2017 HSC Section 2 - Practice Management

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Original Research—Sinonasal Disorders
Malpractice in Treatment of Sinonasal
Disease by Otolaryngologists: A Review of
the Past 10 Years
Otolaryngology–
Head and Neck Surgery
2015, Vol. 152(3) 536–540
American Academy of
Otolaryngology—Head and Neck
Surgery Foundation 2015
Reprints and permission:
DOI: 10.1177/0194599814566787
Tyler W. Winford, MD 1, Jordan L. Wallin, MD1 ,
John D. Clinger, MD1, and Aaron M. Graham, JD2
No sponsorships or competing interests have been disclosed for this article.
Abstract
Objective. Sinonasal disease is a common condition treated
by otolaryngologists. Malpractice in this area is the most
common litigation faced by otolaryngologists. This study
analyzes malpractice in the treatment of sinonasal disease.
Study Design. Case series, review of legal records.
Setting. Legal databases.
Subjects and Methods. Using 2 different computerized legal
databases, the phrase medical malpractice was searched with
terms related to sinonasal disease involving court cases in
the past 10 years (2004-2013), yielding 26 cases. The cases
were analyzed for pertinent data regarding plaintiffs, pre-
senting complaint, practice setting, type of malpractice,
resulting injury, result of verdict, and amount of reward or
settlement.
Results. Chronic sinusitis (42%) was the most common pre-
senting symptom. Many cases included multiple types of
alleged malpractice, with the most common being negligent
technique (38%) and lack of informed consent (27%). The
most common alleged injuries included cerebrospinal fluid
leak, meningitis, nasal obstruction, and orbital trauma.
Defendants prevailed in 13 of 18 cases in which outcomes
were known, with mean award of $225,000 and mean set-
tlement of $212,500. The cases won by plaintiffs were all in
a private practice setting.
Conclusion. Otolaryngologists should be aware of the causes
of malpractice litigation as it relates to treatment of sinonasal
disease. Lack of informed consent continues to be a common
allegation, and surgeons should ensure complete informed
consent is obtained and well documented. A unified and com-
plete database of medical malpractice cases is needed to
allow for further analysis of specialty-related claims.
Keywords
medical malpractice, otolaryngology, sinonasal disease, sinus
surgery
Received August 21, 2014; revised December 8, 2014; accepted
December 12, 2014.
Physicians are under more pressure than ever to deliver
cost-effective, efficient health care without compro-
mising patient safety. Frivolous lawsuits comprise
approximately 37% of malpractice cases, accounting for
about 15% of medical malpractice costs.1,2 Recent studies
have shown that rates of malpractice claims are plateauing,
with most cases not resulting in payment to plaintiffs.3,4
Regardless of the appropriateness of a lawsuit, any litigation
is viewed as an attack on the character and competence of
the physician involved. Given the economical, psychologi-
cal, and patient safety implications, the malpractice system
has a tremendous effect on physicians and patients.
The margin of error in the surgical management of sino-
nasal disease is small, and there are several postoperative
consequences of iatrogenic injury. Endoscopic sinus surgery
(ESS) in particular has well-described complications. These
include blindness, diplopia, cerebrospinal fistula (with or
without meningitis), intracranial brain injury, and life-
threatening hemorrhage from carotid artery injury.5 Any
otolaryngologist performing sinonasal procedures should be
aware of these potential adverse outcomes and take mea-
sures to avoid them.
It is pertinent for an otolaryngologist to be informed of the
recent nature of malpractice suits involving the treatment of
sinonasal disease. The objective of this review is to examine the
most recent litigation involving the management of sinonasal
disease by otolaryngologists. Information drawn from this
review and analysis should help otolaryngologists to be aware
1Department of Otolaryngology, Wake Forest University School of
Medicine, Winston-Salem, North Carolina, USA
2Bradley, Arant, Boult, Cummings, LLP, Jackson, Mississippi, USA
This article was presented at the 2014 AAO-HNSF Annual Meeting & OTO
EXPO; September 21-24, 2014; Orlando, Florida.
Corresponding Author:
Tyler W. Winford, MD, Department of Otolaryngology, Wake Forest
University School of Medicine, Winston-Salem, Medical Center Blvd,
Department of Otolaryngology–4th Floor, Winston-Salem, NC 27157,
USA.
Email:
Reprinted by permission of Otolaryngol Head Neck Surg. 2015; 152(3):536-540.
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