2017 HSC Section 2 - Practice Management

Research Original Investigation

Lasers and Malpractice

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.

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- 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.

ARTICLE INFORMATION Submitted for Publication: November 29, 2013; final revision received January 11, 2014; accepted January 22, 2014.

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 1 . AndersonGF,HusseyPS,FrognerBK,WatersHR.Health spendingintheUnitedStatesandtherestofthe industrializedworld. HealthAff(Millwood) .2005;24(4): 903-914. 2 . Jena AB, Chandra A, Lakdawalla D, Seabury S. Outcomes of medical malpractice litigation against US physicians. Arch Intern Med . 2012;172(11):892-894. 3 . Jena AB, Chandra A, Seabury SA. Malpractice risk among US pediatricians. Pediatrics . 2013;131(6): 1148-1154.

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

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

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