An analysis of malpractice litigation related to the management of brain aneurysms

OBJECTIVEGiven the highly complex and demanding clinical environment in which neurosurgeons operate, the probability of facing a medical malpractice claim is high. Recent emphasis on tort reform within the political sphere has brought this issue to the forefront of medical literature. Despite the widespread fear of litigation in the medical community, few studies have provided an analysis of malpractice litigation in the field. Here, the authors attempt to delineate the medicolegal factors that impel plaintiffs to file medical malpractice claims related to the management of brain aneurysms, and to better characterize the nature of these lawsuits.METHODSThe online legal database WestLawNext was searched to find all medical malpractice cases related to brain aneurysms across a 30-year period. All state and federal jury verdicts and settlements relevant to the search criterion were considered.RESULTSSixty-six cases were obtained. The average age of the patient was 46.7 years. Seventy-one percent were female. The cases were distributed across 16 states. The jury found in favor of the plaintiff in 40.9% of cases, with a mean payout of $8,765,405, and in favor of the defendant in 28.8% of the cases. A failure to diagnose and/or a failure to treat in a timely manner were the 2 most commonly alleged causes of malpractice. Settlements, which were reached in 25.8% of the cases, had a mean payout of $1,818,250. Neurosurgeons accounted for 6.7% of all defendants.CONCLUSIONSUnlike other medical specialties, a majority of the verdicts were not in the defendant's favor. The mean payouts were nearly 5-fold less in cases in which a settlement was reached, as opposed to a summary judgment. Neurosurgeons accounted for a small percentage of all codefendants.

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Medical Malpractice Litigation: Do the British Have a Better Remedy?

American Journal of Law & Medicine ◽

10.1017/s0098858800006742 ◽

1986 ◽

Vol 11 (4) ◽

pp. 433-463

Author(s):

Frances H. Miller

Keyword(s):

Great Britain ◽

National Health Service ◽

Health Service ◽

Medical Malpractice ◽

Medical Service ◽

Institutional Factors ◽

Malpractice Litigation ◽

American System ◽

Malpractice Claims ◽

Medical Malpractice Claims

AbstractMedical malpractice claims are filed nearly ten times more frequently in America than they are in Great Britain. British patients generally adopt a less adversarial stance toward medical malpractice than do American patients. This Article examines the British malpractice system, as compared with the American system, and explores the differences between the two, in terms of costs and fees, liability rules, statutory provisions, and judicial attitudes toward malpractice litigation. The Article also discusses British social and institutional factors, such as the “taint” of litigation and the National Health Service, and evaluates how these factors affect British malpractice litigation. The Article presents the alternative forums available to British patients in seeking satisfaction for their medical service complaints. The Article concludes with an evaluation of how these factors achieve the three societal objectives of malpractice litigation: reparation, emotional vindication and deterrence.

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Medical Malpractice and Rhinology

American Journal of Rhinology ◽

10.2500/ajr.2007.21.3076 ◽

2007 ◽

Vol 21 (5) ◽

pp. 584-590 ◽

Cited By ~ 25

Author(s):

Douglas E. Dawson ◽

Eric M. Kraus

Keyword(s):

Paranasal Sinuses ◽

Medical Malpractice ◽

Claims Data ◽

Neck Surgery ◽

Sinus Surgery ◽

Malpractice Litigation ◽

Malpractice Claims ◽

Medical Malpractice Claims ◽

Nose And Sinuses ◽

Management Report

Background Physicians facing malpractice litigation are in uncharted territory. The language, concepts, rules, and strategies of the legal system are foreign to science-based physicians. Understanding the statistics of rhinology malpractice litigation may aid the physician to cope with the assault of a claim. Methods Information from the 2006 Physician Insurers Association of America (PIAA) and the 2006 PIAA Risk Management Report (RMR)–Otorhinolaryngology were searched for claims data referable to the nose, nasal chamber, and paranasal sinuses. The PIAA data sharing report (DSR) is the largest single resource of malpractice claims data containing both settlement and trial judgment information. Results The nose, nasal cavity, and paranasal sinuses represent nearly two-thirds of the total indemnity paid for improper performance from otolaryngology head and neck surgery (Oto-HNS) medical malpractice claims between 1985 and 2005 based on claims information. Improper performance accounts for 50.3% of total monies paid ($107.6 million of $213.6 million) to resolve Oto-HNS claims in this period. Of nearly 2400 operative claims closed in the period of 1985–2005, 34.1% involved procedures on the nose and sinuses. In the past 6 years, $103.5 million indemnity has been added to the otolaryngology total. Conclusion The area of endoscopic sinus surgery has substantially contributed to Oto-HNS claims in the PIAA DSR. Despite malpractice being a cost of medical practice, every claim is perceived as an assault on the surgeon's competence. Ensuring informed consent and complete documentation may assist the provider in defending their care.

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The Anti-Patient Psychology of Health Courts: Prescriptions from a Lawyer-Physician

American Journal of Law & Medicine ◽

10.1177/009885881003600104 ◽

2010 ◽

Vol 36 (1) ◽

pp. 188-220 ◽

Cited By ~ 1

Author(s):

Freeman L. Farrow

Keyword(s):

Medical Malpractice ◽

The United States ◽

Specialized Knowledge ◽

Malpractice Litigation ◽

Insurance Premiums ◽

Malpractice Insurance ◽

Malpractice Claims ◽

Practice Of Medicine ◽

Tort System ◽

Medical Malpractice Insurance

Critics of the current medical malpractice tort system claim that adjudication of malpractice claims before generalist judges and lay juries contributes to rising costs of medical malpractice insurance premiums and medical care. They claim that properly deciding issues in this realm requires specialized knowledge of medicine and medical technology that juries, and even judges of general jurisdiction, do not possess. One lobbying group alleges there is a continuing medical malpractice litigation crisis in the United States, evidenced by increasing medical costs, deaths from needless medical errors, departure of physicians from the practice of medicine due to increasing medical malpractice insurance premiums, and random medical justice in medical malpractice cases. Whether there is a direct, causal correlation between the increasing cost of medical malpractice insurance premiums and medical malpractice litigation is debatable.

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Characteristics of medical malpractice claims related to cancer in Florida.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.29_suppl.202 ◽

2020 ◽

Vol 38 (29_suppl) ◽

pp. 202-202

Author(s):

Guanming Chen ◽

Jinhai Huo ◽

Vivek Ghosal ◽

Sokol Daniel

Keyword(s):

Medical Malpractice ◽

Insurance Regulation ◽

Common Cause ◽

Malpractice Litigation ◽

Delay In Diagnosis ◽

Malpractice Claims ◽

Severity Of Injury ◽

Medical Malpractice Claims ◽

Test Result

202 Background: Florida is among the states that have highest number of cases and total medical malpractice payments. The aim of the study is to examine the characteristics of cancer-related malpractice cases in Florida. Methods: Cancer-related malpractice claims with payment occurred during Jan. 2005 to Dec. 2015 were identified from the Florida Office of Insurance Regulation (FLOIR) database. The characteristics of malpractice cases examined in the study includes cause of allegation, severity of injury, specialty of healthcare provider, length of delay in diagnosis, settlement stage, and indemnity paid. Results: A total of 811 claims were identified. The most common general cause was delay in diagnosis (49.8% of total claims), followed by failure to interpret test result (9.3%) and failure to perform procedure (9.2%). Among the claims of delay in diagnosis, 22.7% were breast cancer, followed by lung cancer (11.1%), and head and neck cancer (10.9%). About 30% claims reported death caused by malpractice. Radiologist (26.1%) was the most common specialty among all specialties, followed by general practice (12.2%) and internal medicine (11.6%). Radiologists were also more likely to have recurrent malpractice claims. The median payout was $250,000 (mean $277,493). The period from case report to settlement was 1.64 years on average. Conclusions: Delay in diagnosis was the most common cause of cancer-related malpractice suits. Our results aligned with previous reports that radiologists were more likely to be involved in the malpractice claims. This study highlights possible pathways to reduce malpractice litigation, as well as improving quality of care in cancer treatment.

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The Impact of Defense Expenses in Medical Malpractice Claims

The Journal of Law Medicine & Ethics ◽

10.1111/j.1748-720x.2012.00651.x ◽

2012 ◽

Vol 40 (1) ◽

pp. 135-142 ◽

Cited By ~ 22

Author(s):

Aaron E. Carroll ◽

Parul Divya Parikh ◽

Jennifer L. Buddenbaum

Keyword(s):

Medical Malpractice ◽

The United States ◽

Medical Professional ◽

Liability Insurance ◽

Medical Liability ◽

Professional Liability ◽

Medical Specialties ◽

Insurance Premiums ◽

Malpractice Claims ◽

The Impact

Whenever health care reform is debated, the state of the medical professional liability (MPL) system (i.e., medical malpractice system) in the United States re-emerges as an issue of importance. What exactly is broken with the MPL system and what the implications are is a point of contention among different stakeholder groups. Recent data demonstrate that medical liability premiums have been improving in recent years and the majority of premiums remained flat in 2010. General agreement still exists, however, that medical professional liability insurance premiums have become unaffordable for many physicians, and coverage has become less available, especially for certain medical specialties and in specific areas of the country.Multiple factors go into the determination of medical professional liability insurance premiums including return on investments, reinsurance costs, claims frequency, average amount paid out on malpractice claims, defense expenses, and administrative costs such as underwriting expense.

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A Look at the Massachusetts Malpractice Tribunal System

American Journal of Law & Medicine ◽

10.1017/s0098858800005360 ◽

1977 ◽

Vol 3 (2) ◽

pp. 197-207

Author(s):

Walter H. McLaughlin

Keyword(s):

Health Care ◽

American Medical ◽

Health Care Provider ◽

Care Provider ◽

Medical Malpractice ◽

Malpractice Litigation ◽

Court Judge ◽

Chief Justice ◽

Normal Manner ◽

Malpractice Claims

AbstractIn this Oration, the retired Chief Justice of the Massachusetts Superior Court offers some personal observations on the American medical malpractice crisis and examines the Massachusetts malpractice tribunal system, which is aimed at reducing the incidence of malpractice litigation that is either frivolous or involves simply an “unfortunate medical result” for which the health care provider should not be held accountable. First, the author relates some of his impressions of the evolution of the malpractice crisis and identifies its salient characteristics. Next, he provides a description and an evaluation of the Massachusetts tribunal system. Under that system, the plaintiff in any malpractice action must argue before a special tribunal—composed of a Superior Court judge, an attorney, and a surgeon—that his case raises a “legitimate question of liability.” If the tribunal finds that such a question exists, the plaintiff may pursue his case in the normal manner. But if the tribunal finds that the case involves “merely an unfortunate medical result,” and if the plaintiff still wishes to press his claim, he must, before proceeding, post a $2,000 bond, which is used to help pay the defendant’s litigation costs if the defendant prevails at the trial. The author offers data to support his contention that this tribunal system already is screening out a significant number of inappropriate malpractice claims. Nevertheless, he suggests that the system has substantial problems. He identifies those problems, and proposes methods for solving them.

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319 Determining the Role of Informed Consent Allegations in Spinal Surgery Medical Malpractice

Neurosurgery ◽

10.1093/neuros/nyx417.319 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 269-269

Author(s):

Jennifer Grauberger ◽

Panagiotis Kerezoudis ◽

Asad Choudhry ◽

Mohammed Ali Alvi ◽

Sandy Goncalves ◽

...

Keyword(s):

Informed Consent ◽

Spinal Surgery ◽

Medical Malpractice ◽

Bivariate Analysis ◽

Control Group ◽

Malpractice Litigation ◽

Additional Surgery ◽

Increased Risk ◽

Malpractice Claims ◽

Severity Of Injury

Abstract INTRODUCTION Predictive factors associated with increased risk of medical malpractice litigation have been identified including severity of injury, physician sex and error in diagnosis. However, there is a paucity of literature investigating informed consent in spinal surgery malpractice. Our objective was to highlight the failure to obtain informed consent as an allegation in medical malpractice claims for patients undergoing spine-surgery. METHODS This was a retrospective case-control study using a national medico-legal database westlaw next. We identified a total of 233 patients (80 with no informed consent allegation, 153 who cited lack of informed consent) who underwent spinal surgery and filed a malpractice claim were studied. RESULTS >The most common informed consent allegations were failure to explain risks/side effects of surgery (30.4%) and failure to explain alternative treatment options (9.9%). In bivariate analysis, patients in the control group were more likely to require additional surgery (56.3% vs 34.6%, P = 0.002) and suffer from more permanent injuries compared to the informed consent group (P = 0.033). On multivariable regression analysis, permanent injuries were more often associated with indemnity payment following a plaintiff verdict (OR 3.12, 95% CI 1.46 - 6.65, P = 0.003) or a settlement (OR 6.26, 95% CI 1.06 - 36.70, P = 0.042). Informed consent allegations were significantly associated with less severe (temporary/emotional) injury (OR 0.52, 95% CI 0.28 - 0.97, P = 0.043). Additionally, allegations of informed consent were found to be predictive of a defense verdict versus a plaintiff ruling (OR 0.41, 95% CI 0.17 - 0.98, P = 0.046) or settlement (OR 0.01, 95% CI 0.001 - 0.15, P < 0.001). CONCLUSION Lack of informed consent is an important cause for medical malpractice litigation. Although associated with a lower rate of indemnity payments, malpractice lawsuits including informed consent allegations still present a time, money, and reputation toll for physicians

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Overview of medical malpractice in neurosurgery

Neurosurgical FOCUS ◽

10.3171/2020.8.focus20588 ◽

2020 ◽

Vol 49 (5) ◽

pp. E2

Author(s):

Collin J. Larkin ◽

Anastasios G. Roumeliotis ◽

Constantine L. Karras ◽

Nikhil K. Murthy ◽

Maria Fay Karras ◽

...

Keyword(s):

Spinal Surgery ◽

Medical Malpractice ◽

Healthcare Costs ◽

Residency Education ◽

The United States ◽

Medical Specialties ◽

Career Changes ◽

Malpractice Claims ◽

Practical Education ◽

Medical Malpractice Claims

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

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Medical malpractice and meningiomas: an analysis of 47 cases

Neurosurgical FOCUS ◽

10.3171/2020.8.focus20598 ◽

2020 ◽

Vol 49 (5) ◽

pp. E22

Author(s):

Andre E. Boyke ◽

Edward R. Bader ◽

Ishan Naidu ◽

Sharon Lam ◽

Mohammed Ali Alvi ◽

...

Keyword(s):

Surgical Complications ◽

Medical Malpractice ◽

Financial Loss ◽

Motor Weakness ◽

Malpractice Litigation ◽

Prophylactic Measures ◽

Malpractice Claims ◽

Medicine Physician ◽

The Mean ◽

Postoperative Complaints

OBJECTIVEAmong medical practices, surgical fields, including neurosurgery, are at a high risk for medical malpractice litigation. With meningiomas contributing to 10% of the total neurosurgery litigation cases, the aim of this study was to identify demographic characteristics, reasons for litigation, and surgical complications commonly reported in these cases. This analysis serves to increase neurosurgeons’ awareness of factors associated with medical malpractice litigation.METHODSThe online legal database Westlaw was utilized to query public litigation cases related to the medical management of meningiomas between December 1985 and May 2020. Variables extracted included the following: plaintiff and defendant demographics, litigation category, plaintiff medical complaints, and trial outcomes. The authors compared these characteristics between cases with decisions in favor of the defendant and those with decisions in favor of the plaintiff.RESULTSA total of 47 cases met the inclusion criteria. Failure to diagnose (68.1%) was the most common type of malpractice claim, and surgical complications (19.1%), motor weakness (33%), and financial loss (33%) were cited as the most common postoperative complaints. Individual specialties that most often required defense due to malpractice claims were radiology (21.7%) and neurosurgery (19.6%). The jury verdict was in favor of the defense in 51.1% of cases and in favor of the plaintiff in 27.7% of cases. A settlement was reached in 19.1% of cases. The mean payout for a verdict in favor of the plaintiff was $3,409,650.22, while the mean payout for settlements was $867,555.56. The greatest average payout for specialties was in neurosurgery at $3,414,400, followed by radiology at $3,192,960. Cases with a verdict in favor of the plaintiff were more likely to involve an internal medicine physician as a defendant (p = 0.007).CONCLUSIONSOver one-half of the cases resulted in a defendant’s verdict with failure to diagnose cited as the most common reason for litigation. Radiology and neurosurgery were the most common specialties for legal cases and also had some of the largest average payouts based on specialty. Motor weakness and financial loss were the most common plaintiff postoperative complaints. These findings may inform surgeons on active measures to take, such as increasing focus on diagnostic accuracy and reducing specific postoperative complaints, such as motor weakness, through risk management and prophylactic measures, to reduce unfavorable legal outcomes.

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Characterization of Medical Malpractice Litigation after Rhinoplasty in the United States

Aesthetic Surgery Journal ◽

10.1093/asj/sjaa380 ◽

2020 ◽

Author(s):

Adrian A Ong ◽

Andrew Kelly ◽

Geroline A Castillo ◽

Michele M Carr ◽

David A Sherris

Keyword(s):

United States ◽

Patient Satisfaction ◽

Informed Consent ◽

Medical Malpractice ◽

The United States ◽

Medication Administration ◽

Ocular Injury ◽

Contributing Factors ◽

Malpractice Litigation ◽

Malpractice Claims

Abstract Background Rhinoplasty is one of the most common operations performed with favorable results and high patient satisfaction. However, when complications occur or when the desired outcome is not achieved, patients may seek litigation on the premise that there was a violation in the standard of care. Knowledge of malpractice claims can inform rhinoplasty surgeons on how to minimize risk of future litigation as well as improve patient satisfaction. Objectives 1) To identify motives for seeking medical malpractice litigation after rhinoplasty; 2) To examine outcomes of malpractice litigation after rhinoplasty in the United States. Methods The Westlaw legal database was reviewed for all available court decisions related to malpractice after rhinoplasty. Data collected and analyzed included plaintiff gender, location, specialty of defendant(s), plaintiff allegation, and adjudicated case outcomes. Results Twenty-three cases were identified between 1960 and 2018, located in 12 states in the United States. Plaintiffs were 70% female. Otolaryngologists were cited in 11 cases while 12 cases involved a plastic surgeon. All cases alleged negligence. Cases involved “technical” errors (69.6%), “unsatisfactory” outcomes (39.1%), inadequate follow-up or aftercare (30.4%), issues with the informed consent process (21.7%), unexpectedly extensive surgery (8.7%), improper medication administration (4.3%), and failure to recognize symptoms (4.3%). Twenty of the 23 adjudicated cases (86.9%) were ruled in favor of the surgeon. Contributing factors in cases alleging malpractice included poor aesthetic outcome/disfigurement (60.7%), new (post-surgical) onset/persistent nasal symptoms (30.4%), postoperative pain (21.7%), orbital/ocular injury (17.4%), burns (4%), nerve damage (4%), and issues with sleep (4%). Conclusions Malpractice litigation after rhinoplasty favored the surgeon in the majority of the adjudicated cases reviewed. The most common reason for litigating was dissatisfaction with aesthetic outcomes. Rhinoplasty surgeons may mitigate possible litigation by developing a positive doctor-patient relationship, clearly understanding the patient’s surgical expectations, obtaining detailed informed consent while maintaining frequent and caring communication with the patient.

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