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Zaman M, Li JH, Dhir M. Malpractice Claims Following Major Liver and Pancreatic Surgeries: What Can we Learn? J Surg Res 2024; 298:291-299. [PMID: 38640614 DOI: 10.1016/j.jss.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/08/2024] [Accepted: 03/21/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION General surgery is a highly litigious specialty. Lawsuits can be a source of emotional distress and burnout for surgeons. Major hepatic and pancreatic surgeries are technically challenging general surgical oncology procedures associated with an increased risk of complications and mortality. It is unclear whether these operations are associated with an increased risk of lawsuits. The objective of the present study was to summarize the medical malpractice claims surrounding pancreatic and hepatic surgeries from publicly available court records. METHODS The Westlaw legal database was searched and analyzed for relevant malpractice claims from the last two decades. RESULTS Of 165 search results, 30 (18.2%) cases were eligible for inclusion. Appellant cases comprised 53.3% of them. Half involved a patient death. Including co-defendants, a majority (n = 21, 70%) named surgeons as defendants, whereas several claims (n = 13, 43%) also named non-surgeons. The most common cause of alleged malpractice was a delay in diagnosis (n = 12, 40%). In eight of these, surgery could not be performed. The second most common were claims alleging the follow-up surgery was due to negligence (n = 6). Collectively, 20 claims were found in favor of the defendant. Seven verdicts (23.3%) returned in favor of the plaintiff, two of which resulted in monetary awards (totaling $1,608,325 and $424,933.85). Three cases went to trial or delayed motion for summary judgment. There were no settlements. CONCLUSIONS A defendant verdict was reached in two-thirds of malpractice cases involving major hepatic or pancreatic surgery. A delay in diagnosis was the most cited claim in hepatopancreaticobiliary lawsuits, and defendants may often practice in nonsurgical specialties. While rulings favoring plaintiffs are less frequent, the payouts may be substantial.
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Affiliation(s)
- Muizz Zaman
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, New York; Department of Surgery, SUNY Upstate Medical University, Syracuse, New York.
| | - Jian Harvard Li
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, New York
| | - Mashaal Dhir
- Department of Surgery, SUNY Upstate Medical University, Syracuse, New York.
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Doolin JW, Schaffer AC, Tishler RB, Jacobson JO. An analysis of medical malpractice claims against medical oncologists from a national database: Implications for safer practice. J Healthc Risk Manag 2024; 43:18-28. [PMID: 38098175 DOI: 10.1002/jhrm.21563] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/27/2023] [Indexed: 12/24/2023]
Abstract
Malpractice claims data include valuable information about patient safety. We used mixed methods to analyze claims against medical oncologists (MO) from 2008 to 2019 using a national database. MO claims were compared to a group of other internal medicine subspecialties (OIMS). Logistic regression was used to examine correlates of closing with an indemnity payment. A subset of claims against MO were thematically analyzed using a validated safety incident taxonomy as a framework. 456 claims against MO were compared with 5771 claims against OIMS. MO claims closed with indemnity payments 29.8% of the time versus OIMS 30.3% (p = 0.87). Median MO and OIMS indemnity payments were similar ($190,591 vs. $233,432; p = 0.20). Correlates of MO claims closing with payment included patient assessment, communication among providers, and safety and security as contributing factors. Thematic analysis identified provider cognitive error, adverse drug events and relational problems as the most common safety incidents. MO malpractice claims have similar outcomes to OIMS. We demonstrate the proof-of-concept of applying a safety incident taxonomy to medical malpractice. Finding ways to reduce patient exposure to provider cognitive errors, adverse drug reactions, and communication breakdowns should be strategic priorities for safer cancer care.
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Affiliation(s)
- Jim W Doolin
- Lahey Hospital and Medical Center, Hematology/Oncology, Burlington, USA
| | - Adam C Schaffer
- CRICO/Risk Management Foundation of the Harvard Medical Institutions, Brigham and Women's Hospital, Internal Medicine, Boston, USA
| | - Roy B Tishler
- Dana-Farber Cancer Institute, Radiation Oncology, Boston, USA
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Forrest C, Madden D, O'Sullivan MJ, O'Reilly S. Learning From Medical Litigation. JCO Oncol Pract 2023; 19:160-163. [PMID: 36652657 DOI: 10.1200/op.22.00763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Clara Forrest
- Academic Track Intern Programme, Intern Network Executive, School of Medicine, University College, Cork, Ireland
| | | | | | - Seamus O'Reilly
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland.,Cancer Research@UCC, University College Cork, Cork, Ireland
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Palaniappan A, Sellke F. A review of medical malpractice cases in congenital cardiac surgery in the Westlaw database in the United States from 1994 to 2019. J Card Surg 2020; 36:134-142. [PMID: 33131138 DOI: 10.1111/jocs.15109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/11/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Medical malpractice litigations are common for cardiac surgeons, and congenital cardiac surgeons are uniquely held accountable by patients, who are minors, and their families. Therefore, it is imperative for physicians to be cognizant of clinically effective and legally tenable practices. METHODS The Westlaw legal research service was utilized to collect medical malpractice litigations from 1994 to 2019 pertaining to congenital cardiac surgery, inclusive, in the United States. Court documents were manually screened, with 177 litigations satisfying criteria for inclusion. Data collection included patient demographics, verdict and litigation characteristics, and clinical data. Fisher's exact test was used to assess the significance of association. RESULTS Across the 177 litigations, 44% had defendant verdicts, 30% had plaintiff verdicts, and 26% had settlements. The average plaintiff award was $9,363,710, and the average settlement was $4,141,825. Patient mortality occurred in 87 cases (49.2%), and wrongful death claims were argued in 71 cases (40%). The most common reason for litigation were procedural errors (79 cases, 45%). The most frequent clinical event was cardiac arrest (95 cases, 54%). California recorded the most litigations (34 cases, 19.2%). Defendant verdicts were significantly associated with cardiac arrest, procedural errors, and permanent neurological injury (p < .05). CONCLUSIONS Defendant's verdicts were more common in cases with patient mortality, which had lower average plaintiff awards and settlements, since future healthcare expenses are inapplicable to this cohort. Future litigations can be minimized with an emphasis on reducing procedural errors, treating and diagnosing patients timely, and monitoring patients sufficiently.
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Affiliation(s)
- Ashwin Palaniappan
- Alpert Medical School, Brown University, Providence, Rhode Island, USA.,Division of Cardiothoracic Surgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Frank Sellke
- Alpert Medical School, Brown University, Providence, Rhode Island, USA.,Division of Cardiothoracic Surgery, Rhode Island Hospital, Providence, Rhode Island, USA
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Aboumrad M, Fuld A, Soncrant C, Neily J, Paull D, Watts BV. Root Cause Analysis of Oncology Adverse Events in the Veterans Health Administration. J Oncol Pract 2018; 14:e579-e590. [PMID: 30110226 DOI: 10.1200/jop.18.00159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Oncology providers are leaders in patient safety. Despite their efforts, oncology-related medical errors still occur, sometimes resulting in patient injury or death. The Veterans Health Administration (VHA) National Center of Patient Safety used data obtained from root cause analysis (RCA) to determine how and why these adverse events occurred in the VHA, and how to prevent future reoccurrence. This study details the types of oncology adverse events reported in VHA hospitals and their root causes and suggests actions for prevention and improvement. METHODS We searched the National Center for Patient Safety adverse event reporting database for RCA related to oncology care from October 1, 2013, to September 8, 2017, to identify event types, root causes, severity of outcomes, care processes, and suggested actions. Two independent reviewers coded these variables, and inter-rater agreement was calculated by κ statistic. Variables were evaluated using descriptive statistics. RESULTS We identified 48 RCA reports that specifically involved an oncology provider. Event types included care delays (39.5% [n = 19]), issues with chemotherapy (25% [n = 12]) and radiation (12.5% [n = 6]), other (12.5% [n = 6]), and suicide (10.5% [n = 5]). Of the 48 events, 27.1% (n = 13) resulted in death, 4.2% (n = 2) in severe harm, 18.8% (n = 9) in temporary harm, 20.8% (n = 10) in minimal harm, and 2.1% (n = 1) in no harm. The majority of root causes identified a need to improve care processes and policies, interdisciplinary communication, and care coordination. CONCLUSION This analysis highlights an opportunity to implement system-wide changes to prevent similar events from reoccurring. These actions include comprehensive cancer clinics, usability testing of medical equipment, and standardization of processes and policies. Additional studies are necessary to assess oncologic adverse events across specialties.
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Affiliation(s)
- Maya Aboumrad
- National Center for Patient Safety; White River Junction VA Medical Center, White River Junction, VT; The National Center for Patient Safety, Ann Arbor, MI; and Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Alexander Fuld
- National Center for Patient Safety; White River Junction VA Medical Center, White River Junction, VT; The National Center for Patient Safety, Ann Arbor, MI; and Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Christina Soncrant
- National Center for Patient Safety; White River Junction VA Medical Center, White River Junction, VT; The National Center for Patient Safety, Ann Arbor, MI; and Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Julia Neily
- National Center for Patient Safety; White River Junction VA Medical Center, White River Junction, VT; The National Center for Patient Safety, Ann Arbor, MI; and Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Douglas Paull
- National Center for Patient Safety; White River Junction VA Medical Center, White River Junction, VT; The National Center for Patient Safety, Ann Arbor, MI; and Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Bradley V Watts
- National Center for Patient Safety; White River Junction VA Medical Center, White River Junction, VT; The National Center for Patient Safety, Ann Arbor, MI; and Geisel School of Medicine at Dartmouth, Hanover, NH
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Saletti P, Sanna P, Gabutti L, Ghielmini M. Choosing wisely in oncology: necessity and obstacles. ESMO Open 2018; 3:e000382. [PMID: 30018817 PMCID: PMC6045771 DOI: 10.1136/esmoopen-2018-000382] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/25/2018] [Accepted: 05/26/2018] [Indexed: 12/25/2022] Open
Abstract
In the last decades, the survival of many patients with cancer improved thanks to modern diagnostic methods and progresses in therapy. Still for several tumours, especially when diagnosed at an advanced stage, the benefits of treatment in terms of increased survival or quality of life are at best modest when not marginal, and should be weighed against the potential discomfort caused by medical procedures. As in other specialties, in oncology as well the dialogue between doctor and patient should be encouraged about the potential overuse of diagnostic procedures or treatments. Several oncological societies produced recommendations similar to those proposed by other medical disciplines adhering to the Choosing Wisely (CW) campaign. In this review, we describe what was reported in the medical literature concerning adequacy of screening, diagnostic, treatment and follow-up procedures and the potential impact on them of the CW. We only marginally touch on the more complex topic of treatment appropriateness, for which several evaluation methods have been developed (including the European Society for Medical Oncology-magnitude of clinical benefit scale). Finally, we review the possible obstacles for the development of CW in the oncological setting and focus on the strategies which could allow CW to evolve in the cancer field, so as to enhance the therapeutic relationship between medical professionals and patients and promote more appropriate management.
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Affiliation(s)
- Piercarlo Saletti
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
| | - Piero Sanna
- Palliative and Supportive Care Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Luca Gabutti
- Internal Medicine Department, Ente Ospedaliero Cantonale (EOC), Choosing Wisely EOC, Bellinzona, Switzerland
| | - Michele Ghielmini
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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Shin DW, Cho J, Yang HK, Kim SY, Mok HK, Lee H, Park SM, Huh JS, Ryu J, Park JH. Attitudes towards second opinion services in cancer care: a nationwide survey of oncologists in Korea. Jpn J Clin Oncol 2016; 46:441-7. [PMID: 27004900 DOI: 10.1093/jjco/hyw016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 01/26/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Second opinion is a common phenomenon in many health systems, especially in the care of patients with cancer. However, it is not clear whether second opinion seeking should be promoted or discouraged and how second opinion services and policies can be better formalized to maximize the benefits and minimize the disadvantages. METHODS A nationwide survey was conducted with a representative sample of 678 physicians involved in cancer care (75.5% participation rate) recruited in 13 cancer centres. RESULTS Most physicians involved with cancer care perceived patients' second opinion seeking as a legitimate right (96.0%) and they acknowledged the need for second opinion services under certain conditions (98.2%). Many believed that second opinions can enhance patient satisfaction (77.3%) and quality of care (74.3%), but they also had concerns about increase in healthcare and societal costs (91.3%) and concentration in a high-volume centre (90.7%). While the majority agreed with the involvement of the first opinion physicians in the second opinion services (69.5%), there were mixed opinions regarding the desirability of remote (teleconsultation) second opinion services (49.0%) and coverage by national health insurance (51.9%). CONCLUSION Physicians were generally positive to second opinion services and expected positive consequences in terms of patient satisfaction and quality of care. However, they had concerns about the consequences regarding cost and equity, and disagreements were observed regarding the way to improve second opinion services. The physicians' opinions revealed in our study will be helpful in developing clearer guidelines used to maximize the benefits of second opinion services.
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Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Juhee Cho
- Department of Health, Behavior and Society & Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA Cancer Education Center, Samsung Comprehensive Cancer Center, SAHIST and School of Medicine, Sunkyungkwan University School of Medicine, Seoul
| | - Hyung Kook Yang
- Division of Cancer Policy and Management, National Cancer Control Institute, National Cancer Center, Goyang
| | - So Young Kim
- Division of Cancer Policy and Management, National Cancer Control Institute, National Cancer Center, Goyang
| | - Hyung Kyun Mok
- Division of Cancer Policy and Management, National Cancer Control Institute, National Cancer Center, Goyang
| | - Hyejin Lee
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Seon Mee Park
- Department of Gastroenterology, Chungbuk National University College of Medicine, Cheongju
| | - Jung Sik Huh
- Department of Urology, Jeju National University Hospital, Jeju National University College Medicine, Jeju
| | - Junsun Ryu
- Department of Otolaryngology-Head and Neck Surgery, Head & Neck Oncology Clinic, Center for Thyroid Cancer, Research Institute and Hospital, National Cancer Center, Goyang
| | - Jong Hyock Park
- Division of Cancer Policy and Management, National Cancer Control Institute, National Cancer Center, Goyang College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Korea
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