Physician accountability in iatrogenic cerebrospinal fluid leak litigation
- 27 March 2013
- journal article
- research article
- Published by Wiley in International Forum of Allergy & Rhinology
- Vol. 3 (9) , 722-725
Abstract
Background: The potentially severe complications resulting from cerebrospinal fluid (CSF) leak makes iatrogenic injury a medicolegal area of concern for otolaryngologists and neurosurgeons. The objectives of this analysis were to study legal outcomes as well as medical and nonmedical elements affecting malpractice litigation.Methods: Public court records available in the Westlaw legal database (Thomson Reuters, New York, NY) were searched for medical malpractice litigation related to iatrogenic CSF leak. Of the 18 jury verdicts and settlements included, outcomes and awards, patient demographic data, and other factors instrumental in determining legal responsibility were recorded for comparison.Results: Ten (55.6%) cases were resolved in the defendant's favor, 2 (11.1%) resulted in damages awarded by a jury, and 6 (33.3%) were settled out of court before resolution of trial. Mean damages awarded were $1.1 million, while out of court settlements averaged $966,887. Malpractice stemming from patients who underwent endoscopic sinus surgery comprised 77.8% of cases analyzed. The most frequent alleged factors cited for litigation included having to undergo additional surgery (88.9%), developing meningitis (50.0%), and failing to recognize complications in a timely manner (44.4%). Perceived deficits in informed consent were alleged in one‐third of cases.Conclusion: Although a slight majority of cases were resolved in the defendant's favor, payments made were considerable, averaging approximately $1 million. Strategies to decrease liability and allow patients to make more informed decisions should include clear communication with patients that explicitly states potential risks, such as meningitis, and possible need to undergo additional reparative surgery.Keywords
This publication has 28 references indexed in Scilit:
- Challenges and surgical nuances in reconstruction of large planum sphenoidale tuberculum sellae defects after endoscopic endonasal resection of parasellar skull base tumorsThe Laryngoscope, 2013
- Triple‐layer reconstruction technique for large cribriform defects after endoscopic endonasal resection of anterior skull base tumorsInternational Forum of Allergy & Rhinology, 2012
- Double flap technique for reconstruction of anterior skull base defects after craniofacial tumor resection: technical noteInternational Forum of Allergy & Rhinology, 2012
- Surgical nuances for nasoseptal flap reconstruction of cranial base defects with high-flow cerebrospinal fluid leaks after endoscopic skull base surgeryNeurosurgical Focus, 2012
- Efficacy of the pedicled nasoseptal flap without cerebrospinal fluid (CSF) diversion for repair of skull base defects: incidence of postoperative CSF leaksInternational Forum of Allergy & Rhinology, 2012
- Nasoseptal flap repair after endoscopic transsellar versus expanded endonasal approaches: Is there an increased risk of postoperative cerebrospinal fluid leak?The Laryngoscope, 2012
- Endoscopic Nasoseptal Flap Repair of Skull Base DefectsOtolaryngology–Head and Neck Surgery, 2012
- Management and Implications of Intraoperative Cerebrospinal Fluid Leak in Transnasoseptal Transsphenoidal MicrosurgeryOperative Neurosurgery, 2011
- Endoscopic Reconstruction of Large Anterior Skull Base Defects using Acellular Dermal AllograftAmerican Journal of Rhinology, 2007
- Endoscopic Repair of Cerebrospinal Fluid Fistulae and EncephalocelesThe Laryngoscope, 1996