Analysis of judicial precedent cases regarding epidural injection in chronic pain management in Republic of Korea

Abstract

BackgroundAlthough there is a low incidence of complications associated with epidural injections, pain physicians should still remain vigilant for potentially serious adverse outcomes. This study aimed to identify and describe the major complications of epidural injections.MethodsThis retrospective, observational, medicolegal study analyzed closed cases of precedents involving complications of epidural injections from January 1997 to August 2019 using the database of the Supreme Court of Korea’s judgement system. Clinical characteristics and judgement statuses were analyzed.ResultsOf the 73 potential cases assessed for eligibility, a total of 49 malpractice cases were included in the final analysis. Thirty-three claims resulted in payments to the plaintiffs, with a median payment of US$103 828 (IQR: US$45 291–US$265 341). The most common complication was infection (n=13, 26.5%), followed by worsening pain (n=8, 16.3%). Physician malpractice before, during, and after the procedure was claimed by plaintiffs in 18 (36.7%), 44 (89.8%), and 31 (63.3%) cases, respectively. Of these cases, 6 (33.3%), 19 (43.2%), and 15 (48.4%), respectively, were adjudicated in favor of the plaintiffs by the courts. In cases involving postprocedural physician errors, the majority (13/15) of the plaintiff verdicts were related to delayed management. Violation of the physician’s duty of informed consent was claimed by plaintiffs in 31 (63.3%) cases, and 14 (45.2%) of these cases were judged medical malpractice.ConclusionsOur data will allow pain physicians to become acquainted with the major epidural injection-associated complications that underlie malpractice cases.

Analysis of endotracheal intubation-related judicial precedents in South Korea

“…This analysis was conducted in a similar manner as our previous medicolegal studies [ 4 , 5 ]. Each precedent text included detailed clinical information related to the events, the plaintiff’s claim, and the court decisions regarding medical malpractice.…”

“…Three anesthesiologists (HY Cho, SJ Lee, and S Yoon) scrutinized the precedent texts, collecting the following variables: demographics (including age and sex), department of primary defendant physician, type of medical institution (local clinic, hospital), location of event, reason for tracheal intubation, and the types and severities of the complications. The severity of complications was evaluated using the 10-point National Association of Insurance Commissioners (NAIC) scale (0: no obvious injury, 1: emotional only, 2: temporary insignificant, 3: temporary minor, 4: temporary major, 5: permanent minor, 6: permanent significant, 7: permanent major, 8: permanent grave, 9: death) [ 6 ]; and classified as low (0–2), medium (3–5), or high (6–9) [ 5 ]. During the second review, we investigated the potential predictors of difficult tracheal intubation [ 7 ], the number of laryngoscopic attempts, whether or not alternative airway intervention was performed, and the duration from the determination of intubation to intubation (min) in cases associated with delayed intubation.…”

“…Since the judgments were provided to the researcher after de-identification, the need for informed consent was waived. This analysis was conducted in a similar manner as our previous medicolegal studies [4,5].…”

“…Temporary insignificant, 3: Temporary minor, 4: Temporary major, 5: Permanent minor, 6: Permanent significant, 7: Permanent major, 8: Permanent grave, 9: death) [6], and classified as low (0-2), medium (3)(4)(5), or high (6-9) [5]. During the second review, we investigated the potential predictors of difficult tracheal intubation [7], the number of laryngoscopic attempts, whether or not alternative airway intervention was performed, and the duration from the This article is protected by copyright of Korean Journal of Anesthesiology.…”

<p>Medicolegal Consideration to Prevent Medical Malpractice Regarding Opioid Administration: An Analysis of Judicial Opinion in South Korea</p>

“…Therefore, in this study, we attempted to investigate the very rare but serious complications associated with opioid administration through the analysis of medical malpractice lawsuits. 13 Through this study, we hope to increase awareness regarding catastrophic complications of opioids and to prevent medical malpractice associated with opioid administration.…”