Analysis of NHSLA Claims in Orthopedic Surgery

Abstract

National Health Service (NHS) statistics in the United Kingdom demonstrate an increase in clinical negligence claims over the past 30 years. Reasons for this include elements of a cultural shift in attitudes toward the medical profession and the growth of the legal services industry. This issue affects medical and surgical health providers worldwide.The authors analyzed 2117 NHS Litigation Authority (NHSLA) orthopedic surgery claims between 1995 and 2001 with respect to these clinical areas: emergency department, outpatient care, surgery (elective or trauma operations), and inpatient care. The authors focused on the costs of settling and defending claims, costs attributable to clinical areas, common causes of claims, and claims relating to elective or trauma surgery. Numbers of claims and legal costs increased most notably in surgery (elective and trauma) and in the emergency department. However, claims are being defended more robustly. The annual cost for a successful defense has remained relatively stable, showing a slight decline. The common causes of claims are postoperative complication; wrong, delayed, or failure of diagnosis; inadequate consent; and wrong-site surgery. Certain surgical specialties (eg, spine and lower-limb surgery) have the most claims made during elective surgery, whereas upper-limb surgery has the most claims made during trauma surgery.The authors recommend that individual trusts liaise with orthopedic surgeons to devise strategies to address areas highlighted in our study. Despite differences in health care systems worldwide, the underlying issues are common. With improved understanding, physicians can deliver the service they promise their patients.

Characteristics of Orthopaedic Malpractice Claims of Pediatric and Adult Patients in Private Practice

“…It contributes a substantial amount to the overall cost of health care in the United States through indemnity payments, lost wages as a result of patient injury, and the practice of defensive medicine, which appears to be a common practice overall and specifically within orthopaedics. 1,2,[8][9][10][11][12] The risk of facing a malpractice claim appears to differ based on medical subspecialty, with surgical subspecialties having the most risk. 13 Previous work examining the structure of the liability system has found variability in risk exposure of physicians based on scope of practice, location of practice, with speculation that patient demographics, specifically the age of the patient also effects risk variability.…”

“…Previous work has examined medical liability in terms of scope and location of practice. [1][2][3] Gould et al 4 looked at orthopaedic medical liability in the acute care setting and found both technical errors in patient management, and poor physician-patient communication frequently led to malpractice claims independent of the severity of injury. This is similar to information found in other medical subspecialties.…”

Professional Liability in Orthopaedics and Traumatology in Italy

“…Medical malpractice claims have increased during the last 10 years [12,24]. A medical error may be defined as an inappropriate action in medical practice because of an act commission or omission attributable to incorrect judgment.…”

Mediation - an alternative to litigation in medical malpractice

“…An easily identifiable and prominent cost-driving factor can be attributed to the law, or rather the implementation thereof. Khan et al [5] have suggested, somewhat pointedly, that apart from the role played by the changing expectations of the public, a growing legal services industry plays an active role in the cost escalation. Fear of litigation fuels cost-inefficient defensive practice.…”