A Legal Database Review of Circumcision Related Litigation in the United States

Li, Kevin D.; Hakam, Nizar; Low, Patrick; Lui, Jason; Sadighian, Michael; Nabavizadeh, Behnam; Shaw, Nathan M.; Breyer, Benjamin N.

doi:10.1016/j.urology.2021.09.036

Cited by 4 publications

(9 citation statements)

References 16 publications

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“…8,[13][14][15][16][17][18] Within the field of paediatric urology, legal database reviews are limited. 9,12,19 Similar to our findings, litigation in these reviews most commonly relate to negligent surgical performance and post-operative surveillance and were decided in favour of the surgeon. 8,9,20 The settlement and monetary damages in our review were lower than average monetary damages associated in other congenital malpractice lawsuits.…”

Section: Discussionsupporting

confidence: 79%

“…9,12,19 Similar to our findings, litigation in these reviews most commonly relate to negligent surgical performance and post-operative surveillance and were decided in favour of the surgeon. 8,9,20 The settlement and monetary damages in our review were lower than average monetary damages associated in other congenital malpractice lawsuits. This finding may be associated with higher mortality and permanent injury rates reported in cardiac, respiratory and plastic surgery congenital malformations.…”

Section: Discussionsupporting

confidence: 79%

“…8,14,15 However, compared to monetary damages in paediatric urology, BEEC payments were greater. 9,20 An estimated incidence of 75 new bladder exstrophy cases per year, 900 over the course of this study, allows us to comment on incidence of malpractice litigation in this sphere. Such an estimate yields 0.7% for all malpractice litigation, 0.2% for surgery related to initial closure, 0.1% for surgery performed after initial closure.…”

Section: Discussionmentioning

confidence: 94%

“…Paediatric surgery is believed to have increased potential for medical malpractice claims, as parents, guardians and patients may file claims over a longer period than adult patients. 8,9 Current evidence suggests successful lawsuits in paediatric urology, while rare, are associated with large indemnity payments. [9][10][11][12] Bladder exstrophy-epispadias complex (BEEC) is a rare congenital genito-urinary malformation representing a spectrum from simple epispadias to severe cloacal exstrophy.…”

Section: Introductionmentioning

confidence: 99%

“…8,9 Current evidence suggests successful lawsuits in paediatric urology, while rare, are associated with large indemnity payments. [9][10][11][12] Bladder exstrophy-epispadias complex (BEEC) is a rare congenital genito-urinary malformation representing a spectrum from simple epispadias to severe cloacal exstrophy. In the US, bladder exstrophy occurs in approximately 1:40,000 live births equating to 75-80 new cases annually.…”

Section: Introductionmentioning

confidence: 99%

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Bladder exstrophy-epispadias complex related litigation: A legal database review

et al. 2023

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Objective To review the nature and extent of bladder exstrophy-epispadias related malpractice litigation in the United States. Methods Two legal databases (Nexis Uni, WestLaw) were reviewed for state and federal cases using the terms “bladder exstrophy”, “cloacal exstrophy”, “epispadias”, in combination with “medical malpractice”, or “negligence”, or “medical error”, or “complication”, or “malpractice”, or “tort”. Databases were queried from 1948 to 2022 and reviewed for medical and legal details. Results Our search yielded 16 unique legal cases with 6 fitting established criteria for analysis. Urology and paediatric urologists were named in 50% of cases as were community medical systems. Cause for lawsuit included negligence in surgical performance (50%), primary closure of exstrophy (33%), and post-operative care (50%). Settlement agreement was reached in one case (17%). Outcomes favoured the physician in 60% of trials. Lawsuits alleging negligent surgical performance and/or post-operative care exclusively named urologists with outcomes favouring the surgeon in 66% of cases. The settlement payment (n = 1) was $500,000 and monetary damages (n = 1) equated to $1.3 million. Conclusions Malpractice litigation related to BEEC treatment is rare. Trial outcomes favour the medical provider. Cases that resulted in financial liability successfully alleged avoidable negligence resulting in irreversible physical damage. The authors recommend families with BEEC seek board-certified paediatric urologists experienced in treating this complex and/or Bladder Exstrophy Centers of Excellence. Further, we recommend surgeons treating BEEC properly educate patients and families on the severity of this major birth defect including its lifelong implications and need for surgical revisions.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Bladder exstrophy-epispadias complex related litigation: A legal database review

et al. 2023

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Surgical margins after partial nephrectomy as prognostic factor for the risk of local recurrence in pT1 RCC: a systematic review and narrative synthesis

et al. 2022

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Purpose To systematically review the published literature on surgical margins as a risk factor for local recurrence (LR) in patients undergoing partial nephrectomy (PN) for pT1 renal cell carcinomas (RCC). Evidence acquisition A systematic literature search of relevant databases (MEDLINE, Embase and the Cochrane Library) was performed according to the PRISMA criteria up to February 2022. The hypothesis was developed using the PPO method (Patients = patients with pT1 RCC undergoing PN, Prognostic factor = positive surgical margins (PSM) detected on final pathology versus negative surgical margins (NSM) and Outcome = LR diagnosed on follow-up imaging). The primary outcome was the rate of PSM and LR. The risk of bias was assessed by the QUIPS tool. Evidence synthesis After assessing 1525 abstracts and 409 full-text articles, eight studies met the inclusion criteria. The percentage of PSM ranged between 0 and 34.3%. In these patients with PSM, LR varied between 0 and 9.1%, whereas only 0–1.5% of LR were found in the NSM-group. The calculated odds ratio (95% confident intervals) varied between 0.04 [0.00–0.79] and 0.27 [0.01–4.76] and was statistically significant in two studies (0.14 [0.02–0.80] and 0.04 [0.00–0.79]). The quality analysis of the included studies resulted in an overall intermediate to high risk of bias and the level of evidence was overall very low. A meta-analysis was considered unsuitable due to the high heterogeneity between the included studies. Conclusion PSM after PN in patients with pT1 RCC is associated with a higher risk of LR. However, the evidence has significant limitations and caution should be taken with the interpretation of this data.

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