Allegations of failure to obtain informed consent in spinal surgery medical malpractice claims

Jennifer Grauberger, Panagiotis Kerezoudis, Asad J. Choudhry, Mohammed Ali Alvi, Ahmad Nassr, Bradford Currier, Mohamad Bydon

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

IMPORTANCE Predictive factors associated with increased risk of medical malpractice litigation have been identified, including severity of injury, physician sex, and error in diagnosis. However, there is a paucity of literature investigating informed consent in spinal surgery malpractice. OBJECTIVE To investigate the failure to obtain informed consent as an allegation in medical malpractice claims for patients undergoing a spinal procedure. DESIGN, SETTING, AND PARTICIPANTS In this retrospective cohort study, a national medicolegal database was searched for malpractice claim cases related to spinal surgery for all years available (ie, January 1, 1980, through December 31, 2015). MAIN OUTCOMES AND MEASURES Failure to obtain informed consent and associated medical malpractice case verdict. RESULTS A total of 233 patients (117 [50.4%] male and 116 [49.8%] female; 80 with no informed consent allegation and 153 who cited lack of informed consent) who underwent spinal surgery and filed a malpractice claim were studied (mean [SD] age, 47.1 [13.1] years in the total group, 45.8 [12.9] years in the control group, and 47.9 [13.3] years in the informed consent group). Median interval between year of surgery and year of verdict was 5.4 years (interquartile range, 4-7 years). The most common informed consent allegations were failure to explain risks and adverse effects of surgery (52 [30.4%]) and failure to explain alternative treatment options (17 [9.9%]). In bivariate analysis, patients in the control group were more likely to require additional surgery (45 [56.3%] vs 53 [34.6%], P = .002) and have more permanent injuries compared with the informed consent group (46 [57.5%] vs 63 [42.0%], P = .03). On multivariable regression analysis, permanent injuries were more often associated with indemnity payment after a plaintiff verdict (odds ratio [OR], 3.12; 95%CI, 1.46-6.65; P = .003) or a settlement (OR, 6.26; 95%CI, 1.06-36.70; P = .04). Informed consent allegations were significantly associated with less severe (temporary or emotional) injury (OR, 0.52; 95%CI, 0.28-0.97; P = .04). In addition, allegations of informed consent were found to be predictive of a defense verdict vs a plaintiff ruling (OR, 0.41; 95%CI, 0.17-0.98; P = .046) or settlement (OR, 0.01; 95%CI, 0.001-0.15; P > .001). CONCLUSIONS AND RELEVANCE Lack of informed consent is an important cause of medical malpractice litigation. Although associated with a lower rate of indemnity payments, malpractice lawsuits, including informed consent allegations, still present a time, money, and reputation toll for physicians. The findings of this study can therefore help to improve preoperative discussions to protect spinal surgeons from malpractice claims and ensure that patients are better informed.

Original languageEnglish (US)
Article numbere170544
JournalJAMA Surgery
Volume152
Issue number6
DOIs
StatePublished - Jun 1 2017

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Malpractice
Informed Consent
Odds Ratio
Wounds and Injuries
Jurisprudence
Insurance
Physicians
Control Groups
Cohort Studies
Retrospective Studies
Regression Analysis
Outcome Assessment (Health Care)
Databases

ASJC Scopus subject areas

  • Surgery

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Grauberger, J., Kerezoudis, P., Choudhry, A. J., Alvi, M. A., Nassr, A., Currier, B., & Bydon, M. (2017). Allegations of failure to obtain informed consent in spinal surgery medical malpractice claims. JAMA Surgery, 152(6), [e170544]. https://doi.org/10.1001/jamasurg.2017.0544

Allegations of failure to obtain informed consent in spinal surgery medical malpractice claims. / Grauberger, Jennifer; Kerezoudis, Panagiotis; Choudhry, Asad J.; Alvi, Mohammed Ali; Nassr, Ahmad; Currier, Bradford; Bydon, Mohamad.

In: JAMA Surgery, Vol. 152, No. 6, e170544, 01.06.2017.

Research output: Contribution to journalArticle

Grauberger, J, Kerezoudis, P, Choudhry, AJ, Alvi, MA, Nassr, A, Currier, B & Bydon, M 2017, 'Allegations of failure to obtain informed consent in spinal surgery medical malpractice claims', JAMA Surgery, vol. 152, no. 6, e170544. https://doi.org/10.1001/jamasurg.2017.0544
Grauberger J, Kerezoudis P, Choudhry AJ, Alvi MA, Nassr A, Currier B et al. Allegations of failure to obtain informed consent in spinal surgery medical malpractice claims. JAMA Surgery. 2017 Jun 1;152(6). e170544. https://doi.org/10.1001/jamasurg.2017.0544
Grauberger, Jennifer ; Kerezoudis, Panagiotis ; Choudhry, Asad J. ; Alvi, Mohammed Ali ; Nassr, Ahmad ; Currier, Bradford ; Bydon, Mohamad. / Allegations of failure to obtain informed consent in spinal surgery medical malpractice claims. In: JAMA Surgery. 2017 ; Vol. 152, No. 6.
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abstract = "IMPORTANCE Predictive factors associated with increased risk of medical malpractice litigation have been identified, including severity of injury, physician sex, and error in diagnosis. However, there is a paucity of literature investigating informed consent in spinal surgery malpractice. OBJECTIVE To investigate the failure to obtain informed consent as an allegation in medical malpractice claims for patients undergoing a spinal procedure. DESIGN, SETTING, AND PARTICIPANTS In this retrospective cohort study, a national medicolegal database was searched for malpractice claim cases related to spinal surgery for all years available (ie, January 1, 1980, through December 31, 2015). MAIN OUTCOMES AND MEASURES Failure to obtain informed consent and associated medical malpractice case verdict. RESULTS A total of 233 patients (117 [50.4{\%}] male and 116 [49.8{\%}] female; 80 with no informed consent allegation and 153 who cited lack of informed consent) who underwent spinal surgery and filed a malpractice claim were studied (mean [SD] age, 47.1 [13.1] years in the total group, 45.8 [12.9] years in the control group, and 47.9 [13.3] years in the informed consent group). Median interval between year of surgery and year of verdict was 5.4 years (interquartile range, 4-7 years). The most common informed consent allegations were failure to explain risks and adverse effects of surgery (52 [30.4{\%}]) and failure to explain alternative treatment options (17 [9.9{\%}]). In bivariate analysis, patients in the control group were more likely to require additional surgery (45 [56.3{\%}] vs 53 [34.6{\%}], P = .002) and have more permanent injuries compared with the informed consent group (46 [57.5{\%}] vs 63 [42.0{\%}], P = .03). On multivariable regression analysis, permanent injuries were more often associated with indemnity payment after a plaintiff verdict (odds ratio [OR], 3.12; 95{\%}CI, 1.46-6.65; P = .003) or a settlement (OR, 6.26; 95{\%}CI, 1.06-36.70; P = .04). Informed consent allegations were significantly associated with less severe (temporary or emotional) injury (OR, 0.52; 95{\%}CI, 0.28-0.97; P = .04). In addition, allegations of informed consent were found to be predictive of a defense verdict vs a plaintiff ruling (OR, 0.41; 95{\%}CI, 0.17-0.98; P = .046) or settlement (OR, 0.01; 95{\%}CI, 0.001-0.15; P > .001). CONCLUSIONS AND RELEVANCE Lack of informed consent is an important cause of medical malpractice litigation. Although associated with a lower rate of indemnity payments, malpractice lawsuits, including informed consent allegations, still present a time, money, and reputation toll for physicians. The findings of this study can therefore help to improve preoperative discussions to protect spinal surgeons from malpractice claims and ensure that patients are better informed.",
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N2 - IMPORTANCE Predictive factors associated with increased risk of medical malpractice litigation have been identified, including severity of injury, physician sex, and error in diagnosis. However, there is a paucity of literature investigating informed consent in spinal surgery malpractice. OBJECTIVE To investigate the failure to obtain informed consent as an allegation in medical malpractice claims for patients undergoing a spinal procedure. DESIGN, SETTING, AND PARTICIPANTS In this retrospective cohort study, a national medicolegal database was searched for malpractice claim cases related to spinal surgery for all years available (ie, January 1, 1980, through December 31, 2015). MAIN OUTCOMES AND MEASURES Failure to obtain informed consent and associated medical malpractice case verdict. RESULTS A total of 233 patients (117 [50.4%] male and 116 [49.8%] female; 80 with no informed consent allegation and 153 who cited lack of informed consent) who underwent spinal surgery and filed a malpractice claim were studied (mean [SD] age, 47.1 [13.1] years in the total group, 45.8 [12.9] years in the control group, and 47.9 [13.3] years in the informed consent group). Median interval between year of surgery and year of verdict was 5.4 years (interquartile range, 4-7 years). The most common informed consent allegations were failure to explain risks and adverse effects of surgery (52 [30.4%]) and failure to explain alternative treatment options (17 [9.9%]). In bivariate analysis, patients in the control group were more likely to require additional surgery (45 [56.3%] vs 53 [34.6%], P = .002) and have more permanent injuries compared with the informed consent group (46 [57.5%] vs 63 [42.0%], P = .03). On multivariable regression analysis, permanent injuries were more often associated with indemnity payment after a plaintiff verdict (odds ratio [OR], 3.12; 95%CI, 1.46-6.65; P = .003) or a settlement (OR, 6.26; 95%CI, 1.06-36.70; P = .04). Informed consent allegations were significantly associated with less severe (temporary or emotional) injury (OR, 0.52; 95%CI, 0.28-0.97; P = .04). In addition, allegations of informed consent were found to be predictive of a defense verdict vs a plaintiff ruling (OR, 0.41; 95%CI, 0.17-0.98; P = .046) or settlement (OR, 0.01; 95%CI, 0.001-0.15; P > .001). CONCLUSIONS AND RELEVANCE Lack of informed consent is an important cause of medical malpractice litigation. Although associated with a lower rate of indemnity payments, malpractice lawsuits, including informed consent allegations, still present a time, money, and reputation toll for physicians. The findings of this study can therefore help to improve preoperative discussions to protect spinal surgeons from malpractice claims and ensure that patients are better informed.

AB - IMPORTANCE Predictive factors associated with increased risk of medical malpractice litigation have been identified, including severity of injury, physician sex, and error in diagnosis. However, there is a paucity of literature investigating informed consent in spinal surgery malpractice. OBJECTIVE To investigate the failure to obtain informed consent as an allegation in medical malpractice claims for patients undergoing a spinal procedure. DESIGN, SETTING, AND PARTICIPANTS In this retrospective cohort study, a national medicolegal database was searched for malpractice claim cases related to spinal surgery for all years available (ie, January 1, 1980, through December 31, 2015). MAIN OUTCOMES AND MEASURES Failure to obtain informed consent and associated medical malpractice case verdict. RESULTS A total of 233 patients (117 [50.4%] male and 116 [49.8%] female; 80 with no informed consent allegation and 153 who cited lack of informed consent) who underwent spinal surgery and filed a malpractice claim were studied (mean [SD] age, 47.1 [13.1] years in the total group, 45.8 [12.9] years in the control group, and 47.9 [13.3] years in the informed consent group). Median interval between year of surgery and year of verdict was 5.4 years (interquartile range, 4-7 years). The most common informed consent allegations were failure to explain risks and adverse effects of surgery (52 [30.4%]) and failure to explain alternative treatment options (17 [9.9%]). In bivariate analysis, patients in the control group were more likely to require additional surgery (45 [56.3%] vs 53 [34.6%], P = .002) and have more permanent injuries compared with the informed consent group (46 [57.5%] vs 63 [42.0%], P = .03). On multivariable regression analysis, permanent injuries were more often associated with indemnity payment after a plaintiff verdict (odds ratio [OR], 3.12; 95%CI, 1.46-6.65; P = .003) or a settlement (OR, 6.26; 95%CI, 1.06-36.70; P = .04). Informed consent allegations were significantly associated with less severe (temporary or emotional) injury (OR, 0.52; 95%CI, 0.28-0.97; P = .04). In addition, allegations of informed consent were found to be predictive of a defense verdict vs a plaintiff ruling (OR, 0.41; 95%CI, 0.17-0.98; P = .046) or settlement (OR, 0.01; 95%CI, 0.001-0.15; P > .001). CONCLUSIONS AND RELEVANCE Lack of informed consent is an important cause of medical malpractice litigation. Although associated with a lower rate of indemnity payments, malpractice lawsuits, including informed consent allegations, still present a time, money, and reputation toll for physicians. The findings of this study can therefore help to improve preoperative discussions to protect spinal surgeons from malpractice claims and ensure that patients are better informed.

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