2017 HSC Section 2 - Practice Management
Original Investigation Research
Lasers and Malpractice
Table 3. Cases Resolved With a Plaintiff Verdict Patient Age, y/ Sex a Award, $ Defendant Indication Laser 52/F 977 000 Derm Aging CO 2
Qualifi- cation Burn Pigment
Postop- erative
Unnec- essary Consent Additional Work Perm Comments
Yes
Third degree First degree Third degree
Yes
No
No
Yes
Yes
No No Perioral scarring
F
150 000 Unspeci- fied
Hair
Unspeci- fied
No
Yes
No
No
No
No
Yes Yes Positive erythema
F
2300 OB
Aging Titan
No
No
No
No
Yes
No
No Yes Involvement of cheeks, forehead No Yes “Should have” used argon laser No No Lost tip of nose No Yes Skin breakdown needing HBO Yes Yes Ulcers that scarred
35/F 20 000 GS
Vascular CO 2
No
No No
No
Yes
Yes
No
F
391 000 Plastic
Scar
CO 2
No No
No No No No
No No
No Yes
Yes Yes
No No
71/F 1 265 000 Oculo- plastic
Aging CO 2
F
80 000 Derm Vascular Unspeci- fied
No
No No
No
No
Yes
No
83/M 200 000 O/A
VC
Unspeci- fied
No
No No
No
No
No
No
No No See Table 2
M 1 665 000 Oto
Rhinologic Unspeci- fied
No
No No
No
No
Yes
No
Yes Yes See Table 2
M 850 000 Oto
OSA
Unspeci- fied Unspeci- fied
No
No No
Yes
Yes
Yes
No
Yes Yes See Table 2
Dental b
38/F 100 000 Dentist
Yes
No No
No
Yes
Yes
Yes
Yes No Loss of bone; death of 7 teeth
Abbreviations: Additional, required additional surgery; CO 2 , carbon dioxide; consent, alleged deficits in informed consent; defendant, defendant specialty; Derm, dermatologist; GS, general surgeon; hair, hair removal; HBO, hyperbaric oxygen therapy; indication, indication for procedure; O/A, otolaryngologist and anesthesiologist codefendants; OB, obstetrician-gynecologist; oculoplastic, oculoplastic surgeon; OSA, obstructive sleep apnea surgery; Oto, otolaryngologist; perm, permanent injury; pigment, dyspigmentation; plastic, plastic surgeon; postoperative, postoperative negligence; qualification,
defendant allegedly not qualified to perform procedure; rhinologic, rhinologic procedure; unnecessary, unnecessary or inappropriate procedure; vascular, removal of vascular anomaly; VC, vocal cord procedure; work, employment/income affected. a Ages were not available for many patients. b Laser gingivectomy.
Table 4. Allegations in Cases Involving Removal of Vascular Lesions Patient Age, y/Sex a Defendant Award (S/P), $ Postop- erative Unnec- essary
Consent Additional Perm Comments
CO 2 laser to remove PWS on neck/jaw; scarring; plaintiff claimed defendant should have used argon laser Candella laser for PWS on face, neck, and arm; hyperpigmentation; “inappropriate” candidate because patient was African American Telangiectasias on face removed; resulting nonhealing ulcer Postoperative application of aloe, to which patient had known allergy; facial swelling; physician not in room during procedure; procedure for veins on cheek
35/F
Not specified 20 000 (P) No
Yes
Yes
No
Yes
… b
8/M Derm
No
Yes
Yes
No
Yes
F
Derm
80 000 (P) No
No
Yes
No
Yes
… b
F
General surgeon
Yes
No
No
No
No
Abbreviations: Additional, required additional surgery; CO 2 , carbon dioxide; consent, alleged deficits in informed consent; Derm, dermatologist; P, plaintiff decision; perm, permanent injury; postoperative, postoperative negligence; PWS, port-wine stain; S/P, settlement or plaintiff decision; unnecessary,
unnecessary or inappropriate procedure. a Ages were not available for some patients. b Defendant decision.
formed consent have been consistently found in a variety of medicolegal analyses. 21,45,55-57 This is particularly important for cosmetic procedures, in which informed consent allega- tions can stem from a patient’s expectations not being met rather than a physician’s simply not mentioning a potential risk. 44 Consequently, in a comprehensive discussion of risks, benefits, and alternatives, physicians and patients should ex- plore specific goals of a procedure, as well as what plan to fol- low if expectations are not met. Although including the spe- cific injuries detailed in this analysis (Figure 3) is certainly
Despite the myriad benefits accompanying these trends, there is certainly the potential for complications, including thermal injury and skin discoloration, as noted in our analy- sis. Allegations of inadequate informed consent were raised in 50% of cases included (17 cases) (Figure 3). Nearly 60% of these cases (10 cases) were resolved with a payment, com- pared with the 29% payment rate in cases without this issue, andmedianpayments trendedhigherwith the presence of this factor ($246 000vs $150 000), although this trenddidnot reach statistical significance ( P = .17) (Table 2). Alleged deficits in in-
JAMA Facial Plastic Surgery July/August 2014 Volume 16, Number 4
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