RESUMO
Introduction: Plastic surgeons are more likely to face medical litigation, compared to other specialists. Although this has been previously studied in other countries, there is a paucity of data regarding legal medical cases within Canada. The goal of this study was to compile and analyze all medical litigations in plastic surgery in Canada and identify themes associated them. Methods: A systematic search of the 2 largest Canadian online legal databases, LexisNexis Canada and WestLawNext Canada, was conducted to retrieve all legal medical cases against plastic surgeons in Canadian courts. Quantitative and qualitative analyses were performed to dissect the characteristics of plastic surgery litigation in Canada. Results: A total of 105 legal cases were included in this analysis, including 81 lawsuits and 24 appeals. The preponderance of cases was related to breast surgeries (47.0%), followed by head and neck surgeries (18.1%), with 76.5% being related to cosmetic surgery; 64.2% were ruled in favour of the surgeon. The lack of preoperative informed consent was highly associated with a final ruling in favour of the patient (P < .0001). The average monetary value of damages awarded was $61 076. There was no significant difference in monetary value between cosmetic and reconstructive cases. Conclusion: The majority of medical litigation in plastic surgery in Canada is associated with cosmetic surgeries, most commonly of the breast. Lack of informed consent is associated with judicial rulings in favour of patients. By understanding the themes underlying these legal cases, we hope to highlight the main issues that lead to litigation in plastic surgery.
Introduction: Les chirurgiens plastiques sont plus susceptibles de faire face à un contentieux médical que d'autres spécialistes. Si cela a déjà été étudié dans d'autres pays, il y a peu de données sur les affaires judiciaires de nature médicale au Canada. L'objectif de cette étude était de compiler et analyser les contentieux médicaux en chirurgie plastique au Canada et d'identifier les thèmes qui leur sont associés. Méthodes: Une recherche systématique a été menée dans les deux grandes bases de données juridiques canadiennes sur internet, LexisNexis® Canada et WestLawNext® Canada, pour en tirer toutes les affaires judiciaires contre des chirurgiens plastiques passées devant les tribunaux canadiens. Des analyses quantitatives et qualitatives ont été réalisées pour disséquer les caractéristiques des contentieux en chirurgie plastique au Canada. Résultats: Un total de 105 cas judiciaires ont été inclus dans cette analyse, dont 81 poursuites en justice et 24 appels. Une prépondérance de cas avait trait à la chirurgie mammaire (47,0 %), suivie par la chirurgie de la tête et du cou (18,1 %), et 76,5 % étant liés à chirurgie cosmétique. Dans 64,2 % des cas, la décision a été en faveur du chirurgien. L'absence de consentement éclairé préopératoire a été fortement associée à des jugements définitifs en faveur des patients (P < 0,0001). La valeur monétaire moyenne des dommages et intérêts accordés était de 61 076 $. Il n'y a pas eu de différence significative de valeur monétaire entre les cas cosmétiques et la chirurgie reconstructrice. Conclusion: La majorité des cas de contentieux médicaux en chirurgie plastique au Canada est associée à la chirurgie cosmétique, le plus souvent la chirurgie mammaire. L'absence de consentement éclairé est associée aux décisions judiciaires favorables aux patients. En comprenant les thèmes sous-tendant ces affaires judiciaires, nous espérons souligner les principaux problèmes qui débouchent sur un contentieux en chirurgie plastique.
RESUMO
Incidence rates of melanoma and keratinocyte skin cancers have been on the rise globally in recent decades. While there has been a select focus on personal sun protection awareness, to our knowledge, there is a paucity of legislation in place to help support citizens' efforts to protect themselves from the harmful effects of ultraviolet radiation (UVR). Given this, we conducted a comprehensive review of legislation and guidelines pertaining to a variety of sun protection-related topics in countries of the Group of Seven (G7), Australia and New Zealand. Australia was the only country to have banned tanning beds for individuals of all ages, while other select countries have instituted bans for minors. In workplace policy, there is very little recognition of the danger of occupational UVR exposure in outdoor workers, and thus very few protective measures are in place. With regard to sports and recreation, certain dermatological/professional associations have put forward recommendations, but no legislation was brought forward by government bodies outside of Australia and New Zealand. With regard to youth, while there are various guidelines and frameworks in place across several countries, adherence remains difficult in the absence of concrete legislation and standardization of procedures. Finally, only Australia and a few select jurisdictions in the United States have implemented sales tax exemptions for sunscreen products. In light of our findings, we have made several recommendations, which we anticipate will help reduce the rates of melanoma and keratinocyte cancers in years to come. However, minimizing UVR exposure is not without risk, and we, therefore, suggest the promotion of vitamin D supplementation in conjunction with sun protective practices to limit potential harm.