2017 HSC Section 2 - Practice Management

were also interested in examining the occurrence of litigation

regarding noncosmetic causes. Our objectives were to exam-

ine relevant cases for such factors as outcome, awards, and

other allegations present in malpractice litigation, including

both specific injuries as well as general considerations. For ex-

ample, in addition to perceived deficits in informed consent,

a previous analysis of negligence regarding cranial nerve in-

jury found that the requirement of additional reparative pro-

cedures as well as allegations that a procedure was unneces-

sary or inappropriate were factors that may influence trial

outcomes.

Methods

We used the advanced search function of theWestlawNext da-

tabase (Thomson Reuters) to identify jury verdict and settle-

ment reports spanning from 1992 to October 2013, using the

search terms illustrated in

Figure 1

. This database draws from

court proceedings progressing to the point of inclusion in pub-

licly available federal and state court records. Although some

jurisdictions include attorney-reported cases,

22,23

nonvolun-

tary (ie, confidential) reports are available frommost jurisdic-

tions and are labeled with such terms as

confidential, anony-

mous,

Jane Doe/John Doe

. Along with the comprehensive

detail available in most court reports, WestlawNext’s ease of

use (for the laypersonwithout legal expertise)makes it awidely

used resource within and beyond the legal community, and it

has consequently been valuable in amultitude of medicolegal

analyses.

21-48

We comprehensively examined each court rec-

ord, recording plaintiff age and sex, specific issues put for-

ward in litigation, and case outcomes. All data were collected

in October 2013.

Becausemonetary values did not follow a symmetric dis-

tribution, jury awards and out-of-court settlementswere com-

pared as appropriate using nonparametric statistical analysis

with Mann-Whitney tests. The threshold for significance was

set at

< .05, and SPSS software (version 20; IBM) was used

for statistical analysis.

Results

Most cases included in this analysis involved female plain-

tiffs (82%). The median plaintiff age was 46 years (range, in-

fancy to 83 years). Of 34 cases (

Figure 2

), 19 (56%) were re-

solved with a defendant verdict (Figure 2A). Aggregate

payments (including verdict awards and settlements) totaled

$6.55million.Median jury-awardeddamageswere greater than

out-of-court settlements ($200 000 vs $102 750), although this

difference was not statistically significant (

= .30). Derma-

tologists were the most frequently named physician defen-

dants (11 cases [32%]), and otolaryngologists and plastic

surgeons were equally represented (6 cases each [18%])

(Figure 2B). In addition, 3 cases had litigation involving non-

physician defendants. The most frequent procedures

included laser treatment for age-related changes, followed by

revision of acne marks and hair removal (Figure 2C). Nearly

three-quarters of procedures were for cutaneous conditions,

and the other most frequent allegations raised in litigation in-

cluded sustaining permanent injury, disfigurement or scar-

ring, inadequate informed consent, and undergoing unneces-

sary or inappropriate procedures (

Figure 3

). Procedures for

noncutaneous conditions and cases with informed consent

Figure 3. Alleged Factors Most Frequently Raised in Litigation

Perm

Disf

Burn

Hypo

Hyper

Death

Specific injuries

0 10 20 30 40

Cases, %

50 60 70 80

Cutaneous

Consent

Unnecessary

Additional

Work

Postoperative

Qualification

Delay

Other procedures and allegations

0 10 20 30 40 50 60 70 80

Top panel depicts specific alleged injuries; bottom panel, types of procedures

and allegations not regarding specific injuries. Additional indicates additional

procedures required because of adverse event; CO

, cases in which use of a

carbon dioxide laser was explicitly mentioned (most others did not specify laser

type); consent, alleged deficits in informed consent; cutaneous, cutaneous

procedure; delay, delay in diagnosis of complication; Disf, poor cosmesis,

disfigurement, or scarring; Hyper, hyperpigmentation; Hypo, hypopigmen-

tation; Perm, permanent injury; postoperative, postoperative negligence;

qualification, defendant allegedly not qualified to perform procedure;

unnecessary, unnecessary or inappropriate procedure; and work, employment

or income affected by injury.

Table 1. Common Factors and Their Effect on Case Resolution

Factor

Cases Resolved With Payment, %

(Median Payment, $)

Value

for

Median

Payments

Factor Present

Factor Absent

Noncutaneous

56 (600 000)

40 (103 000)

.09

Consent

59 (246 000)

29 (150 000)

.17

Unnecessary

33 (100 000)

53 (175 000)

.95

Burn

55 (133 000)

39 (200 000)

.61

Pigmentation

48 (150 000)

33 (158 000)

.84

Consent

refers to the presence or absence of allegations regarding perceived

deficits in informed consent;

pigmentation,

allegations regarding

dyspigmentation (hypopigmentation or hyperpigmentation);

unnecessary

allegedly unnecessary or inappropriate procedure.

Lasers and Malpractice

Original Investigation

Research

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