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Billions Paid Out for Surgical Errors

Surgical “never events”  –  such as leaving a sponge in a patient  –  cost healthcare professionals a minimum of $1.3 billion in malpractice payouts from 1990 to 2010, researchers found.

In an analysis of such surgical mishaps, a mean of $133,055 per event was paid out for 9,744 “never events” that resulted in permanent injury in 32.9% of patients, according to Martin Makary, MD, of Johns Hopkins University School of Medicine, and colleagues.

“These [malpractice] payments do not capture the even greater financial burdens of legal fees, additional inpatient and disability care, lost work days, and harm to the provider and hospital reputation,” they wrote online in the journal Surgery.

The researchers gathered data on the 9,744 paid malpractice settlements and judgments for surgical “never events” through the National Practitioner Data Bank (NPDB), a federal reserve of medical malpractice claims, from Sept. 1, 1990 to Sept. 30, 2010.

“Never events” were defined as retained foreign bodies, such as surgical sponges, in patients, surgery on the wrong site, surgery on the wrong patient, or the wrong surgical procedure carried out on the right patient.

The researchers included malpractice payments, patient outcomes, and provider characteristics in their analysis.

An estimated 4,082 “never event” claims occur annually during the study period, the researchers found.

Retention of foreign bodies was the most common event and occurred in nearly half of all cases (49.8%). Wrong procedure and wrong surgery site each occurred in roughly a quarter of cases (25.1% and 24.8%, respectively), and wrong-patient surgery occurred in less than half a percent of cases (0.3%).

Although most patients experienced only temporary injury (59.2%), permanent injury occurred in 32.9% of “never event” cases, and 6.6% of cases resulted in death. Cases of death were more common in patients 60 and older than in those younger than 60 (14.8% versus 4%).

The highest median payment was associated with wrong-procedure events ($106,777) and the lowest was associated with retained foreign bodies ($33,953).

By healthcare professional characteristics, physicians, ages 40 to 49, were responsible for the majority of reports (35.8%), followed by those ages 60 and older (14.4%). Nearly two-thirds of those involved in one malpractice case were also involved in at least one other (62%). Only 10% of those who were responsible for a “never event” were disciplined at least once by their state licensing board.

The authors found that physicians with clinical privilege or state licensure disciplinary action reports were more likely to be named in multiple “never event” reports than were those who had no reports of clinical privilege or disciplinary actions (adjusted odds ratio 1.73, 95% CI 1.47 to 2.03).

A great majority of “never event” malpractice claims were settled out of court (96%), while court judgments increased the odds of a higher-than average payment nearly threefold (aOR 2.75, 95% CI 2.18 to 3.47).

Events that resulted in death (aOR 5.88, 95% CI 4.07 to 8.50) or permanent injury (aOR 4.66, 95% CI 3.74 to 5.79) were more likely to pay higher than average than those resulting in temporary injury.

“Surgical ‘never events’ are being used increasingly as quality metrics in healthcare in the U.S.,” they cautioned, adding that “there is unanimous consensus that surgical ‘never events’ are preventable.”

The authors noted that safety training programs and better methods of reporting could help curb the costly and dangerous “never events.”

The authors also noted that their research was limited to paid malpractice claims; the NPDB does not capture events in which there was no settlement or payment. Also, payments and settlements made by corporate entities instead of physicians are exempt from NPDB reporting.

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