sued by a patient. Previous studies about litigation and spine have been focused on medical tort reform and not on the reasons for litigation and lawsuit outcome. A large national medicolegal research service for civil and criminal court called "VerdictSearch" was queried for "spinal cord injury" between the years 2000 and 2010. Reason for lawsuit separated into 2 groups, error in diagnosis (n = 48), and error in treatment (n = 25). The anatomical region, outcome, cost, and job for sued health care workers recorded for each lawsuit. Compared with physicians who were sued for errors in diagnosis, those sued for an error of treatment had a relative risk of 2.69 (95% confidence interval, 1.40-5.16) to receive a defense verdict (P = 0.003). There were no significant differences in demographic information, including age, sex, occupation type, and level of injury. Among specialties, surgeons had the highest number of suits. The median value for each anatomic area was highest in thoracic spine ($1.90 million), followed by cervical spine ($1.80 million) and lumbar spine ($0.750 million), although there were no statistical differences between the 3 areas (P = 0.301). The median monetary award for a plaintiff verdict was higher than that for a settlement ($2.90 million, interquartile range: 1.50-12.5 million vs. $1.45 million, interquartile range: 1.00-2.90 million, P = 0.008). Physicians are more likely to successfully defend a lawsuit for an error in treatment than for an error in diagnosis. The key to increase the success of defending a lawsuit in regard to spinal cord injury is to avoid delayed and incorrect diagnosis. N/A.

The litigation cost of negligent scaphoid fracture management

The aims of the study were to quantify the litigation cost of scaphoid mismanagement, identify the main reasons why patients sought compensation and hence provide suggestions for reducing litigation. Data were obtained from the National Health Service Litigation Authority. All orthopaedic-related litigation between 1995 and 2010 in the UK was reviewed. Litigation specifically against mismanagement of scaphoid fractures were identified and grouped according to the plaintiff's complaint. Exclusions were all unsettled claims. There were 85 closed cases of scaphoid fracture mismanagement over 15 years. Reasons for litigation were as follows: seven failures in interpreting radiographs, 57 missed fractures, four fractures not immobilized, nine discharged too early, five delayed operations and three inappropriate surgeries. The mean cost was &OV0556;41 680 per case (range &OV0556;0-&OV0556;206 789), and a cumulative cost of &OV0556;3 542 855. The majority of litigation may relate to a lack of follow-up and may demonstrate a failure of protocol-driven reassessment. Secondary surveys following major trauma are also highly relevant.

Wrist and scaphoid fractures: A 17-year review of NHSLA litigation data

Wrist and scaphoid fractures are common injuries seen and treated in everyday orthopaedic practice. The purpose of the study was to assess the trends and reasons for litigation related to wrist and scaphoid fractures within the NHS. Under a freedom of information (FOI) request, data from 1995 to 2012 were provided by the National Health Service Litigation Authority (NHSLA) on all litigation claims made as a result of wrist and scaphoid fractures. A total of 1354 claims relating to the hand and wrist were identified. Wrist and scaphoid fractures accounted for 492 (36.3%) of these claims, and 365 of these claims were settled, representing 74.2% of all wrist and scaphoid fracture claims. Overall, the most common reason for lost claims was due to incorrect, missed or delayed diagnosis (43.5%). Alleged mismanagement (29.5%), poor care (10.1%) and incompetent surgery (8.0%) were other common causes for litigation. This paper augments previous work published in this area and explores litigation trends specific to wrist and scaphoid fractures. We discuss the trends and reasons for litigation in this area, suggesting areas for improvement that may aid health-care professionals who deal with these injuries and potentially help reduce future litigation.

EMTALA and Patients With Psychiatric Emergencies: A Review of Relevant Case Law

Emergency department (ED) care for patients with psychiatric complaints has become increasingly challenging given recent nationwide declines in available inpatient psychiatric beds. This creates pressure to manage psychiatric patients in the ED or as outpatients and may place providers and institutions at risk for liability under the Emergency Medical Treatment and Labor Act (EMTALA). We describe the patient characteristics, disposition, and legal outcomes of EMTALA cases involving patients with psychiatric complaints. Jury verdicts, settlements, and other litigation involving alleged EMTALA violations related to psychiatric patients between the law's enactment in 1986 and the end of 2012 were collected from 3 legal databases (Westlaw, Lexis, and Bloomberg Law). Details about the patient characteristics, disposition, and reasons for litigation were independently abstracted by 2 trained reviewers onto a standardized data form. Thirty-three relevant cases were identified. Two cases were decided in favor of the plaintiffs, 4 cases were settled, 10 cases had an unknown outcome, and 17 were decided in favor of the defendant institutions. Most patients in these 33 cases were men, had past psychiatric diagnoses, were not evaluated by a psychiatrist, and eventually committed or attempted suicide. The most frequently successful defense used by institutions was to demonstrate that their providers used a standard screening examination and did not detect an emergency medical condition that required stabilization. Lawsuits involving alleged EMTALA violations in the care of ED patients with psychiatric complaints are uncommon and rarely successful.

The Emergency Medical Treatment and Labor Act and Patients with Psychiatric Emergencies: A Review of Relevant Case Law

The Emergency Medical Treatment and Labor Act and Patients with Psychiatric Emergencies: A Review of Relevant Case Law