2017 HSC Section 2 - Practice Management

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Copyright 2014 American Medical Association. All rights reserved.
A n increasingly litigious environment has characterized
health care delivery in theUnited States during the past
3decades.1-5 Althoughsomehavenotedmalpractice liti-
gationmaybe“plateauing,”defensivemedical practices areper-
vasive and make up a considerable proportion of the “indi-
rect” costsmedicolegal issues contribute towardour healthcare
system.6-10 Accordingly, these trends have spurred consider-
able interest in characterizing factors that play a role in alleged
medical negligence, alongwithoutcomes and awards. Jalian et
al11 recently examined common causes of injury in cutaneous
laser surgery, noting that “hair removal” was the most com-
monly litigated procedure and that “lack of informed consent”
waspresent innearlyone-thirdof cases. Noanalysis,wasnoted,
however, regardinganatomic sitesof injury. Inour current analy-
sis, wewere interested in conducting a focused examination of
litigation regarding cases in the head and neck, as close prox-
imity of critical structures harbor the potential for significant
functionalsequelaethatmayadverselyaffectqualityoflife.Con-
sequently, we hypothesized that laser-relatednegligence in the
procedures in the head and neck, including the face, is prob-
ably associated with higher payments in cases resolved with a
jury awarding damages or an out-of-court settlement.
The use of lasers increasingly encompasses procedures be-
yond those related to cosmetic and cutaneous consider-
ations, particularly in otolaryngology.12-20 As such, as part of
a focused examination on negligence in the head and neck, we
Figure 1. Search Terms and Results
“Medical malpractice” AND laser
AND
scalp OR head OR neck OR face OR ear OR cheek OR eyebrow OR forehead
OR chin OR nose OR lip OR mouth OR “oral cavity”
OR throat OR larynx OR laryngeal OR “vocal cord”
8 Duplicates
4 With laser part of procedure
not reason for litigation
15 Ophthalmologic
9 Not head and neck
38 Not laser
108 Cases
34 Head and neck cases
A total of 34 malpractice litigation cases concerning laser procedures in the
head and neck were identified.
Figure 2. Characteristics of Cases Included in This Analysis
0
7 $977
$200 ($2.2-$1665)
$103 ($50-$600)
6
Cases, No.
5
4
2
3
1
0
12
8
10
Cases, No.
6
4
2
A
C
B
Derm
Age Acne Hair Other
Cutaneous
Vascular Rhinologic Airway Oral Other
Oto Plastic Unsp Anes Oculo Other
Defendant 56%
Settlement 12%
Plaintiff 32%
$90 $100
$253 $50
$1665
$475 $400
Defendant specialty
A, Overall outcomes and median payments, given in thousands of dollars, with
ranges in parentheses. B, Specialty of physician defendants. Anes
indicates anesthesiology; Derm, dermatology; Oculo, oculoplastic surgery
(fellowship-trained surgeons); Oto, otolaryngology; Plastic, plastic surgery; and
Unsp, unspecified. C, Indications for procedures/types of procedures included
in current analysis. Acne indicates resurfacing for acne marks; age, cutaneous
laser resurfacing for age-related changes; hair, hair removal; oral,
oral/oropharyngeal; and vascular, removal of vascular lesions. Median payments
(in thousands of dollars) for each type of procedure are noted above bars. B and
C, Top portions of bars represent plaintiff decisions; middle portions,
settlements; and bottom portions, defendant decisions.
Research Original Investigation Lasers and Malpractice
JAMA Facial Plastic Surgery July/August 2014 Volume 16, Number 4
197