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Background: The Iranian National Health Service (NHS) suggested that gynecologists face a higher risk of medicolegal claims, with a significant number of claims being related to delivery events. This study aimed to investigate the factors associated with delivery related claims., Method: In this cross-sectional study, we conducted an analysis of medico-legal documents which related to complications during delivery events and presented to Iranian Medical Legal Organization spanning from March 2018 to February 2020. A total of 227 legal prosecutions that were initiated by patients or, in cases where that wasn't possible, by their families, were included in the study and all of them were evaluated in commission with experienced professionals. The data collection phase occurred between February 2023 and May 2023. The collected data encompassed various aspects, including patient characteristics mode of delivery, reasons for claims, hospital type, accused party, the occurrence of instrumental delivery and the final disposition of the claims (paid claims or closed claims). Paid claims represent successful lawsuits where the healthcare provider or their insurer made a financial settlement to the patient. Closed claims encompass those that were either denied or dismissed. Chi-square or t-tests were employed to compare factors between paid claims and closed claims., Result: In this study, it was observed that vaginal delivery was performed in 51.1% of the claims, whereas 48.9% underwent a caesarean section.. Approximately half of the claims were against obstetrician-gynecologists, and 33% of the claims against other providers were against midwives.. The majority of complaints were related to perinatal mortality (34.8%) and neonatal asphyxia (18.5%). In 58.1% of cases, no malpractice was identified, while 41.9% resulted in paid claims. Also, there were no significant differences between the paid claims and closed claims groups in several factors, such as the type of hospital (P = 0.904), maternal age (P = 0.157), type of delivery (P = 0.080), and accused party (P = 0.168). However, the number of instrumental deliveries (13.8% of vaginal deliveries) and the reasons for claims, exhibited significant differences between the two claims (P = 0.021, P<0.001 respectively)., Conclusion: This study found that maternal complications were more common in caesarean sections, while neonatal claims were more prevalent in vaginal deliveries. The study recommended public health interventions to reduce the overall prevalence of delivery-related claims., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Eshraghi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This article reviews the medico-legal aspects associated with infectious diseases, highlighting their complexity and the challenges they pose. Infectious diseases cause not only an increase in morbidity and mortality in the healthcare setting but also involve complex legal issues. Healthcare-Associated Infections (HAIs) represent a growing risk with the increase in invasive procedures and can lead to patient complications and legal claims against healthcare professionals and institutions. The consequences of medical malpractice in this context are discussed, such as diagnostic delays, inappropriate use of treatments, and lack of adequate testing, which can have serious sequelae or even result in the patient's death. The review focuses on highlighting the importance of prevention, considering that healthcare-associated infections can be difficult to avoid, posing complex legal challenges. It concludes that managing infectious diseases and their legal consequences requires careful consideration of clinical practice guidelines, prevention and control strategies, and effective communication with patients. An integrated and evidence-based approach is advocated to address these challenges, emphasizing continuous education, the use of advanced diagnostic technologies, and interdisciplinary collaboration., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)

Objective: The aim of this study was to analyze medication-related nursing medical malpractice cases to gain insights regarding how malpractice risk can be reduced., Background: The criminal prosecution and verdict of nurse RaDonda Vaught focused attention on the potential medicolegal risk for nurses related to medications., Methods: Medication-related medical malpractice cases involving nurses were obtained from a national database. Various attributes of these cases were examined, including contributing factors, injury severity, and case outcomes., Results: Authors identified 231 nursing medication-related medical malpractice cases closed from 2017 to 2021. The most frequent adverse events involved medication administration. Not following policies or protocols was the most common contributing factor. Opioids and epinephrine were the medications most frequently involved in the cases. Indemnity payments were made in 56.3% of the cases, with an average indemnity payment of $366 002., Conclusions: Nursing medication-related medical malpractice cases are relatively uncommon, which may reassure nurses regarding medicolegal risk. Medications and contributing factors involved in the cases suggest patient safety interventions including education related to policies, procedures, and protocols., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Medico-legal complaints against physicians are a significant source of anxiety and could be associated with defensive medical practices that may correlate with poor patient outcomes. Little is known about patient concerns brought to regulatory bodies and courts against dermatologists in Canada., Objective: To characterize factors contributing to medico-legal complaints brought against dermatologists in Canada., Methods: The Canadian Medical Protective Association (CMPA) repository was queried for all closed cases involving dermatologists over the past decade. Aggregate, anonymized data was reviewed and case outcomes, patient harm, and contributing factors were extracted., Results: Nearly one-fifth of all dermatologists who are CMPA members have been named in at least one medico-legal case between 2013 to 2022. A total of 396 civil-legal actions or College complaint cases involving dermatologists were closed at the CMPA during this timeframe. The most common patient allegations were deficient assessment (34%), diagnostic error (28%), and unprofessional manner (22%). Nearly half of patients experienced a harmful event, the majority of which were asymptomatic or mild. The most frequently identified contributing factors related to providers were poor clinical decision making (n = 73), lack of situational awareness (n = 67), and conduct and boundary issues (n = 59). Team factors included a breakdown of communication with patients (n = 124)., Conclusions: Improved communication with patients for informed consent, treatment plans, clinical follow-up, and documentation of thorough clinical patient assessments can improve patient satisfaction and health outcomes, and mitigate dermatologists' medico-legal risk., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: Adolescent and young adult patients occupy a clinically transitional space between pediatric and adult care. Youth with chronic conditions and special healthcare needs may have trouble accessing and receiving appropriate care in this transition, which may lead to patient safety issues and medicolegal risks for physicians. The objectives of this article were to explore patient safety issues and identify medicolegal risks for physicians., Methods: A national repository was retrospectively searched for medicolegal cases (MLCs) involving complaints from youth. The study included MLCs closed at the Canadian Medical Protective Association between 2013 and 2022 involving youth. The study participants were adolescents and young adults aged ≥ 15 and ≤ 21 years with medical complexity. The frequencies and proportions of patient safety events and medicolegal risks for physicians were calculated by exploring factors that contributed to each incident using established frameworks., Results: A total of 182 eligible MLCs were identified. Of 206 involved physicians, 55 were psychiatrists. The most common reasons for patient complaints were deficient assessment, diagnostic error, and communication breakdown with the patient and/or family. More than half of the cases were related to a harmful incident. Peer experts reviewed the cases and identified factors such as a deficient assessment, a failure to perform a test or intervention, failure to refer the patient, and insufficient provider knowledge/skill as contributing to the patient safety event., Discussion: The impact of our findings is to identify gaps in care delivery to youth that can inform practitioners of ways to mitigate the gaps and improve patient care and health outcomes., (Copyright © 2024 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Summary: Informed consent is the principal tool that bridges the gap between clinical practice and our society's ethical ideals. The intricacies of informed consent, however, are frequently misunderstood, and its effective implementation can be challenging in practice. The continuous stream of innovations, wide array of procedures, and other characteristics inherent to the practice of plastic surgery compound the challenges of implementing informed consent. Unfortunately, there remains a dearth of literature to provide a comprehensive overview of informed consent as it relates to plastic surgery. In this article, the authors highlight the history, legal components, and challenges of informed consent within plastic surgery and offer recommendations on how to approach them. A deeper understanding of informed consent helps enhance patient care, mitigates unnecessary malpractice risk, and leads to better physician-patient relationships., (Copyright © 2024 by the American Society of Plastic Surgeons.)

Parity of esteem describes an aspiration to see mental health valued as much as physical. Proponents point to poorer funding of mental health services, greater stigma and poorer physical health for those with mental illness. Stubborn persistence of such disparities suggests a need to do more than stipulate ethical and legal obligations toward justice or fairness. Here, I propose that we should rely more on our legal obligations toward informed consent. The latter requires clinicians to disclose information about risks in a way that is sufficient to satisfy what a prudent patient would reasonably want to understand in their circumstances. I argue that inadequate disclosure of the mental health complications of common surgeries risks exposing the craft specialists performing them to clinical negligence claims. Patients could argue they were counselled about said risks, improperly or not at all: improperly, if advised by a craft specialist lacking sufficient expertise in mental health; not at all, if mental health complications were simply forgotten. From this, I argue that a prudent approach for craft specialists would be to support and fund 'integrative' specialists (from rehabilitation medicine, liaison psychiatry and health psychology), more often to work alongside them within a multidisciplinary team that is better placed to navigate consent (via a prehabilitation process, for example). Based on duties toward consent, the extension of this type of coworking is another way to improve the resource and understanding accorded to mental health-but by starting within the citadels of physical health., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Competing interests: None to declare.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Aim: Medical errors are critical in obstetrics and gynecology (OB/GYN) and contribute to high litigation risks. However, few studies have examined system and diagnostic errors as potential preventable problems. This study aimed to enhance medical safety and reduce litigation by identifying and addressing key contributory factors., Methods: We retrospectively searched the national Japanese malpractice claims database for OB/GYN cases between 1961 and 2017. We evaluated provider characteristics and background information of the patients (plaintiffs). The main outcome was litigation (acceptance or rejection) in the final judgment. Using multivariable logistic regression models, we assessed the associations between medical malpractice variables (system and diagnostic errors, facility size, situation, place, time, and clinical outcomes) and litigation outcomes (acceptance)., Results: Overall, 344 malpractice claims were analyzed. Among these, 277 (80.5 %) were obstetric, and 67 (19.5 %) were gynecological. Of the obstetric cases, 193 were perinatal, and 84 were maternal. Malpractice claims were accepted (OB-GYN losses) in 185 cases (53.8 %). In multivariable analyses, system errors (odds ratio 97.4, 95 % confidence interval 35.2-270.0), diagnostic errors (odds ratio 4.5, 95 % confidence interval 1.8-11.3), and clinic (odds ratio 2.7, 95 % confidence interval 1.2-4.8) had a significant statistical association with accepted claims., Conclusion: System errors, diagnostic errors, and clinics were significantly associated with acceptance claims. These findings underscore the necessity of addressing modifiable factors at the physician level and within the healthcare management system to enhance patient safety and reduce litigation risks, thereby ensuring a safer and more reliable healthcare environment for patients and medical professionals., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To analyse the litigation trends and the reasons for claims within the specialty of Urology, within the UK National Health Service (NHS), over a 16-year period., Materials and Methods: Data were requested from NHS Resolution under the Freedom of Information Act 2000. This included the total number of claims in Urology, the number of these that were successful (settled or closed), and the costs in damages paid out per financial year between 2006 and 2022. A breakdown of the successful claims by their primary cause was also collected. These were coded into the categories: 'non-operative', 'intraoperative', 'postoperative', and 'other'., Results: A total of 4124 litigation claims were made between 2006 and 2022 and 60.9% (2511/4124) of these claims were successful. In all, £145 million (British pounds) was paid out in damages. The number of successful claims increased 2.9-fold from the start to end of this 16-year period, and the costs in damages paid out increased 10-fold. Regarding primary causes for the successful claims, failure or delay in treatment (20.9%, 525/2511), failure or delay in diagnosis (14.5%, 364/2511), and intraoperative problems (9.1%, 229/2511) accounted for the highest proportion. Overall, non-operative causes for successful claims accounted for 73.3% (1840/2511), intraoperative for 20.1% (504/2511), and postoperative for 3.9% (98/2511)., Conclusions: The number of successful urological litigation claims, and their associated costs is rising. The majority are due to non-operative causes, which may be partially explained by NHS waiting lists alongside the effects of the coronavirus disease 2019 (COVID-19) pandemic., (© 2024 BJU International.)

Competing Interests: Conflicts of interest None disclosed.

Background: Dupuytren's disease (DD) is a chronic and progressive fibroproliferative disease consisting of the progressive pathological fibrosis of the palmar fascia leading to permanent flexion and deficit of extension, with marked deformity and severe disability. Among treatment options, conservative and infiltrative therapies, physiotherapy, or surgery, with less invasive surgical options, are reported. The therapeutic planning, shared with the patient, must consider the severity of the disease, surgical risks, the functional, aesthetic, and occupational consequences, and the risk of recurrence., Case Report: We describe a complicated clinical case that led her to a claim for compensation under presumed medical professional liability profiles. A female patient, 32-years-old, suffering from early symptomatic DD in the left non-dominant hand, underwent to palmar fasciotomy complicated by severe paraesthesia. In the re-surgery, vascular and nerve injury was found, leading to permanent disabling sequelae., Discussion: The early stage of DD, although symptomatic, without previous medical or infiltrative therapy, in a young subject with insulin-dependent diabetes and a high risk of recurrence contraindicated the surgical approach, especially palmar fasciotomy, according to the best evidence. The vascular-nervous lesion in the hand palm indicated a censurable surgical execution technique. The technical consultation ascertained the causal relationship between impairments and surgical malpractice, followed by compensation., Conclusion: The analysis of this case highlights the value of informed clinical practice to provide optimal care and mitigate the risks associated with the management of DD. The choice of possible treatment options must be tailored to the patient in accordance with the best evidence.

Hypoxic ischemic encephalopathy (HIE) in neonates can cause severe, life-long functional impairments or death. Treatment of these neonates can involve ethically challenging questions about if, when, and how it may be appropriate to limit life-sustaining medical therapy. Further, parents whose infants suffer severe neurologic damage may seek recourse in the form of a medical malpractice lawsuit. This study uses several hypothetical cases to highlight important ethical and legal considerations in the care of infants with HIE., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Only a few physicians are willing to comprehensively concern themselves with how a legally watertight treatment documentation should be structured, in addition to their practical activities; however, the importance of the documentation cannot be emphasized enough, not only for a potential case of liability but also for the medical (further) treatment. This article therefore illustrates the legal foundations of the mandatory documentation and the most important questions associated with it for the practice, in particular on the content of the documentation, the timing of the documentation, the preservation of treatment documents and on the conduct in cases of an impending incident., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

The last few years have seen a boom in the popularity of artificial intelligence (AI) around the world, and the health care sector has not been immune from what has been perceived by some as a revolutionary technology. Although AI has been around for many years, including in the field of health care, the recent introduction of consumer-facing generative AI tools has put a spotlight on the technology that has drawn attention from governments, corporations, consumers and more. Health care systems, physician groups, health insurance companies, and others in the space have shown an eagerness to explore AI's potential to improve various aspects of health care, but new legal risks and challenges are unfolding every day. This contribution looks at the latest health care-related measures in the United States and international legal and regulatory landscapes, as well as data privacy implications and discrimination concerns coming out of AI-enabled solutions. It also discusses concerns that health care systems and physicians alike are monitoring, including the potential for medical errors resulting from AI, liability considerations, and malpractice insurance trends., Competing Interests: Declaration of competing interest The author declares no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Many physicians, particularly neurosurgeons, face malpractice claims during their career. The aim of this paper is to identify which factors increase the risk of litigation and influence legal outcomes relating to cerebrospinal fluid shunt management. Westlaw, an online legal database, was used to identify all medico-legal cases pertaining to cerebrospinal fluid shunts. Information regarding plaintiff demographics, defendant specialties, reasons for litigation, and trial outcomes were analysed. Thirty-six cases met criteria for inclusion. Most cases returned a defence verdict (44.4%), with delayed treatment or failure to appropriately treat patients with shunts the most common reason for litigation (66.7%). The average plaintiff verdict payout was $4,888,136.75 and average settlement $1,362,307.69. Delay or failure to treat resulted in the largest average payouts for plaintiff verdicts and settlements ($5,329,299.14 and $1,531,500.00, respectively).

Background: This is the first study of Canadian thyroid and parathyroid surgery legal decisions, and the first study of surgical malpractice using the Canadian Legal Information Institute (CanLII) database. The objective was to identify quality improvement opportunities in surgical practice, to increase patient safety and satisfaction., Methods: Legal decisions relating to thyroid and parathyroid surgery in the CanLII database were screened. Cases were included if a surgeon was listed as applicant or respondent; they related to pre-, intra-, or post-operative management of thyroid or parathyroid disease; and malpractice was alleged. Cases were excluded if surgery was mentioned incidentally or for non-surgical focus., Results: Of the 347 unique legal decisions screened, 14 met inclusion and exclusion criteria. Surgeries occurred between 1976 and 2012, with 13 thyroid surgeries, 1 parathyroidectomy, and 4 mortalities., Conclusions: Quality improvement lessons include communication, pre-operative patient education and documentation of risks discussed, and in-person assessment of complications., Competing Interests: Declaration of competing interest The authors do not report any conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Aim: To investigate the extent and impact of litigation on the UK physiotherapy profession., Design: An online cross-sectional questionnaire survey design was used. The survey was open to all qualified physiotherapists who have practiced in the UK, from any speciality, of any grade and from any setting including NHS, non-NHS, and private practice., Results: 688 respondents completed the survey (96% CI). All UK nations were represented. 73% were female, 44% were qualified >20 Years. Most worked in the NHS (74%) and worked in a neuromusculoskeletal setting (62%). 10% of respondents had been involved in litigation. 128 claims were reported with some respondents being involved in more than 1 case. Litigation was a highly stressful experience for those who experienced it and was a source of concern for many others. The personal impact was stress (76%) and worry and anxiety (67%). The most common professional impact was defensive practice (68%). Most respondents incorrectly identified who should provide their legal support. 46% were not satisfied with the support received. Most (77%) reported that litigation training should be included in pre-registration, as well as postgraduate (68%) programs., Conclusion: This is the first UK survey that has investigated the experiences of litigation on the UK physiotherapy profession. Ten percent of physiotherapists in our survey had been involved in litigation. Litigation impacted physiotherapists' physical and mental wellbeing and their clinical practice. Improved support, both emotional and legal is required. Clinical negligence training should be included in pre-registration and postgraduate programs. CONTRIBUTION OF THE PAPER., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Given high patient expectations in the setting of complex surgeries, orthopedic surgeons are at risk of being subject to malpractice claims which can impose significant economic and psychological burden. This study investigates malpractice claims against orthopedic surgeons and podiatrists performing hindfoot arthrodesis and determine factors associated with plaintiff verdicts and settlements using the Westlaw legal database. The database was queried for all cases involving hindfoot arthrodesis using the terms "malpractice" and either "ankle fusion," "arthrodesis," "subtalar fusion," "tibiotalar fusion," "tibiotalocalcaneal fusion," "TTC fusion," or "tibiofibular fusion" from 1987 to 2023. Data regarding patient demographics, causes cited for litigation, case outcomes, and indemnity settlements were collected. Cases were excluded if the defendant was not an orthopedic surgeon or a podiatrist, the procedure involved was not a hindfoot arthrodesis, or if the patient was a minor. Forty-five cases of hindfoot arthrodesis met the inclusion criteria. The mean plaintiff age was 51.5 ± 13.8 years with 51.1% male. Thirty-three cases (73%) were in favor of the defendant, with an average inflation-adjusted payout of $853,863 (±456,179). The most alleged category of negligence was procedural/intraoperative error (75%) followed by postsurgical error (38%) and failure to inform (31%). The most common specific damages included functional/ROM limitation (49%), need for additional surgery (47%), continuing/worsened pain (27%), and nonunion/malunion (29%). Given the frequency of hindfoot arthrodesis performed, this study highlights the importance of effective communication with patients concerning potential postoperative complications, prognosis of their injury, and risks and benefits associated with each treatment modality., (Copyright © 2024 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Introduction: Total hip arthroplasty (THA) is one of the most frequent orthopedic surgery procedures, and orthopedic surgeons are among the most frequently accused of malpractice by their patients. Identifying the main reasons for malpractice claims after THA is a prior condition to reducing their frequency. The quality of the preoperative risk information given to the patient by the surgeon is crucial for these purposes. Data specific to THA are sparse in France, and we therefore conducted a retrospective study (1) to determine whether the outcome of medico-legal expert appraisal correlated with the quality and traceability of preoperative information, and (2) to identify the most frequent grounds for complaint after primary THA., Hypothesis: The quality of patient information partly determines expert appraisal., Material and Method: A retrospective study was conducted based on data from the Branchet medical professional insurance agency for malpractice claims following THA over the period 2014-2017, with 240 complete files, for 125 women and 115 men. Data comprised: type of procedure, main grounds of complaint (complications), positive or negative expert appraisal, quality of preoperative patient information, amounts of compensation accorded and fees paid, and the practitioner's liability. We assessed correlations between information quality and liability., Results: Surgical site infection and neurologic deficit were the two main grounds for malpractice claims. In the 240 files, cases for 106 operations (44.2%) were submitted to arbitration, 95 (39.6%) were brought to court, and 39 (16.2%) were settled out of court. The practitioner was held at least partly liable in 40 files (16.7%). Information to the patient was deemed imperfect or poor for 119 files (49.6%) and good in 121 (50.4%). Mean compensation was €30,940 (range, €0 to €198,100). In 27 of the 40 cases of liability (67.5%), the information to the patient was deemed imperfect or poor. Twenty-six of the 40 cases (65%) were settled out of court. In case of poor information, there was a significant risk for the practitioner to be held liable: 7.5 vs. 25% (p=0.003)., Discussion: The present study listed the main complications underlying malpractice claims after THA: infection, neurologic complications, and limb-length discrepancy. This should enable practitioners to improve patient information so as to reduce the rate of malpractice claims or at least decrease the practitioner's liability, as the study found a correlation between information quality and expert appraisal., Level of Evidence: IV; retrospective study., (Copyright © 2024. Published by Elsevier Masson SAS.)

More than 75% of emergency physicians will be named in a malpractice suit over the course of their careers. When a case is brought to trial, it is the chart that will be the primary source of information, not the faded memories of an encounter that happened years in the past. Being mindful of all 3 audiences that the chart is generated for and developing techniques to adequately address all 3 should be the focus of the clinician when documenting a patient encounter., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Chest pain is a common chief complaint in the emergency department. When looking at patients with chest pain cases of acute coronary syndrome, pulmonary embolism and aortic dissection account for the majority of cases that involve an allegation of malpractice. While it is likely impossible to catch all these cases having a structured approach to these patients may improve outcomes for both patients and clinicians., Competing Interests: Disclosure The authors have no financial disclosures or conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

While clinical practice guidelines (CPGs) were developed to help improve patient care, they have increasingly been used as evidence in medical malpractice lawsuits. They are used by both sides in malpractice litigation as a surrogate for the standard of care. Providing care compliant with a CPG can be protective for physicians, but it does not completely absolve them of liability. Providing noncompliant care does carry an increased risk of litigation, but there are several defenses that have been successfully used to defend physicians. Effective communication and comprehensive documentation help mitigate the risk incurred by not following a CPG., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Abdominal pain accounts for approximately 10% of emergency department visits and 4% to 6% of litigation. Clinical history and examination are important, as all diagnostic testing has limitations. Specific pathologies, such as appendicitis, warrant a review of factors increasing risk. In all cases, documentation of prompt communication with consultants can be protective in the event of any unforeseen delays in care. Careful attention should be paid to special populations including patients with cancer, diabetes, and patients with postsurgical, geriatric, and bariatric surgery., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The majority of physicians will face at least one medical malpractice claim over the course of their careers. The stress caused by medical malpractice claims can lead to litigation stress or malpractice stress syndrome. Physicians experiencing a claim may have strained family relationships, worsening anxiety and depression, and burnout, and have higher rates of medical errors. In such cases, physicians should seek support of their legal counsel and from a licensed professional therapist. Above all, physicians should remember that malpractice claims are an occupational hazard and not a sign that they are a bad physician., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Misdiagnosis in Emergency Medicine can be associated with patient harm, with neurologic diagnoses among the most common conditions to confound physicians. These are often complex, time-sensitive and nuanced, offering opportunity for mimics and chameleons to make assessment, diagnosis and treatment challenging. This article discusses the legal considerations pertinent to neurologic diagnoses for the emergency physician, including assessment, diagnosis, treatment, transfer and documentation in order to ensure excellent patient care as well as protection from liability., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Headache is a common complaint of patients in the emergency department. The large majority of them have self-limited causes but some have life, limb, brain, or vision-threatening secondary causes. The job of the emergency physicians is to distinguish the 2 groups. This article focuses on clinical tips to avoid or at least mitigate medico-legal risk in patients with headache. Each process of care-history, physical examination, laboratory testing, brain imaging, spinal fluid analysis, specialist consultation, and documentation-will be considered., Competing Interests: Disclosure The author reviews medical malpractice cases, some of which deal with acute headache, for both plaintiff and defense firms., (Copyright © 2024 Elsevier Inc. All rights reserved.)

For emergency medicine physicians, being named in a malpractice suit is not an if, it is a when. By the age of 55 years, 68% of emergency physicians have been sued. In the following article, we review the most common factors shared by closed claims in adult and pediatric patients from emergency departments and acute care settings. Our hope is that by identifying shared characteristics, we may improve patient care and reduce litigation risk., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Meningitis, appendicitis, and testicular torsion are among the most common conditions resulting in malpractice litigation in Pediatric Emergency Medicine. With meningitis, most litigation claims involved patients <2 years old. Notably, 25% of patients had no fever and many lacked classic signs of meningitis. For appendicitis, nearly 3/4 of litigated cases claimed delayed/missed diagnosis. A non-diagnostic ultrasound (eg, no appendix visualized) has a negative predictive value of only 86%. Finally, testicular torsion carries a 34-42% testicular loss rate and 10% of patients with torsion only present with isolated abdominal pain. Atypical presentations must be considered and clear return precautions are imperative., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Good decision-making, solid notes that show care and a reasonable thought process, and skillful interpersonal dealings with patients and loved ones are keys to avoiding claims and lawsuits related to care in the emergency department (ED). This means taking measures to control the brisk assembly line of work in the ED so that important steps such as assessment, testing, treatment, and communication promptly occur without any dilution in quality. It is crucial that the physician in the ED displays excellent bedside manner, including dealing with an increasing challenging patient population and the family and friends who often accompany them., Competing Interests: Disclosure The author has nothing to disclose concerning financial interests. Artificial intelligence was a help in creating some of the original images in this article., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Medical malpractice is an inevitable truth of being a practicing provider. Despite awareness of malpractice risk, education on understanding the legal landscape and protecting oneself from being named in a malpractice claim is sorely underrepresented in medical school and residency curricula. This review summarizes what is known about the legal risks to the resident in training and the attending physician supervisor. It also explores the legal landscape for physicians practicing and supervising telehealth encounters., Competing Interests: Disclosure The opinions expressed in this article are solely the author’s and do not represent the views of Troutman Pepper. This article is for informational purposes only and does not constitute legal advice. Please consult with a qualified legal professional for advice specific to your situation., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The balance between risk of missing serious disease and potential harms from over testing involves knowledge of the literature, familiarity of clinical guidelines, incorporation of clinical decision tools where appropriate, use of metacognition to be aware of cognitive decisions to respond and use of shared decision-making in the context of a patient's presentation and with the guidance of the clinician., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Surgical procedures carry certain risks of complications, which need to be considered and discussed when any procedure is suggested to a patient. In this article, some ethical problems will be discussed concerning the communication of problems after they have occurred. Some clinical case studies will serve to clarify the need for having standards of ethical behavior, even in difficult situations. Further information will be given from experience gained from a medicolegal commission for malpractice complaints., (© 2025. The Author(s).)

Qualified physicians have an ethical duty to participate as expert witnesses in court proceedings. Most of those court proceedings relate to issues of medical negligence which fall under civil law. The physician expert witness needs to understand the duties and expectations of conduct and be willing to work collaboratively with attorneys as part of the legal team. Physicians risk discipline from state medical boards and professional societies if they provide dishonest testimony. Ethical remuneration for the services should be based on hourly rates consistent with the time spent and not on the outcome of a case., Competing Interests: Disclosure The author confirms that the author or the author’s relatives have no financial or other interest in the subject/matter of this submitted work in which the author has written, which may be considered as constituting a real, potential, or apparent conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The current study is an explanatory analysis of Dutch disciplinary law regarding aortic aneurysm and aortic dissection care. We aim to give insight in the way disciplinary judges rule on quality of care and to extract the lessons to be learned., Methods: The online open-access governmental database, which includes all disciplinary rulings since 2010, was searched using search terms related to aortic aneurysm and dissection care. First, abstracts were screened for relevance. Thereafter, the full text of all remaining cases was read. Cases related to the diagnosis, treatment, or the postoperative phase of an aortic aneurysm or aortic dissection were included. Characteristics were registered and analyzed for quantitative assessment. Each case was summarized and coded for qualitative analysis., Results: Forty-eight first-instance cases were included, of which 19 (40%) were founded. Reprimands (n = 9) and warnings (n = 7) were the prevailing measures. Seven out of 8 appeal cases filed by plaintiffs were unfounded. Six out of 9 appeals filed by defendants were adjudged and led to a less severe measure. Most cases concerned the subject of 'wrong treatment/wrong diagnosis' (75%). Whether not recognizing an aneurysm or dissection led to disciplinary culpability depended on case-specific circumstances, and much importance was attached to adequate documentation. In many complaints, an element of inadequate communication was recognized., Conclusions: Patient-involvement, clear communication, and implementing changes after a mistake could increase patient satisfaction, avert complaints, and prevent time-consuming trials. Maintaining adequate documentation and having knowledge on the analytical framework of the court is beneficial when confronted with a complaint., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Developments in preconception and prenatal technologies have led to undeniable advances in how health-care providers screen and treat patients. Despite these advances, at any point errors can occur leading to misdiagnosis or a missed diagnosis. In some instances, the missed information can lead to the birth of a child with health issues where short of the error, the decision to avoid conception or terminate the pregnancy might have been made. When these lapses unfold, there exists the potential for a wrongful birth or wrongful life lawsuit to ensue. While these 2 actions are based on the same set of events, they are distinct legal claims with varying degrees of judicial permissibility. Global legal acceptability of wrongful birth and life lawsuits tends to resemble patterns in the United States. Analyzing prior wrongful birth and wrongful life claims can reveal common trends in events leading to these types of lawsuits, as well as an understanding of their potential outcomes. A familiarity with wrongful birth and wrongful life lawsuits demonstrates how these cases are unique from other forms of prenatal or birth injury tort lawsuits and can provide insights to common shortcomings in clinical practice. Applying these lessons to clinical practice highlights key approaches towards limiting the risk of certain errors leading to wrongful birth and wrongful life lawsuits, with the goal of health-care providers offering high quality health care., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Previous research suggests that medico-legal complaints often arise from various factors influencing patient dissatisfaction, including medical errors, physician-patient relationships, communication, trust, informed consent, perceived quality of care, and continuity of care. However, these findings are not typically derived from actual patients' cases. This study aims to identify factors impacting the interpersonal dynamics between physicians and patients using real patient cases to understand how patients perceive doctor-patient relational problems that can lead to dissatisfaction and subsequent medico-legal complaints., Methods: We conducted a retrospective study using data from closed medical regulatory authority complaint cases from the Canadian Medical Protective Association (CMPA) between January 1, 2015, and December 31, 2020. The study population included patients who experienced sepsis and survived, with complaints written by the patients themselves. A multi-stage standardized thematic analysis using Braun and Clarke's approach was employed. Two researchers independently coded the files to ensure the reliability of the identified codes and themes., Results: Thematic analysis of 50 patient cases revealed four broad themes: (1) Ethics in physician's work, (2) Quality of care, (3) Communication, and (4) Healthcare system/policy impacting patient satisfaction. Key sub-themes included confidentiality, honesty, patient involvement, perceived negligence, perceived lack of concern, active engagement and empathy, transparency and clarity, informed consent, respect and demeanor, lack of resources, long wait times, and insufficient time with physicians., Conclusions: This study identifies and categorizes various factors impacting relational issues between physicians and patients, aiming to increase patient satisfaction and reduce medico-legal cases. Improving physicians' skills in areas such as communication, ethical practices, and patient involvement, as well as addressing systemic problems like long wait times, can enhance the quality of care and reduce medico-legal complaints. Additional training in communication and other skills may help promote stronger relationships between physicians and patients., (© 2024. The Author(s).)

The incidence of medical negligence claims is well documented in South Africa (SA). Civil and criminal processes are in place to deal with this, and the matter may be reported to the Health Professions Council of SA (HPCSA). There is a school of thought that suggests that these processes do not provide sufficient relief to an affected party. The processes are not always satisfactory; an aggrieved party may wish to know the reasons why a particular error occurred and why a healthcare practitioner acted in a particular manner. In addition to this, they may want to receive a sincere apology. Medical practitioners may also want to communicate with patients or family members of a patient who has passed away as a result of an iatrogenic event, but may be fearful of litigation. This article considers the current position in SA in relation to issuing an apology related to an iatrogenic event, and consults foreign jurisdictions for further guidance on the topic.

Postgraduate students or physicians in training are bound to make mistakes. In medical negligence litigation involving the postgraduate students, the supervising faculty members as well as the hospital where the alleged act has occurred could also be found liable. In this review article, the applicable legal principles and a brief summary of the case laws are presented., (© Journal of the Association of Physicians of India 2024.)

Background: Dental malpractice claims, which pertain to legal actions against dentists accused of clinical negligence that caused harm to patients, have increased in the past ten years in South Korea. The claims are caused by complications, particularly trigeminal nerve injuries, resulting from various dental procedures. Medicolegal issues related to trigeminal nerve injury have not been previously described in South Korea. Therefore, in this study, we aimed to identify the general, dental, and judicial characteristics of closed dental malpractice claims., Methods: This study was designed as a descriptive study. We collected the data of 51 closed claims related to trigeminal nerve injury resulting from dental procedures such as dental implant emplacement, tooth extraction, and local anesthesia. The claims were decided by courts in South Korea between 2016 and 2023. The general, dental, and judicial characteristics of the claims were analyzed retrospectively., Results: The average claim resolution period was 4.2 (range: 1.47-8.39) years post-adverse events that occurred more frequently in dental clinics (68.6 %) than in dental (25.5 %) or general hospitals (5.9 %). Inferior alveolar (66.7 %) and lingual (17.6 %) nerves were injured following dental procedures. The duty to inform was breached in 68.6 % of claims. The dental procedure performed (P < 0.001) and the injured nerve (P < 0.001) were associated with the violation of the duty to care., Conclusion: To improve the quality of dental care services, the analysis of the adverse events using various resources including judgments should be strongly addressed., Competing Interests: Declaration of competing interest The author declares no conflicts of interest., (Copyright © 2024 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Background: The reasons for malpractice litigation in elbow surgery are not well understood. The aim of this study is to report the most frequently litigated surgeries of the elbow and analyze the reasons for litigation and case outcomes., Methods: A retrospective review of the Westlaw legal database was performed, and all federal and state jurisdiction litigation cases involving the elbow from 2000 to 2023 were queried. Cases were excluded if they did not involve an orthopedic surgeon, nor primary elbow injury or procedure. Cases were reviewed for demographic information, surgical procedure based on reference Current Procedural Terminology codes, complications, symptoms, and reasons for litigation. Quantitative information, including settlement and indemnity cost to the defendant orthopedic surgeon, was analyzed. Cases were subdivided based on United States Census Bureau regions and states to assess regional frequency of litigation with analyses of variance., Results: There were 59 cases meeting inclusion criteria from 2000 to 2023. The most litigated cases involved were ulnar nerve transposition/release and open reduction and internal fixation of the proximal radius and/or ulna at the elbow. The most litigated complication was claimed nerve damage (46%) and permanent disability (27%). Of the total cases, the most frequently litigated symptoms were nerve damage (46%) and loss of function (37%), whereas the least frequent was postoperative stiffness (2%). The Pacific region demonstrated the highest litigation rate (20%), whereas the East South Central, Mountain, and New England regions had the lowest litigation rate (3% each). A favorable verdict was given to the defendant orthopedic surgeon in 59% of the cases. The average loss incurred through settlement was $245,590, whereas the average indemnity paid through verdict was $523,334., Conclusion: Operative fixation of the proximal ulna/radius and ulnar nerve release/transposition are the most litigated procedures of the elbow. Litigation is most associated with nerve injury. Across Census Bureau regions, there is no significant difference in monetary cost incurred through settlements and verdict losses. Although a majority of litigated cases are won by the defending orthopedic surgeon, thorough informed consent and perioperative expectation management may mitigate litigation risk., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)