Analysis of patient injury based on anesthesiology closed claims data from a major malpractice insurer

Ranum, Darrell; Ma, Haobo; Shapiro, Fred E.; Chang, Beverly; Urman, Richard D.

doi:10.1002/jhrm.21156

Cited by 22 publications

(8 citation statements)

References 33 publications

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“…As in liability insurance cases, the average amount of compensation for dental damages remains low compared to other intra-operative accidents during general anesthesia. 28 Finally, in the event of an appeal, there is a significant chance that the amount of compensation will increase in favor of the patient.…”

Section: Discussionmentioning

confidence: 99%

“…In this study, the median time between the date of damage and the verdict of the first instance court was 3.5 years [0.8–13.1] and the median time between the date of damage and the final verdict was 5.8 years [1.3–14.9], which are longer than insurance compensation procedures (1–2 years in France). As in liability insurance cases, the average amount of compensation for dental damages remains low compared to other intra‐operative accidents during general anesthesia 28 . Finally, in the event of an appeal, there is a significant chance that the amount of compensation will increase in favor of the patient.…”

Section: Discussionmentioning

confidence: 99%

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Medicolegal issues of peri‐anaesthetic dental injuries: A 21‐years review of liability lawsuits in France

Diakonoff

Rocquigny

Tourtier

et al. 2022

Dental Traumatology

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Background/Aim Peri‐anaesthetic dental injuries (PDI) represent a major source of potential malpractice claims against anesthesiologists. Studies about the medico‐legal aspects of PDI have mainly focused on liability insurance cases thus not encompassing those cases brought to court. The aim of this study was to assess the medico‐legal issues of PDI‐related liability lawsuits in France. Material and Methods A review of judicial decisions pertaining to PDI was conducted on a French legal database, spanning the period between January 2000 and October 2021. Characteristics of decisions, patients and anesthesiologists, peri‐operative care, dental injuries, and convictions were collected when available for analysis. Results Twenty‐four judicial decisions fulfilled the inclusion criteria and were analyzed. All cases of dental injuries took place during elective surgery, 16 in the private sector and 8 in the public sector. Most injuries concerned two or more teeth and the most predominant dental injuries were luxation or avulsion (70.8% of cases). Eight cases resulted in a final verdict in favor of the plaintiff, four in the private sector (conviction rate: 25%), and four in the public sector (conviction rate: 50%). The causes of conviction were either a lack of information (5/8), a breach in the standard of care or technical negligence (3/8). The average amount of indemnification for the plaintiff was 3614 Euros (3753 Euros in 2022 inflation‐adjusted Euros) excluding legal fees. Conclusions The analysis of PDI‐related liability lawsuits shows that medico‐legal issues differ from those of PDI‐related insurance claims. Avulsion and luxation of multiple anterior teeth during elective surgery appear to be a risk factor for liability lawsuits. In addition, inadequacy of patient information about PDI‐risk seems to be a risk factor for conviction. Lastly, dental injuries are less at risk of civil conviction than other anesthesia‐related damages.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Medicolegal issues of peri‐anaesthetic dental injuries: A 21‐years review of liability lawsuits in France

Diakonoff

Rocquigny

Tourtier

et al. 2022

Dental Traumatology

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“…18 Our results are clinically important since prior studies examining liability resulted from anesthesiology claims of nontrainees have frequently identified the intraoperative period and obstetric patients as high-risk populations. [19][20][21] The Accreditation Council for Graduate Medical Education 2:1 supervision rule during the intraoperative period may reduce the attribution of severe unexpected outcomes to anesthesiology trainees. 22 Procedures that are commonly performed in the operating room under direct supervision (eg, central lines, intubations) may be done outside the operating room under indirect supervision, and this may result in malpractice claims in which physician trainees were directly involved in the harm events.…”

Section: Discussionmentioning

confidence: 99%

Medical Malpractice Lawsuits Involving Anesthesiology Residents: An Analysis of the National Westlaw Database

2020

JEPM

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Background: Medical specialties have evaluated malpractice claims in residents, but to the best of our knowledge, malpractice claims have not been evaluated in anesthesiology residents. Methods:The Westlaw legal database was queried for all malpractice litigation cases involving anesthesiology residents in the United States from January 1959 through December 2018. The cases were divided into 2 cohorts by year (before and after 1990) to account for the differences in patient safety features and monitoring available in the different time periods.Results: Ninety cases were included in the analysis. The median (interquartile range) for inflation adjusted payments was $1 140 544 (0 to 4 158 589). There was no association between the year the claim was filled and the payment amount, Spearman rho = -0.17, P = 0.15. In contrast, for claims that occurred in the intraoperative period, there was a moderate negative association between the year of the claim and the inflation adjusted payment, Spearman rho = -0.45, P = 0.003.

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“…Finally, closed claim analysis is a methodology used to highlight systematic failures and procedural weaknesses [12,13]. It has been used especially in the field of anaesthesiology [14][15][16]. To our knowledge, this is the first internationally published study in orthopaedic surgery, where the methodology of closed claims analysis has been applied successfully.…”

Section: Discussionmentioning

confidence: 99%

Fractures of the knee in children—what can go wrong? A case file study of closed claims in the Patient Compensation Association covering 16 years

Leeberg

Sonne‐Holm

Christoffersen³

et al. 2015

Journal of Children's Orthopaedics

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IntroductionIntra-articular knee fractures in children are rare. The Patient Compensation Association (PCA) receives claims for financial compensation from patients who believe they have sustained damage from their treatment in the health care system. We used relevant cases of closed claims to identify causality and co-factors contributing to these apparent malpractices.Materials and methodsA partial root core analysis was performed on closed claims from the PCA database concerning proximal tibial fractures in children aged ≤15 years.ResultsWe identified 13 cases. The main complaint was missed diagnosis (6 cases)—fractures of the tibial eminence were the main culprit, with damage to the popliteal artery caused by a medial condyle fracture being the most serious. All cases were missed by junior doctors. Secondary complaints were problems with casting, dissatisfaction with correct treatment, and insufficient surgery or complications relating to surgery. Eight of the complaints were acknowledged, with six receiving financial compensation ranging from EUR 9,600 to EUR 70,000. Five out of the six cases of missed diagnosis were acknowledged.ConclusionsThis study indicates that recognizing the degree of injury to the knee in children, which should include an X-ray examination, is key to preventing missed diagnosis and delayed and potentially more difficult surgery with long-lasting sequelae for the child. The PCA database seems to be a useful way to highlight systematic problems in the Danish health care system and could potentially be an important means to improving patient safety and preventing treatment-related injuries.

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Analysis of patient injury based on anesthesiology closed claims data from a major malpractice insurer

Cited by 22 publications

References 33 publications

Medicolegal issues of peri‐anaesthetic dental injuries: A 21‐years review of liability lawsuits in France

Medicolegal issues of peri‐anaesthetic dental injuries: A 21‐years review of liability lawsuits in France

Medical Malpractice Lawsuits Involving Anesthesiology Residents: An Analysis of the National Westlaw Database

Fractures of the knee in children—what can go wrong? A case file study of closed claims in the Patient Compensation Association covering 16 years

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