Causes and Outcomes of Dental Malpractice Litigation in the Riyadh Region of the Kingdom of Saudi Arabia

<b><i>Introduction:</i></b> Every health organization aims to provide high-quality service and promote patient safety. However, achieving these goals can be challenging in many healthcare systems around the world. In dentistry, dentists can face medicolegal issues, which can be overcome by exploring the reasons for dental malpractice litigation. In this study, we aim to identify the most common causes and outcomes of dental malpractice litigation in the Kingdom of Saudi Arabia. <b><i>Methods:</i></b> This is a retrospective study. We reviewed all closed cases in dentistry as decided by the Medico-Legal Committee of Saudi Arabia in the Riyadh region over a period of 5 years and 3 months, from January 1, 2014, to March 31, 2019. Descriptive analysis was used to examine the phenomenon of dental malpractice claims. <b><i>Results:</i></b> In total, 151 claims were analyzed. As per our findings, it was determined that the number of closed claims had increased, with the highest number of claims (35%) related to the prosthodontics specialty, followed by endodontics specialty (31%). The most common causes of litigation were failure to conduct the procedure properly (31.5%) and poor documentation (19.7%). With respect to litigation outcomes, 54% ended up with verdict in favor of the plaintiff. <b><i>Conclusions:</i></b> It was determined that there is a rising trend of malpractice litigation in the dentistry field; thus, measures should be taken to address these concerns.

Pulmonary Aspiration of Gastric Contents: A Closed Claims Analysis

Background Perioperative pulmonary aspiration of gastric contents has been associated with severe morbidity and death. The primary aim of this study was to identify outcomes and patient and process of care risk factors associated with gastric aspiration claims in the Anesthesia Closed Claims Project. The secondary aim was to assess these claims for appropriateness of care. The hypothesis was that these data could suggest opportunities to reduce either the risk or severity of perioperative pulmonary aspiration. Methods Inclusion criteria were anesthesia malpractice claims in the American Society of Anesthesiologists Closed Claims Project that were associated with surgical, procedural, or obstetric anesthesia care with the year of the aspiration event 2000 to 2014. Claims involving pulmonary aspiration were identified and assessed for patient and process factors that may have contributed to the aspiration event and outcome. The standard of care was assessed for each claim. Results Aspiration of gastric contents accounted for 115 of the 2,496 (5%) claims in the American Society of Anesthesiologists Closed Claims Project that met inclusion criteria. Death directly related to pulmonary aspiration occurred in 66 of the 115 (57%) aspiration claims. Another 16 of the 115 (14%) claims documented permanent severe injury. Seventy of the 115 (61%) patients who aspirated had either gastrointestinal obstruction or another acute intraabdominal process. Anesthetic management was judged to be substandard in 62 of the 115 (59%) claims. Conclusions Death and permanent severe injury were common outcomes of perioperative pulmonary aspiration of gastric contents in this series of closed anesthesia malpractice claims. The majority of the patients who aspirated had either gastrointestinal obstruction or acute intraabdominal processes. Anesthesia care was frequently judged to be substandard. These findings suggest that clinical practice modifications to preoperative assessment and anesthetic management of patients at risk for pulmonary aspiration may lead to improvement of their perioperative outcomes. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Analyzing Workers’ Compensation Claims and Payments Made Using Data from a Large Insurance Provider

Background: All states in the USA have established Workers’ Compensation (WC) insurance systems/programs. WC systems address key occupational safety and health concerns. This effort uses data from a large insurance provider for the years 2011–2018 to provide estimates for WC payments, stratified by the claim severity, i.e., medical only, and indemnity. Methods: Besides providing descriptive statistics, we used generalized estimating equations to analyze the association between the key injury characteristics (nature, source, and body part injured) and total WC payments made. We also provide the overall cost burden for the former. Results: Out of the total 151,959 closed claims, 83% were medical only. The mean overall WC payment per claim for the claims that resulted in a payment was $1477 (SD: $7221). Adjusted models showed that mean payments vary by claim severity. For example, among medical only claims, the mean payment was the highest for amputations ($3849; CI: $1396, $10,608), and among disability and death related claims, ruptures cost the most ($14,285; $7772, $26,255). With frequencies taken into account, the overall cost burden was however the highest for strains. Conclusions: Workplace interventions should prioritize both the costs of claims on average and the frequency.

Left Lower Lung Collapse in a Patient Undergoing Endoscopic Procedure

ASA closed claims from 2000 to 2009 have shown that adverse respiratory events are more common in nonoperating room locations like endoscopy suite than in the operating room (44% v/s 20%). Here, we report a case of lung atelectasis which resulted in hypoxemia in a malnourished patient undergoing endoscopic procedure. It is crucial to identify the high-risk patients and monitor them appropriately in the postoperative phase. Continuous capnometry may offer additional benefit by identifying hypercapnia, hypoventilation at the earliest in the recovery area, thus preventing serious complications.