A Decade of Lawsuits Against Surgeons Performing Female Genital Cosmetic Surgery (FGCS) in Tehran, Iran.

BACKGROUND: The objective of this study is to evaluate the legal proceedings that arise from Female Genital Cosmetic Surgeries (FGCS) and analyze the reasons why women file complaints against their surgeons. Additionally, we examined the outcomes of the legal decisions associated with these complaints. METHODS: This descriptive cross-sectional study was conducted in Tehran province, Iran, from 2012 to 2021. The primary data source for this study was forensic medical records, which were reviewed to gather relevant information. The collected data included the characteristics of the participants, the reasons for lawsuits, the procedure setting, and the outcomes of the legal decisions. RESULTS: A total of 121 patients were examined in the study, revealing that Labiaplasty was the most prevalent procedure (49.6%), followed by vaginoplasty (19.8%) and perineoplasty (13.2%). The most common complaints were related to cosmetic concerns (57%), lack of recovery (26.4%), and sexual dysfunctions (22.3%). Healthcare providers were found liable for malpractice in 52.1% of cases. Additionally, having the surgery performed by a gynecologist decreased the risk of malpractice (ß = 0.21, p= 0.034), while procedures in private clinics increased the risk (ß = 2.95, p = 0.040). CONCLUSION: The study's findings emphasized the importance of providing women with comprehensive education and consultations to ensure they are well-informed about the potential outcomes and risks of FGCS. Furthermore, the study highlighted the significance of having these surgical procedures performed by skilled and experienced surgeons. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

[The procedural aspects of postmortem defense of non-material goods of patient].

The protection of privacy of patient that is applying for medical care, diagnostics and treatment is one of the main pillars of implementation of medical activities. However, despite sufficient volume of legal regulation of lifetime respect of privacy of examination, observation and facts of medical intervention, in practice occur situations when privacy ceases to be such after death of the patient. The article is based on results of content-analysis of normative legal acts (n = 11), scientific publications (n = 52), cases of judicial practice (n = 8). The problem of non-observance of privacy becomes especially actual after death of person whose name is widely known. Having no possibility to impact on causes and modes of obtaining and propagating such specific information, the deceased, one's illness, stages of treatment, struggle for life, resources spent, clinics and specialists involved become object of close attention of various subjects (mas media, Internet communities) that use obtained information for speculative purposes at the expense of fixation of inhumane public replicas and increase of number of browsing. Despite prohibition provided for by law of dissemination of information constituting privacy of applying for medical care, after death of patient and application of measures of legal liability for fact of such a disclosure, information leak occurs regularly and information that got into common access frequently discredit good name of the deceased or develop other problems that are subjects to legal protection, for family members and legal successors. Yet, circumstances of transfer of information of limited access by medical organization (data leakage) or by intent of medical worker are difficult to be proved. Therefore, in judicial practice there are practically no such cases. At that, after death of famous people, juristic community regularly faces problems of protecting personal rights and non-material values from the side of relatives, legal successors and other interested persons. On the basis of formal logical method and system analysis method of disputable situations, possible perspectives of applying for judicial protection, procedural characteristics of procedure of applying for protection and possible composition of participants are presented.

Medical Malpractice Claims Related to Performance of Transesophageal Echocardiography by Anesthesiologists.

More than 300,000 adults have cardiac surgery in the United States annually, and most undergo intraoperative transesophageal echocardiography (TEE). This patient population is often older with multiple comorbidities, increasing their risk for complications for even routine procedures. Major morbidity or mortality caused by TEE is rare, and it is unknown how often such complications lead to malpractice lawsuits. The authors identified 13 cases out of 2,564 in a closed claims database that involved TEE and reviewed their etiology. Esophageal injury accounted for most of the suits, and only 2 were related to diagnosis. Most expert reviews deemed the care provided by the anesthesiologist to be appropriate.

Help, I've been sued! Demystifying the steps of malpractice litigation for the emergency radiologist.

Being sued can have significant emotional and psychological impact and has implications on the wellness of emergency radiologists. A better understanding of the steps involved in a medical malpractice suit can help defuse some of the anxiety of litigation. This process starts with the inception of the case, the summons, and complaint, then progresses to discovery, including document production, interrogatories, and deposition, and thereafter to settlement or trial. The discussion includes a number of tips and outlines a number of pitfalls inherent in litigation. It is hoped that this discussion will alleviate some of the anxiety that accompanies this long and arduous process.

Ethical & Medicolegal Issues in Otology.

ENT professionals are facing the heat of raised number of malpractice complaints against them. Some of them have a direct impact on surgeon's career & life progression. Lawsuits are not new to otology, but with evolution of education, social media & media trials etc., negativity is being generated against doctors each day. This article considers the causes, types & prevention of medicolegal malpractice claims/lawsuits against the doctors with incorporation of recent NMC guidelines for the same. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04078-5.

Analysis of Medical Malpractice Claims Involving Interventional Radiologists: A Comprehensive Analysis From Two National Legal Databases.

PURPOSE: The nature of lawsuits involving interventional radiologists (IRs) is not well understood. The purposes of this article are to provide an overview of the causes of action underlying medical malpractice lawsuits related to IRs and to characterize the associated factors and outcomes. METHODS: Two large legal databases were used to search for US legal cases in which there were jury awards and settlements involving IRs in the United States. Cases were screened to include only those cases in which the cause of action involved negligence on the part of IRs. RESULTS: A total of 389 published case summaries were identified, of which 93 were eligible to be included in the analysis. In 46% of the cases (43 of 93), medical malpractice was alleged against an individual IR, whereas in 43% (40 of 93), it was alleged against both an individual IR and a health care institution. Thirty-five percent of IR malpractice cases (33 of 93) involved the performance of a vascular procedure, most commonly embolization procedures (30% [n = 10]), stenting or angioplasty (21% [n = 7]), and diagnostic arteriography and angiography (18% [n = 6]). Twenty-six percent of cases (24 of 93) involved IR performance of a biopsy. Eighteen percent of cases (17 of 93) involved a failure to gain informed consent in addition to an allegation of medical negligence during treatment. Eleven percent of cases (10 of 93) were resolved by settlement, with an average settlement amount of $877,500 (range, $200,000-$2,700,000). Among the 72 cases that went to trial, 74% (53 of 72) resulted in judgments for the defendants, and 26% (19 of 72) resulted in judgements for the plaintiffs, with an average award of $2,012,243 (range, $101,667-$6,400,000). CONCLUSIONS: Vascular procedures and biopsies were the most frequent reasons for malpractice lawsuits involving IRs. Failure to gain informed consent in addition to an allegation of medical negligence during treatment was not infrequent. Although the majority of published medical malpractice claims involving IRs resulted in judgments in favor of the defendants, the average amount awarded to plaintiffs was higher compared with previous data reported for all physicians.

Understanding a decade of safety reporting for sacral neuromodulation in the Food and Drug Administration Manufacturer and User Facility Device Experience database.

INTRODUCTION: Over 350 000 sacral neuromodulation (SNM) devices have been implanted since approval by the Food and Drug Administration (FDA) in 1998. SNM technology and clinical applications have evolved, with minimal safety updates after initial trials. We aim to provide an updated overview of real-world SNM safety. These insights will guide informed consent, preoperative counseling, and patient expectation-setting. MATERIALS AND METHODS: The FDA Manufacturer and User Facility Device Experience (MAUDE) database is a repository for medical device safety reports. We performed MAUDE categorical (1/1/98-12/31/10) and keyword (1/1/11-9/30/21) searches for "Interstim." A random sample of 1000 reports was reviewed and categorized by theme. To corroborate our MAUDE database analysis, a legal librarian searched the Public Access to Court Electronic Records (PACER) database, as well as Bloomberg Law's dockets database for all lawsuits related to SNM devices. RESULTS: Our search of the MAUDE database returned 44 122 SNM-related adverse events (AEs). The figure illustrates the prevalence of event categories in the random sample. The largest proportion of reports (25.6%) related to a patient's need for assistance with device use, followed by loss/change of efficacy (19.0%). Interestingly, a fall preceded issue onset in 32% of non-shock pain, 30% of lead/device migration, and 27% of painful shock reports. Our legal search revealed only four lawsuits: one for patient complications after an SNM device was used off-label, one case of transverse myelitis after implant, one for device migration or poor placement, and the fourth claimed the device malfunctioned requiring removal and causing permanent injury. CONCLUSIONS: This review confirms the real-world safety of SNM devices and very low complication rates as seen in the original clinical trials. Our findings indicate that 43.2% (95% confidence interval 40.1%-46.3%) of SNM "complications" are not AEs, per se, but rather reflect a need for improved technical support or more comprehensive informed consent to convey known device limitations to the patient, such as battery life. Similarly, the number of lawsuits is shockingly low for a device that has been in the market for 24 years, reinforcing the safety of the device. Legal cases involving SNM devices seem to relate to inappropriate patient selection-including at least one case in which SNM was used for a non-FDA approved indication-lack of appropriate follow-up, and/or provider inability to assist the patient with utilizing the device after implantation.

Exploring the Legal Implications of Benign Prostatic Hyperplasia Surgeries in the United States: A Comprehensive Analysis of Two Decades of Lawsuits.

INTRODUCTION AND OBJECTIVE: The United States (US) currently faces a medical malpractice crisis, and a survey done in 2006 informed that 63% of urologists faced an average of 2.1 medical malpractice lawsuits. Surgery for benign prostatic hyperplasia (BPH) is performed by 95% of US urologists. Hence, we postulated that these procedures might be responsible for a substantial number of medical malpractice lawsuits. We examined claims related to BPH surgery in various US courts. MATERIALS AND METHODS: Data were collected from Westlaw and LexisNexis databases using the keywords "benign prostatic hyperplasia," "enlarged prostate," "surgery," and "malpractice" to search for cases from the entire US from January 2000 to December 2021. We extracted details such as the type of procedure, the plaintiff and defendant, the nature of the allegation, the alleged complications, the verdict, and the compensation amount. RESULTS: We found 30 cases in which the most common procedure was transurethral resection of the prostate (37%), with inadequate postoperative care as the most frequent reason for claims (33%). Urologists were the most frequently processed professionals (57%). The postsurgical outcomes that resulted in lawsuits were urinary incontinence (23%), erectile dysfunction (13%), and urinary retention (13%). Interestingly, 43% of the patients were inmates. Plaintiffs won only two (7%) cases: colon perforation after interstitial laser coagulation with Indigo laser and recto-urethral fistula after transurethral microwave therapy. CONCLUSION: Most lawsuits were related to postoperative incontinence and erectile dysfunction, with the verdict favoring the defendant in most cases. Inmates were the plaintiffs in a relatively high percentage of cases. Only two cases resulted in a plaintiff victory, wherein both cases presented unexpected and serious postsurgical complications.

Evidence-based informed consent form for total knee arthroplasty.

INTRODUCTION: Informed consent documentation is often the first area of interest for lawyers and insurers when a medico-legal malpractice suit is concerned. However, there is a lack of uniformity and standard procedure about obtaining informed consent for total knee arthroplasty (TKA). We developed a solution for this need for a pre-designed, evidence-based informed consent form for patients undergoing TKA. MATERIALS AND METHODS: We extensively reviewed the literature on the medico-legal aspects of TKA, medico-legal aspects of informed consent, and medico-legal aspects of informed consent in TKA. We then conducted semi-structured interviews with orthopaedic surgeons and patients who had undergone TKA in the previous year. Based on all of the above, we developed an evidence-based informed consent form. The form was then reviewed by a legal expert, and the final version was used for 1 year in actual TKA patients operated at our institution. RESULTS: Legally sound, evidence-based Informed Consent Form for Total Knee Arthroplasty. CONCLUSION: The use of legally sound, evidence-based informed consent for total knee arthroplasty would be beneficial to orthopaedic surgeons and patients alike. It would uphold the rights of the patient, promote open discussion and transparency. In the event of a lawsuit, it would be a vital document in the defence of the surgeon and withstand the scrutiny of lawyers and the judiciary.

Legally Sound, Evidence-Based Informed Consent Form for Total Hip Arthroplasty.

Introduction: Informed consent documentation is often the first area of interest for lawyers and insurers when a medico-legal malpractice suit is concerned. However, there is a lack of uniformity and standard procedure for obtaining informed consent for total hip arthroplasty (THA). We aimed to develop a solution for this need for a pre-designed, evidence-based informed consent form for THA cases. Materials and Methods: We extensively reviewed the literature on the medico-legal aspects of THA, medico-legal aspects of informed consent, and medico-legal aspects of informed consent in THA. We then conducted semi-structured interviews with orthopaedic surgeons and patients who had previously undergone THA in the previous year. Based on all of the above, we developed an informed consent form that was evidence-based. We then had the form reviewed by a legal expert. The final form was utilised for THA cases at our institution for 1 year. Results: Legally sound, evidence-based Informed Consent Form for Total Hip Arthroplasty is given in Form A. Conclusion: The use of legally sound, evidence-based informed consent for total hip arthroplasty cases would be beneficial to orthopaedic surgeons and patients alike. It would uphold the rights of the patient, and promote open discussion and transparency. In the event of a lawsuit, it would be a vital document in the defence of the surgeon and withstand the scrutiny of lawyers and the judiciary.

Endodontic malpractice litigations in the United States from 2000 to 2021.

Background/purpose: Little is known regarding the outcomes and distinguishing characteristics of lawsuits related to endodontic procedures. This study used a verdict-based data from United States of America to analyze the factors associated with endodontic malpractice lawsuits and mitigate the risk of litigation. Materials and methods: The LexisNexis legal database was used to search for endodontic malpractice cases from January 1, 2000 to December 31, 2021 using the terms "medical malpractice" and (I) "endodontist" (II) "endodontics" (III) "root canal" (IV) "dental pulp." Each case was reviewed for reported medical characteristics and litigation outcomes. Results: A total of 650 cases were initially identified, and 97 cases were included in the final analysis. Eighty-four (86.6%) of the 97 defendants were general practitioners; 42 cases favored the plaintiff, 53 (54.6%) favored the defendant, 1 was partial win/loss, and 1 was settled. The annual case mean was 4.41 ± 2.17 (Mean ± SD). The major allegations favored for the patients involving paresthesia, root perforation, rubber dam not use, wrong tooth therapy, and infections. Plaintiffs who claimed with post-procedural reasons had a significantly higher winning rate than non-post-procedural reasons (P < 0.05). Conclusion: In the present study, 54.6% of endodontic litigation favored the dentists in the US. The authors recommend that general practitioners refer complicated cases to endodontists and treat carefully to avoid paresthesia, canal perforation and infections. Clinicians should always diagnose and treat correctly, shared decision making with the patient, use rubber dam routinely, and timely management to prevent malpractice claims.

Malpractice litigation after spinal surgery: A review of allegations in France in 1990-2020.

OBJECTIVE: Spinal surgery is among the specialities with the highest rates of complications and of peri-operative morbidity and mortality. The number of spinal surgeries performed is rising year on year in France. The objectives of this study were to identify the main reasons for malpractice claims after spinal surgery in France, to evaluate the impact of avoidable errors, and to examine differences between civil lawsuits (private institutions) and administrative lawsuits (public institutions). HYPOTHESIS: The leading reasons for malpractice litigation are avoidable errors such as inadequate patient information, errors in indications, and inadequate post-operative monitoring. MATERIAL AND METHODS: We reviewed malpractice claims related to spinal surgery and recorded in two French databases (Legifrance and Doctrine) in 1990-2020. We combined the indexing term "surgery" with any of the following terms: "disc", "spine", "cervical", "vertebral", "lumbar", "scoliosis", "disc replacement", and "fusion". The search was performed by three orthopaedic surgeons who were blind to patient data and recorded the allegations, verdicts, and pay-outs. RESULTS: We included 275 claims. The main plaintiff allegations were inadequate information (34.5%), infection (22%), spinal-cord injury (17%), and errors in indication (13%). Among these reasons, 56.7% may have been partly avoidable. In private institutions, claims for infection and for erroneous indication were significantly more common than in public institutions (p=0.02 for both), whereas the opposite was true for spinal-cord injury (p<0.001). CONCLUSION: After spinal surgery in France, the most common malpractice allegation was inadequate information. Over half the claims were related to potentially avoidable factors. Among allegations, errors in indication were significantly more common in civil than in administrative lawsuits. LEVEL OF PROOF: IV, retrospective observational database study.

The nature of malpractice claims related to nerve damage after dental implants insertion in Israel during 2005-2020: A descriptive study.

INTRODUCTION: Dental implant placement is a routine practice in dentistry, with a possible uncommon risk of neurosensory injury. The present study analyzed all dental implant claims involving sensory nerve disturbances between 2005 and 2020 in Israel. The study was conducted to understand implant risk management better and improve the patient's safety. MATERIALS AND METHODS: All legal claims registered by Medical Consultant International (MCI) involving nerve damage claims between 2005 and 2020 were included in the study. The data included demographic details such as age, sex, event date, claim delivery date, and treatment settings. Information on the nerve damage included the damaged nerve, side of injury, and the number of implants performed in the same surgery. RESULTS: There were 218 claims regarding nerve damage out of 1154 claims for dental implant therapy. The mean age for nerve damage claims was 54.1 ± 11 years. There were more female than male claims (p = 0.02), with 87% of cases concerning damage to the inferior alveolar nerve (p < 0.0001), out of those molar areas being more frequently involved in nerve damage (64.3%, p < 0.0001). The left side was 1.4 times more frequent than the right side (p = 0.043). The risk for nerve injury was 7.4 times higher when placing multiple implants compared to single dental implant (p < 0.0001). CONCLUSIONS: Clinicians should be aware that placement of multiple implants, left-side implant placement, and patient gender may increase risk for a malpractice claim for neurosensory disturbances.

Medical malpractice litigation after total shoulder arthroplasty: a comprehensive analysis based on the Westlaw legal database.

INTRODUCTION: Orthopedic surgery is one of the most common subspecialties subject to medical malpractice claims. Although total shoulder arthroplasty (TSA) is associated with favorable patient outcomes and relatively low complication rates, surgeons performing this procedure may be subject to malpractice litigation leading to significant economic and psychological burden on the provider. The purpose of this study is to characterize and describe malpractice claims against orthopedic surgeons performing TSA using the Westlaw legal database. METHODS: The Westlaw legal database was queried for all cases related to TSA using the terms "malpractice" AND "shoulder replacement" OR "shoulder arthroplasty." Cases were excluded if the defendant was not an orthopedic surgeon, the procedure involved was not a TSA, or if the patient was a minor. Patient demographics, causes cited for litigation, case outcomes, and indemnity payments were analyzed to determine common factors that lead plaintiffs to pursue legal action. RESULTS: Thirty-five TSA cases were identified that met inclusion criteria. The mean plaintiff age was 55 years with 63.6% female. The most common category of negligence alleged was intraoperative error, which occurred in 25 claims (71%). The most common types of damages incurred were nerve injury (23%), functional limitation (20%), and infection (17%). Overall, 27 cases (77%) resulted in a defense verdict. Four cases (11%) resulted in settlements and 4 cases (11%) resulted in plaintiff verdicts. The average inflation-adjusted monetary award in these cases was $1,619,919 (standard deviation, $1,689,452). DISCUSSION: This study provides a comprehensive summary of malpractice claims and associated outcomes in TSA. Given the rapidly increasing rate of TSA in the United States and the burden of associated malpractice claims, understanding potential legal implications of TSA is of great value to orthopedic surgeons. Intraoperative error was the category of negligence cited most commonly in TSA malpractice claims. Nerve injury, functional limitation, and infection were the most commonly cited specific damages. These findings highlight the need for orthopedic surgeons to educate patients regarding potential postoperative complications while continuing to focus on minimizing their occurrence.

Judicial Dilemmas of Female Domestic Violence Victims: An Empirical Study Based on Chinese Civil Judgments in 2020.

Women are the primary victims of domestic violence, but their experiences are often ignored in Chinese judicial judgments. Among 350 Chinese civil judgments on domestic violence in 2020, more than 96% involved female victims, and they faced various judicial dilemmas when seeking civil remedies. The court confirmed the existence of domestic violence in 26% of the cases, and 27% of applications for personal safety protection orders were rejected. More than two-thirds of female plaintiffs' divorce applications were not approved, and they received no compensation. This study analyzed the cause of these judicial dilemmas and proposed some solutions.

A REVIEW OF LAWSUITS RELATED TO POINT-OF-CARE EMERGENCY ULTRASOUND APPLICATIONS.

BACKGROUND: Previous investigators have assessed United States Case Law to evaluate the medicolegal risk surrounding point-of-care ultrasound applications. These studies have suggested that nonperformance is the primary source of an allegation of medical malpractice. OBJECTIVES: The objective of this study is to update the literature regarding medical malpractice cases involving ultrasound applications that could be used at the point of care, and assess the risk conveyed to advanced practice providers and by application of emerging applications of ultrasound. METHODS: Authors reviewed the Westlaw database for medical malpractice cases involving point-of-care ultrasound applications between December 2012 and January 2021. Cases were included if there was an allegation of misconduct by an emergency provider and if an ultrasound included in the American College of Emergency Physicians investigators core, extended, emerging, or adjunct applications was discussed to any degree. Investigators independently reviewed the cases for inclusion. Authors abstracted the case information, type of ultrasound performed, and the specific allegation of misconduct. RESULTS: Nineteen cases met inclusion criteria. Seven cases involved core applications of emergency ultrasound and 13 involved extended, emerging, or adjunct applications. One case was included in both categories as it included elements of both core and extended applications. The most common primary allegation was failure to perform an ultrasound. No cases clearly alleged misinterpretation of a point-of-care ultrasound. CONCLUSION: As previous studies have suggested, nonperformance of ultrasound seems to convey the greatest medicolegal risk. Extended, emerging, or adjunct applications of ultrasound may convey a slightly higher risk.

Malpractice against shoulder surgeons: what the data say.

BACKGROUND: Thousands of orthopedic surgeons in the United State face medical malpractice claims annually; however, little is known regarding the common causes for litigation against shoulder surgeons. In addition, the current analysis does not take into consideration how surgical frequency affects the litigation likelihood. The purpose of our investigation was to identify the most common causes of litigation against shoulder surgeons in the United States adjusting for surgical frequency. METHODS: The VerdictSearch database was used using the search terms "medical malpractice," "shoulder," and "NOT cancer." Results were queried, and all studies pertaining to orthopedic shoulder surgery included. Data gathered included cause of lawsuit, indemnity paid, type of surgery performed, results of the cases, verdict or settlement, and, if applicable, technical error. A query of a multisurgeon institutional database was conducted to determine how frequently surgeries were performed. Then the frequency of litigation was adjusted by the procedure frequency to determine which surgery has the greatest likelihood to be litigated relative to rotator cuff surgery. RESULTS: Forty-five cases were included in our study. After adjusting for the procedure frequency, the most likely procedure to be litigated, relative to rotator cuff repair, was manipulation under anesthesia (MUA), 251 times more likely to be litigated, and washout/lavage procedures, 17 times more likely to be litigated. Injection and total shoulder arthroplasty were 23 and 14 times less likely to be litigated relative to rotator cuff repair, respectively. In addition, the average age of the patients was 47 years, and 53% of the cases involved a male plaintiff. The most commonly litigated procedures were rotator cuff repair (42%), MUA (13%), and humeral open reduction and internal fixation (9%). The most commonly cited symptoms for litigation against shoulder surgeons were pain (60%) and loss of range of motion (40%). Of the 45 cases, 44% ended in physician loss, with the average indemnity paid via verdict being $1,118,714 vs. $416,875 for settlement. CONCLUSIONS: This study identifies that MUA and lavage/washout procedures are much more likely to be litigated relative to rotator cuff repair. Rotator cuff repair is actually one of the least likely procedures to be litigated. Furthermore, settlement may represent a method of decreasing the indemnity paid for malpractice cases for which surgeons are implicated.