M. S. Sussman1, M. Mulder1, S. Carranco1, E. L. Ryon1, B. Sussman1, S. Madiraju1, V. Hart1, K. Proctor1 1University Of Miami,Trauma Surgery/critical Care,Miami, FL, USA
Introduction: Medical malpractice litigation is a source of anxiety for many surgeons. Previous studies indicate that a general surgeon’s chance of being involved in a malpractice claim by age 65 approaches 99%. Although single site analysis has indicated no increased risk of lawsuit for trauma surgeons, a review of a large, national, legal database is lacking. The purpose of this study is to explore the malpractice environment surrounding trauma surgery and acute care surgery services.
Methods: Lexis Nexis is a mode of legal research that uses databases of court opinions, statutes, court documents, and secondary material. We searched 1987-2017, of all state and federal cases using the Boolean search Terms: “trauma” AND “medical malpractice” AND “case summary” AND NOT copyright. Pediatrics, obstetrics, ophthalmologic and incomplete cases were excluded.
Results: During a 30-year period 231 malpractice cases were identified. Several trauma subspecialties were implicated in the lawsuits. These included trauma surgeons, acute care general surgeons (ACS), trauma orthopedics (TO), trauma neurosurgery (TN), and trauma anesthesia (TA). A majority of the cases involved emergent surgery (148/231, 64%). Preoperative assessment was responsible for 82 suits (35%). A total of 62 cases (27%) resulted in death. A total of 20 cases (9%) resulted in monetary award to the plaintiff (patient) for an average payout of $1.1M (range, $35K – $6.4M). Examining trauma surgeons as a separate cohort, 12 malpractice suits resulted in payouts, eight of these (66%) were a result of delayed/missed diagnosis. Technical error was sited in 15% and neglect in 8% of cases where a payout was awarded. Looking at the other subspecialties (ACS, TO, TN, TA) involved, 8 cases resulted in payout, 100% of these cases were as a result of technical error.
Conclusion: Only a small fraction of medical malpractice cases that are filed result in a payout. The majority of suits brought against trauma surgeons arise from delayed/missed diagnosis, whereas all of the suits brought against other subspecialties arise from technical error. This is likely due to the fact that trauma surgeons serve as the frontline diagnosticians and must make rapid assessments. This study highlights the importance of the trauma assessment and time to diagnosis as targets for education on litigation prevention. Further investigation is warranted to understand the underlying causes for malpractice suits between trauma surgeons and other trauma subspecialties.