2017 HSC Section 2 - Practice Management

valuable, further discussion of more general considerations

(such as the potential requirement for additional surgery

[Figure 3]) is also important.

The use of a carbon dioxide laser was noted in 9 cases

(26%), and potassium titanyl phosphate and erbium:YAG la-

sers were noted in 1 case each. The other cases did not specify

which types of lasers were used by the defendant. This find-

ing illustrates a weakness inherent to the use of WestlawNext

in this analysis, in that certainmedical components of the case

may not be detailed in numerous instances. WestlawNext is

compiled to educate litigators about issues brought up inmal-

practice litigation,

22,23

and, consequently,many of the jury ver-

dict and settlement reports are written to disseminate infor-

mation to the layperson without medical expertise.

Another limitation ofWestlawNext is that it includes only

cases progressing far enough for possible inclusion into pub-

licly available federal and state court records. Only 34 cases

met inclusion criteria using our search terms. During a 22-

year span, this represents 1 or 2 cases per year, a relatively low

number compared with other medicolegal topics of interest.

This maymean that litigation concerning head and neck laser

injuries is less frequent than litigation concerning injuries else-

where, or it may represent a higher likelihood of reaching out-

of-court settlements, many of which may not progress far

enough to be included in publicly available federal and state

court records. Confirmingwhich of these scenariosmay be re-

sponsible for the number of cases included is beyond the scope

of this resource. This limitation emphasizes the fact thatWest-

lawNext’s value lies not in estimating the prevalence of litiga-

tion specific to an injury but rather in its utility in analyzing

allegations incases towhichwehadaccess. Despite thesedraw-

backs, WestlawNext is still one of the most detailed sources

describing medicolegal proceedings and as such has been of

value in many analyses.

11,21-30,32-48

Conclusions

Procedures using lasers represent a potential target for mal-

practice litigation should an adverse event occur. Physicians

in numerous specialties, including dermatology, plastic sur-

gery, and otolaryngology, were named as defendants.Whereas

cases in this analysis included cutaneous/cosmetic proce-

dures as well as other head and neck interventions, otolaryn-

gologists were more likely to be named as physician defen-

dants in the latter category. Although cases resolved with

out-of-court settlement or plaintiff verdicts had relatively

modest payments (median, $150 000) compared with prior

analyses, the potential for significant amounts was present;

numerous plaintiff verdicts exceeded $800 000. Inclusion

in the informed consent process of specific factors detailed

in this analysis, such as scarring/disfigurement and pigmen-

tation abnormalities, as well as attention to more general

considerations, such as the potential need for additional

surgery, may decrease liability. In addition, physicians and

patients should have comprehensive discussions regarding

expectations as well as contingency plans to be followed

should adverse events occur.

ARTICLE INFORMATION

Submitted for Publication:

November 29, 2013;

final revision received January 11, 2014; accepted

January 22, 2014.

Published Online:

April 17, 2014.

doi:10.1001/jamafacial.2014.21.

Author Affiliations:

Department of

Otolaryngology–Head and Neck Surgery, Wayne

State University School of Medicine, Detroit,

Michigan (Svider, Carron, Zuliani, Folbe); Section of

Otolaryngology, Department of Surgery, John D.

Dingell VA Medical Center, Detroit, Michigan

(Carron, Zuliani); Department of Otolaryngology–

Head and Neck Surgery, Rutgers New Jersey

Medical School, Newark (Eloy); Department of

Neurological Surgery, Rutgers New Jersey Medical

School, Newark (Eloy); Center for Skull Base and

Pituitary Surgery, Rutgers New Jersey Medical

School, Newark (Eloy); Rhinology Section, North

Shore University Hospital, Manhasset, New York

(Setzen); Department of Otolaryngology, New York

University School of Medicine, New York (Setzen);

Department of Neurosurgery, Wayne State

University School of Medicine, Detroit, Michigan

(Folbe).

Author Contributions:

Dr Svider had full access to

all the data in the study and takes responsibility for

the integrity of the data and the accuracy of the

data analysis.

Study concept and design:

Svider, Carron, Zuliani,

Eloy, Folbe.

Acquisition of data:

Svider.

Analysis and interpretation of data:

Svider, Carron,

Setzen, Folbe.

Drafting of the manuscript:

Svider.

Critical revision of the manuscript for important

intellectual content:

All authors.

Statistical analysis:

Svider.

Study supervision:

Carron, Zuliani, Eloy, Setzen,

Folbe.

Conflict of Interest Disclosures:

Dr Setzen serves

on the speakers bureau for TEVA and MEDA (not

related to current subject).

REFERENCES

. AndersonGF,HusseyPS,FrognerBK,WatersHR.Health

spendingintheUnitedStatesandtherestofthe

industrializedworld.

HealthAff(Millwood)

.2005;24(4):

903-914.

. Jena AB, Chandra A, Lakdawalla D, Seabury S. Outcomes

of medical malpractice litigation against US physicians.

Arch

Intern Med

. 2012;172(11):892-894.

. Jena AB, Chandra A, Seabury SA. Malpractice

risk among US pediatricians.

Pediatrics

. 2013;131(6):

1148-1154.

Table 5. Allegations in 21 Aesthetic Cutaneous Cases Not Involving

Vascular Lesions

Alleged Factor

Cases, No. (%)

Poor cosmesis

18 (86)

Burn

10 (48)

Third degree

3 (14)

Second degree

3 (14)

Informed consent

9 (43)

Unnecessary or inappropriate procedure

8 (38)

Inappropriate procedure

7 (33)

Hypopigmentation

7 (33)

Procedure for aging

7 (33)

Hair removal

5 (24)

Acne spot removal

4 (24)

Postoperative negligence

3 (14)

Underwent additional procedure

3 (14)

Defendant not qualified

2 (10)

Hyperpigmentation

2 (10)

Eight cases (38%) were resolved with payment; the median payment

was $132 750.

Research

Original Investigation

Lasers and Malpractice

JAMA Facial Plastic Surgery

July/August 2014 Volume 16, Number 4

jamafacialplasticsurgery.com

201