Malpractice Litigation in Plastic Surgery: Can We Identify Patterns?
Samuel Sarmiento, MD, MPH, MBA, Charalampos Siotos, MD, Michael Cheah, MD, Stacey B. Lee, JD, Gedge D. Rosson, MD.
Johns Hopkins University, Baltimore, MD, USA.
Purpose: Malpractice litigation is commonplace in current medical practice, and no specialty is spared. Because surgical specialties have higher rates of malpractice cases, it is important for the plastic surgeon to understand the factors that contribute to litigation. Therefore, we sought to comprehensively characterize the litigation landscape in plastic surgery across its different subspecialties.
Methods: We used the Westlaw legal database to conduct a comprehensive search of malpractice cases in plastic surgery in the United States in the following subspecialties: aesthetic, reconstructive, hand, and craniofacial surgery. We conducted both a Boolean and a natural language search to identify cases in which a plastic surgeon was the defendant. Each case was reviewed to obtain information regarding the defendants and plaintiffs, year of the event, legal outcomes, and payout amounts where applicable. The data obtained were analyzed using descriptive statistics.
Results: Between 2000 and 2017, we found a total of 594 cases. After an initial screening for relevance, we included 119 cases. We are presenting the preliminary results of a comprehensive review of 30 of those cases. Most cases occurred in private practice (n=25; 83%) compared to academic medical centers (n=5; 17%). In 3 cases (10%) where this information is mentioned, plastic surgeons were board certified. Only 2 cases (6.7%) mentioned a resident or fellow. Specialties most commonly involved in malpractice litigation are summarized in Table 1. The most common types of errors were gross negligence (n=12; 41%), and errors of commission leading to unwanted outcomes (n=12; 41%). Incomplete informed consent was the cause of action in 3 cases (10%). The majority of plaintiffs were female (28 female vs. 2 male), with an age range of 24 to 65 years (mean: 41 years). The most common adverse outcome was disfigurement (n=12; 40%) followed by emotional or psychological distress (n=4; 13%). Legal outcome was most commonly a jury verdict in favor of the surgeon (n=19; 70%) compared to plaintiffs (n=8; 30%). Only 7 cases included a jury verdict with a monetary award in favor of a plaintiff. The median payout for these cases was $538,000, with a range from $100,000 to $1,700,000. The most common jurisdictions are presented in Figure 1.
Conclusion: Malpractice litigation has a significant impact on health care costs and important professional implications for health care providers. Understanding the factors contributing to malpractice cases in plastic surgery is critical in order to recognize patterns and identify opportunities to address common errors. While legal outcomes were in favor of plastic surgeons in the majority of cases, physicians must be cognizant of the litigation landscape in order to reduce its burden on the health care system and society.
|Table 1. Subspecialties of plastic surgery most commonly mentioned in malpractice cases.|
Figure 1. List of jurisdiction where plastic surgery malpractice litigation occurred.
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