Litigation involving pediatric surgical conditions.

PURPOSE: Malpractice litigation among pediatric surgeons is a subject of concern and interest, but minimal factual data are known. Our goal was to investigate national litigation trends regarding pediatric surgical conditions. METHODS: We queried WestlawNext database for malpractice cases involving pediatric (age ≤ 18) surgical conditions. Cases were included if they named a care provider or health center. We gathered data on diagnoses, procedures, care providers, allegations, location, and outcomes. RESULTS: Our search revealed 4754 cases, and 170 met inclusion criteria. These ranged from 1965 to 2017 and represented 40 states. 110 cases involved a surgeon (41% pediatric surgeons). Appendicitis was the most common diagnosis identified. Cases frequently involved delayed/missed diagnoses or interventions (45.9%), technical concerns (35.9%), mortalities (26.5%), negligent perioperative care (23.6%), and informed consent concerns (4.7%). Technical complication was the most common allegation against surgeons (49.1%), and nonsurgeon cases typically involved a delayed/missed diagnosis (78.3%). 39% of cases resulted in favor of the defendant, 35% plaintiff, and 14% had a split verdict. CONCLUSION: Litigation involving pediatric surgical conditions is diverse, but appendicitis and circumcision comprise almost a third of cases. A greater understanding of these trends can help steer efforts in quality and safety as well as guide improved communication with families. LEVEL OF EVIDENCE: N/A.

[Delayed appendectomy because of diagnostic malpractice: Experiences of the Arbitration Board of the North German Medical Associations]. / Die durch Diagnosefehler bedingte Verzögerung der operativen Behandlung der akuten Appendizitis - Erfahrungen der Norddeutschen Schlichtungsstelle für Arzthaftpflichtfragen.

From 2000 to 2012, 447 panel proceedings concerning acute appendicitis were evaluated. 271 cases (57 %) were related to alleged diagnostic malpractice. This was confirmed in 176 cases (67 %). The following medical specialities were involved (m = quote of malpractice): general surgery 33 %, m = 51 %; paediatric surgery 3 %, m = 44 %; general practitioner and prehospital emergency services 24 %, m = 62 %; internal medicine 19 %, m = 70 %; paediatrics 13 %, m = 57 %; gynaecology 3 %, m = 91 %; urology 2 %, m = 17 %. The most frequent misdiagnosis was gastroenteritis (43 % in adults, 69 % in children), obviously based on the concomitant symptom of diarrhoea. Surgery revealed all stages of advanced appendicitis up to peritoneal sepsis, organic failure and death (n = 5). The evaluation of the files and the experts' reports of the 176 cases of diagnostic malpractice allowed to define the following basic failures, which led to unjustified delay of operation: careless history-taking, no or incomplete physical examination, no follow-up investigations, incorrect interpretation of the patient's complaints and clinical findings, no or incomplete documentation. Conducting a thorough investigation is essential to avoiding diagnostic malpractice. Internal analysis of failures or near failures may contribute to reducing the number of future cases of malpractice.

Causes and costs of a decade of litigation following emergency appendectomy in England.

BACKGROUND: There has been recent interest in the delayed and nonoperative management of appendicitis. The present study assessed the causes and costs of litigation against surgeons following emergency appendectomy, with an emphasis on claims relating to preoperative management. MATERIALS AND METHODS: Data were obtained from the English NHS Litigation Authority for claims relevant to appendectomy between 2002 and 2011. Two authors independently extracted data and classified it against predetermined criteria. RESULTS: Successful litigation occurred in 66 % of closed cases (147/223) with a total payout of £8.1 million. There were 24 claims against organizational operating room delays (9 % of total) and 27 against delayed diagnosis (10 %), with respective success rates of 70 and 68 %. From 21 claims relating to damage to fertility, nine were due to either delayed diagnosis or organizational operating room delays. Misdiagnosis was the second most common cause for litigation (16 %), but it had the lowest likelihood of success (49 %). Faulty surgical technique was the most common reason for litigation (39 %), with a 70 % likelihood of success. Of eight claims related to fatality, one was due to unacceptable preoperative delay leading to preventable perforated appendicitis. The overall highest median payouts were for claims of damage to fertility (£52,384), operating list delays (£44,716), and delayed diagnosis (£42,292). CONCLUSIONS: There were significant medicolegal risks surrounding delays related to access to operating lists and diagnosis. Whereas future evidence regarding the safety of delayed appendectomy may provide scientific defense against these claims, the present study provides evidence of the current medicolegal risk to surgeons following delayed treatment of appendicitis.

Appendicectomy deferred to a CEPOD list: the patients' opinion.

AIMS: Implementation of NCEPOD guidelines to avoid out-of-hours operating, Junior doctors' 'New Deal' and EWTD have significantly altered surgical practice. Patients admitted 'out of hours', who need an emergency procedure, are often deferred until the next day. We have attempted to assess patients' opinions of this management plan. METHODS: Consecutive patients admitted with uncomplicated appendicitis and operation deferred to the next day according to NCEPOD guidelines were studied. A surgeon, other than the one carrying out the initial assessment, performed the operation on a scheduled morning emergency list. A full explanation was given to patients regarding reasons for deferring operation, and they found out that a different surgeon would be performing their operation. Patients completed a questionnaire post-operatively. RESULTS: 42 patients were studied; median age 24 years (range 17-69); 32 men, 10 women. Thirty presented after 6 p.m. and eight after midnight. The remaining four were admitted during the day. Only one third of the patients recalled reasons for deferred operation with seven not remembering being given an explanation. Two thirds (n=27) of the patients slept poorly pre-operatively, principally due to pain (17) and ward noise (10). Operation on the same night as their admission was the preferred option in 24 patients. All of these slept poorly. Some 22 patients would have preferred the admitting surgeon to have performed their operation; 16 expressed no preference. Only four patients preferred a 'new' surgeon the following day. Of the 42 patients, 28 did not know who had performed their operation. CONCLUSION: Despite being told why their operation was delayed most patients would prefer not to have their procedure delayed. Lack of sleep pre-operatively is a major determinant of patient opinion. Few patients wanted a 'new' surgeon to perform their operation.

[Malpractice claims relating to the diagnosis and treatment of acute appendicitis--decisions of the Norddeutsche Schlichtungsstelle (Expert Panel for Extrajudicial Claims Resolution of the Medical Associations in Northern Germany)]. / Arzthaftpflichtverfahren im Zusammenhang mit der Diagnose und der Therapie der akuten Appendizitis. Erfahrungen der Schlichtungsstelle der norddeutschen Arztekammern.

During the five years between 2000 and 2004 the Norddeutsche Schlichtungsstelle decided on 241 malpractice claims relating to the diagnosis and treatment of acute appendicitis including 220 hospitals and 60 primary care outpatient facilities. 29 claims involved two and 5 claims involved three physicians/hospitals. One third of the 241 claims were related to non-surgical specialties. The rate of negligent adverse events was 117/241 (49%); surgeons accounted for 41% of the claims, and non-surgeons for 67%; 46% of the claims involved hospitals, and 65% outpatient facilities. There were 127/241 (53%) cases of perforated appendicitis; and in 90% of these cases the patients complained of delayed diagnosis and/or operation. In the 114/241 (47%) cases with non-perforated appendicitis patients complained of errors related to operative procedures, of delayed re-interventions and of non-surgical complications. The degree of disability was determined in all cases of iatrogenic injury due to medical negligence: the impairment was transient and minimal to moderate in 67 of injured patients; transient and serious in 35, permanent and serious impairment in 12 cases, and 3 patients died (another 2 cases of deaths were unrelated to negligence or iatrogenic injury). Outstanding errors documented in these cases of appendicitis included: failure to conduct a follow-up examination within 12-24 hours; delayed re-intervention for peritonitis or peritoneal abscess. Puncture lesions of the bowel or great vessels due to iatrogenic injury acquired in the course of laparoscopic appendectomy were reported in 8 cases.

Apendicectomía profiláctica / Prophylactic appendicectomy

Las fuerzas armadas en nuestro país destacan personal por períodos prolongados a sitios de difícil acceso, siendo requisito para esta permanencia la apendicectomía profiláctica. El objetivo de este trabajo es evaluar la necesidad de la apendicectomía profiláctica en un individuo sano por la eventualidad que represente una apendicitis(AU)

Why wrongful birth actions are right.

A wrongful birth action is a claim in negligence brought by parents of a child against a doctor who has "wrongfully" caused their child to be born. These claims can be divided into two categories: those where a doctor performs a failed sterilisation procedure that leads to a healthy child being born; and those where a doctor fails to provide sufficient information to allow parents to choose to abort a handicapped child. The recent decision of the High Court of Australia in Cattanach v Melchior (2003) 77 ALJR 1312 falls into the former category. The decision to allow the parents to receive damages for the costs of raising and maintaining their child has generated much public debate. Despite the endorsement of this "wrongful birth" action, there are indications that the legislature will overturn the decision. This article examines whether there is a sound doctrinal basis for recognising wrongful birth actions.