Litigation in Canada against anesthesiologists practicing regional anesthesia. A review of closed claims

Abstract

Purpose: To review the pattern of malpractice litigation related to regional anesthesia in Canada. Source: The Canadian Medical Protective Association (CMPA) provided with information about all anesthesia claims that closed in the years 1990-1997.Principal Findings: In the period 1990-97 there were 7,909 closed legal actions involving all CMPA members (56,000). Of these, there were 310 cases involving anesthesiologists, of which 61 cases (approximately 20%) were related to regional anesthesia. Forty-two involved neuraxial blocks, and the legal outcome was favourable (dismissed or judgement in favour of the defendant doctor) in 37 claims. Nineteen claims involved peripheral nerve blocks. All these had favourable legal outcomes. Overall, 10% of regional anesthesia claims have unfavourable outcomes, compared with 28% of all anesthesia related claims and 30% of all CMPA members' claims. The degree of disability in the regional anesthesia claims were: none 10%; minor 49%; major 36%; catastrophic 5%. There were no deaths in the malpractice claims involving regional anesthesia, compared with 17% in the all anesthesia group and 11% in all members' claims. Conclusion:Twenty percent of all anesthesia claims in Canada are related to regional anesthesia. The legal outcome of these claims is favourable in 90%. Unfavourable clinical outcome is associated with catastrophic or major injury. There were no deaths in the regional anesthesia claims.Objectif : Revoir les accusations pour faute professionnelle concernant l'anesthésie régionale au Canada. Source : L'Association canadienne de protection médicale (ACPM) a fourni les renseignements au sujet de toutes les réclamations réglées de 1990 à 1997 qui concernaient l'anesthésie.Constatations principales : De 1990 à 1997 il y a eu 7 909 poursuites judiciaires réglées qui impliquaient des membres de l'ACPM (56 000). De ce nombre, 61 cas étaient liés à l'anesthésie régionale, donc environ 20 % des 310 cas touchant des anesthésiologistes. Dans 42 cas, il s'agissait de blocs neuraxiaux et l'issue de la poursuite a été favorable (action rejetée ou jugement en faveur du médecin accusé) dans 37 cas. Dans 19 cas, c'était des blocs nerveux périphériques. Toutes ces poursuites ont été favorables aux médecins. Globalement, 10 % des réclamations liées à l'anesthésie régionale ont été défavorables contre 28 % de toutes les réclamations anesthésiques et 30 % de celles des membres de l'ACPM. Le degré d'invalidité concernant l'anesthésie régionale ont été : aucun, 10 %; mineur, 49 %; majeur, 36 %; catastrophique, 5 %. Aucun décès n'est lié aux poursuites pour faute professionnelle dans des cas d'anesthésie régionale, à comparer à 17 % dans tous les groupes d'anesthésie et 11 % des réclamations parmi tous les membres. Conclusion :De toutes les réclamations concernant l'anesthésie au Canada, 20 % sont reliées à l'anesthésie régionale. L'issue de ces poursuites est favorable aux médecins dans 90 % des cas. Des résultats cliniques défa-vorables sont liés à des lésions catastrophiques ou majeures. Auc...

Litigation related to regional anaesthesia: an analysis of claims against the NHS in England 1995–2007*

“…The review of the Canadian Medical Protective Association claims for the period 1990-1997, by Peng and Smedstad, identified 310 cases involving anaesthetists, of which 61 cases (20%) were related to (obstetric and non-obstetric) regional anaesthesia [10]. The authors reported that approximately two thirds of closed claims were related to neuraxial blockade (n = 42), with eye blocks the most commonly cited peripheral nerve block (n = 7 ⁄ 19), accounting for 12% of all regional claims.…”

“…Such techniques may be associated with multiple benefits whether used as an alternative or in addition to general anaesthesia, including superior postoperative analgesia and potentially reduced morbidity and mortality [1][2][3][4][5]. Complications resulting from various regional techniques have been well described [6][7][8][9], and studies of insurance claims related to regional anaesthesia in Canada, Finland and the USA have been published, with detailed analysis of specific patterns of injury and legal liability [10][11][12][13]. Similar information regarding UK practice is lacking, and to the best of our knowledge the pattern of litigation related to regional anaesthesia and analgesia in the UK has not been reported before.…”

Chronic pain practice by consultant anaesthetists in the Republic of Ireland

“…None of the consultant anaesthetists with CPP in the Republic of Ireland chose to perform ESI in their office, compared with slightly less than 4% of anesthesiologists in a similar study carried out in Canada. Although ESI is considered to be a very safe procedure, life-threatening complications can occur [5] and ESI was the major cause of malpractice claims in chronic pain management both in Canada and the United States [6,7]. The only widely accepted indication for ESI is pain associated with radiculopathy.…”

Survey of chronic pain practice by anesthesiologists in Canada

“…Although ESI is considered to be a very safe procedure, life-threatening complications can occur 8 and ESI was the major cause of malpractice claims in chronic pain management both in Canada and the United States. 9,10 It should be performed in a location where resuscitation equipment and personnel are immediately available, particularly when a local anesthestic is used. The only widely accepted indication for ESI is pain associated with radiculopathy.…”