Reason for Lawsuit in Spinal Cord Injury Affects Final Outcome

Quigley, Robert S.; Akpolat, Yusuf T.; Forrest, Brent D.; Wongworawat, Montri D.; Cheng, Wayne K.

doi:10.1097/brs.0000000000000878

Cited by 23 publications

(9 citation statements)

References 10 publications

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“…Additionally, the level of medical detail for each case is variable based on court reports. Despite these limitations, VerdictSearch has been used in numerous studies 7,8,16,17 and provides a unique and meaningful approach to analyzing the impact of malpractice in spine surgery.…”

Section: Discussionmentioning

confidence: 99%

Malpractice litigation following spine surgery

Daniels

Ruttiman

Eltorai

et al. 2017

Journal of Neurosurgery: Spine

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OBJECTIVEAdverse events related to spine surgery sometimes lead to litigation. Few studies have evaluated the association between spine surgical complications and medical malpractice proceedings, outcomes, and awards. The aim of this study was to identify the most frequent causes of alleged malpractice in spine surgery and to gain insight into patient demographic and clinical characteristics associated with medical negligence litigation.METHODSA search for “spine surgery” spanning February 1988 to May 2015 was conducted utilizing the medicolegal research service VerdictSearch (ALM Media Properties, LLC). Demographic data for the plaintiff and defendant in addition to clinical data for the procedure and legal outcomes were examined. Spinal cord injury, anoxic/hypoxic brain injury, and death were classified as catastrophic complications; all other complications were classified as noncatastrophic. Both chi-square and t-tests were used to evaluate the effect of these variables on case outcomes and awards granted.RESULTSA total of 569 legal cases were examined; 335 cases were excluded due to irrelevance or insufficient information. Of the 234 cases included in this investigation, 54.2% (127 cases) resulted in a defendant ruling, 26.1% (61) in a plaintiff ruling, and 19.6% (46) in a settlement. The awards granted for plaintiff rulings ranged from $134,000 to $38,323,196 (mean $4,045,205 ± $6,804,647). Awards for settlements ranged from $125,000 to $9,000,000 (mean $1,930,278 ± $2,113,593), which was significantly less than plaintiff rulings (p = 0.022). Compared with cases without a delay in diagnosis of the complication, the cases with a diagnostic delay were more likely to result in a plaintiff verdict or settlement (42.9% vs 72.7%, p = 0.007) than a defense verdict, and were more likely to settle out of court (17.5% vs 40.9%, p = 0.008). Similarly, compared with cases without a delay in treatment of the complication, those with a therapeutic delay were more likely to result in a plaintiff verdict or settlement (43.7% vs 68.4%, p = 0.03) than a defense verdict, and were more likely to settle out of court (18.1% vs 36.8%, p = 0.04). Overall, 28% of cases (66/234) involved catastrophic complications. Physicians were more likely to lose cases (plaintiff verdict or settlement) with catastrophic complications (66.7% vs 37.5%, p < 0.001). In cases with a plaintiff ruling, catastrophic complications resulted in significantly larger mean awards than noncatastrophic complications ($6.1M vs $2.9M, p = 0.04). The medical specialty of the provider and the age or sex of the patient were not associated with the case outcome or award granted (p > 0.05). The average time to a decision for defendant verdicts was 5.1 years; for plaintiff rulings, 5.0 years; and for settlements, 3.4 years.CONCLUSIONSDelays in the diagnosis and the treatment of a surgical complication predict legal case outcomes favoring the plaintiff. Catastrophic complications are linked to large sums awarded to the plaintiff and are predictive of rulings against the physician. For physician defendants, the costs of settlements are significantly less than those of losing in court. Although this study provides potentially valuable data from a large series of postoperative litigation cases, it may not provide a true representation of all jurisdictions, each of which has variable malpractice laws and medicolegal environments.

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Section: Discussionmentioning

confidence: 99%

Malpractice litigation following spine surgery

Daniels

Ruttiman

Eltorai

et al. 2017

Journal of Neurosurgery: Spine

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“…On the other hand, repeated attempts to obtain adequate CSR could also be ineffective. Moreover, the arrival of fasted low-dose radiation exposure CT, the raise of malpractice lawsuit procedure against emergency physicians and radiologist will probably decrease the number of CSR in the future [ 17 ]. The development and the increasing availability of low dose multidetector CT will be the solution [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Application of the Canadian C-Spine rule and nexus low criteria and results of cervical spine radiography in emergency condition

Ngatchou¹,

Beirnaert²,

Lemogoum³

et al. 2018

Pan Afr Med J

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IntroductionThe Canadian C Spine Rule (CCR) and the National Emergency X-Radiography Utilization Study (Nexus) low criteria are well accepted as guide to help physician in case of cervical blunt trauma.MethodsWe aimed to evaluate retrospectively the application of these recommendations in our emergency department. Secondly we analyzed the quality of cervical spine radiography (CSR) in an emergency setting.Results281 patients with cervical blunt trauma were analyzed retrospectively. The CCR and the NEXUS rules were respected in 91.2% and 96.8% of cases respectively. No lesions were found in 96.4% of patient. A lesion was present in 1.1% of patient and suspected in 2.5% of patient. The quality of CSR was adequate in only 37.7% of patient. The poor quality of CSR was due either to the lack of C7 vertebrae visualization in 64.6% or other lower vertebrae in 28%. Other causes included the absence of open mouth view (8%), the absence C1 vertebrae visualization (3.4%), artifact in 2.3% and the absence of lateral view in 0.6% of patient.ConclusionCCR and NEXUS are widely used in our emergency department. The high rate of inadequate CSR reinforces the debate about it’s utility in emergency condition.

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“…Still, VerdictSearch has been used in several previous studies to evaluate closed claims. 3,4,11 This investigation represents the largest study to date on SEA malpractice suits and provides valuable information for clinicians in multiple specialties. Specifically, surgeons should never delay or defer treatment of a diagnosed SEA, and surgeons should always insist on prompt advanced imaging in cases in which SEA is suspected, although the consulting provider is most often the clinician at risk for malpractice litigation.…”

Section: Discussionmentioning

confidence: 99%

Assessment of malpractice claims due to spinal epidural abscess

DePasse

Ruttiman

Eltorai

et al. 2017

Journal of Neurosurgery: Spine

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OBJECTIVESpinal epidural abscesses (SEAs) can be difficult to diagnose and may result in neurological compromise or even death. Delays in diagnosis or treatment may worsen the prognosis. While SEA presents a high risk for litigation, little is known about the medicolegal ramifications of this condition. An enhanced understanding of potential legal implications is important for practicing spine surgeons, emergency medicine physicians, and internists.METHODSThe VerdictSearch database, a large legal-claims database, was queried for “epidural abscess”–related legal cases. Demographic and clinical data were examined for all claims; any irrelevant cases or cases with incomplete information were excluded. The effects of age of the plaintiff, sex of the plaintiff, presence of a known infection, resulting paraplegia or quadriplegia, delay in diagnosis, and delay in treatment on the proportion of plaintiff rulings and size of payments were assessed.RESULTSIn total, 56 cases met the inclusion criteria. Of the 56 cases, 17 (30.4%) were settled, 22 (39.3%) resulted in a defendant ruling, and 17 (30.4%) resulted in a plaintiff ruling. The mean award for plaintiff rulings was $5,277,468 ± $6,348,462 (range $185,000–$19,792,000), which was significantly larger than the mean award for cases that were settled out of court, $1,914,265 ± $1,313,322 (range $100,000–$4,500,000) (p < 0.05). The mean age of the plaintiffs was 47.0 ± 14.4 years; 23 (41.1%) of the plaintiffs were female and 33 (58.9%) were male. The proportion of plaintiff verdicts and size of monetary awards were not affected by age or sex (p > 0.49). The presence of a previously known infection was also not associated with the proportion of plaintiff verdicts or indemnity payments (p > 0.29). In contrast, juries were more likely to rule in favor of plaintiffs who became paraplegic or quadriplegic (p = 0.03) compared with plaintiffs who suffered pain or isolated weakness. Monetary awards for paraplegic or quadriplegic patients were also significantly higher (p = 0.003). Plaintiffs were more likely to win if there was a delay in diagnosis (p = 0.04) or delay in treatment (p = 0.006), although there was no difference in monetary awards (p > 0.57). Internists were the most commonly sued physician (named in 13 suits [23.2%]), followed by emergency medicine physicians (named in 8 [14.3%]), and orthopedic surgeons (named in 3 [5.4%]).CONCLUSIONSThis investigation is the largest examination of legal claims due to spinal epidural abscess to date. The proportion of plaintiff verdicts was significantly higher in cases in which the patient became paraplegic or quadriplegic and in cases in which there was delay in diagnosis or treatment. Additionally, paralysis is linked to large sums awarded to the plaintiff. Nonsurgeon physicians, who are often responsible for initial diagnosis, were more likely to be sued than were surgeons.

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Reason for Lawsuit in Spinal Cord Injury Affects Final Outcome

Abstract: N/A.

Cited by 23 publications

References 10 publications

Malpractice litigation following spine surgery

Malpractice litigation following spine surgery

Application of the Canadian C-Spine rule and nexus low criteria and results of cervical spine radiography in emergency condition

Assessment of malpractice claims due to spinal epidural abscess

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