2017 HSC Section 2 - Practice Management

Research Original Investigation

Lasers and Malpractice

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 al 11 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”

108 Cases

8 Duplicates 4 With laser part of procedure not reason for litigation

15 Ophthalmologic 9 Not head and neck 38 Not laser

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

Defendant specialty

A

B

12

Settlement 12%

$103 ($50-$600)

10

8

Defendant 56%

6

Plaintiff 32%

$200 ($2.2-$1665)

4

Cases, No.

2

0

Derm

Oto Plastic Unsp Anes

Oculo Other

$977

C

7

6

$90 $100

5

$253 $50

4

$1665

3

Cases, No.

$400

$475

2

1

0

Age

Acne

Hair

Other Cutaneous

Vascular Rhinologic Airway Oral

Other

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.

JAMA Facial Plastic Surgery July/August 2014 Volume 16, Number 4

jamafacialplasticsurgery.com

Copyright 2014 American Medical Association. All rights reserved.

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