2017 HSC Section 2 - Practice Management

Reprinted by permission of Otolaryngol Head Neck Surg. 2015; 152(3):536-540.

Original Research—Sinonasal Disorders

Otolaryngology– Head and Neck Surgery 2015, Vol. 152(3) 536–540 American Academy of Otolaryngology—Head and Neck

Malpractice in Treatment of Sinonasal Disease by Otolaryngologists: A Review of the Past 10 Years

Surgery Foundation 2015 Reprints and permission:

sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599814566787 http://otojournal.org

Tyler W. Winford, MD 1 , Jordan L. Wallin, MD 1 , John D. Clinger, MD 1 , and Aaron M. Graham, JD 2

Received August 21, 2014; revised December 8, 2014; accepted December 12, 2014. P hysicians 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 1 Department of Otolaryngology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA 2 Bradley, 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: twinford@wakehealth.edu

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

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