Alleged malpractice in orthopaedics. Analysis of a series of medmal insurance claims

Abstract

BackgroundMedical malpractice is an important topic worldwide, and orthopedics is a clinical branch that is considered to be at a high risk for claims. The analysis of a series of medmal insurance claims allows forensic pathologists, clinicians, and insurance companies to probe the risk of a specific clinical branch for medical malpractice claims and highlights areas where care may be improved. We investigated the main features of a major Italian insurance broker’s archive in order to identify recurrent pitfalls in this field.Materials and methodsA retrospective study was carried out on orthopedics claims. The archive covered claims from 2002 to 2013 that targeted 1980 orthopedists.Results635 claims were found and analyzed with a focus on the clinical activity invocked in the claim, the presence of alleged team malpractice, the clinical outcome of the case, and the final forensic decision regarding the claim. 299 orthopedists had at least one malpractice claim made against them during the available period; 146 orthopedists were subject to more than one malpractice claim. Most of the claims regarded perioperative and operative cases, usually originating from civil litigation. The anatomical sites most commonly involved were the hip or knees, and sciatic nerve lesions were the main contributor.ConclusionsOrthopedics is a medical specialty with a high risk for malpractice claims. In our study, medical malpractice was observed in nearly 50% of the cases—typically in surgery-linked cases resulting in permanent impairment of the patient. Death from orthopedics malpractice seemed to be rare.Level of EvidenceIV.

Claims in orthopedic foot/ankle surgery, how can they help to improve quality of care? A retrospective claim analysis

“…Klemann et al have previously shown an increase in number of claims until 2012 and a stabilization after that in an investigation of all claims in the Netherlands from 2007 to 2016 [ 19 ]. A series of other studies could also not demonstrate an increase in the number of claims per year [ 4 , 9 ]. However, there are also a few European studies that did find an increase in claim incidence [ 3 , 7 ].…”

“…As for the reasons of filing a claim, in this cohort the claim was often related to a delay in/wrong diagnosis or to (complications of) an elective operative procedure. Both in general and in orthopedic surgery, multiple authors have previously suggested diagnostic mistakes as the most common cause for a claim [ 9 , 23 ]. Injuries of the foot often have a large impact on functional recovery and, within the extremities, the highest number of missed fractures [ 24 , 25 ], which could also explain the high percentage of foot injuries in our cohort, especially in the subgroup analyses of diagnostic claims.…”

Patient Safety in Orthopedics and Traumatology

“…The highest number of clinical negligence claims comes from surgical specialties, orthopedic surgery being the worst offender, responsible for 29.8% of all cases [1]. Casali et al [6] carried out a retrospective study on orthopedic claims based on an archival data analysis from one of the largest medical malpractice insurance brokers in Italy. Their analysis indicates that orthopedics is the specialty with the highest risk of malpractice claims.…”

“…In orthopedics, risk is mainly related to two types of procedures: diagnostic and therapeutic [6][7][8]. Therefore, subsequent discussion will be concentrated on these two types.…”

“…A modern approach to clinical risk management is represented by the Failure Mode and Effects Criticality Analysis (FMECA), a technique that allows to identify defects or errors of the system in a simulated way. Data relating to this interesting procedure, also tested in orthopedic departments [6], are still preliminary but definitely useful in the context of clinical risk management.…”