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Relation between negligent adverse events and the outcomes of medical-malpractice litigation
ABSTRACTS EDITED BY THOMAS J. LIESEGANG, MD
• Relation between negligent adverse events and the outcomes of medical-malpractice litigation. Brennan TA*, Sox CM, Burstin HR. N Engl J Med 1996;335:1963-1967.
T
gence performs poorly in malpractice litigation. — Thomas J. Liesegang * Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115.
HESE AUTHORS FROM THE HARVARD SCHOOL OF
Public Health have previously reported that the initiation of malpractice suits in New York State correlated poorly with the actual occurrence of ad verse events (injuries resulting from medical treat ment) and negligence as determined by independent physician reviewers. To assess the ability of malprac tice litigation to make accurate determinations, the authors studied 51 malpractice suits to identify factors that predict payment to plaintiffs. Forty-six of the 51 litigated cases studied over a 10-year period closed during the study period. Among these cases, 10 of the 24 that the authors had originally identified as involving no adverse event were settled for the plaintiffs (mean payment, $28,760), as were six of 13 cases classified as involving adverse events but no negligence (mean payment, $98,192) and five of nine cases in which adverse events due to negligence were found in the authors' assessment (mean payment, $201,250). In a multivariate analysis, disability (per manent vs temporary or none) was the only signifi cant predictor of payment (P = .03). There was no association between the occurrence of an adverse event due to negligence (P = .32) or an adverse event of any type (P = .79) and payment. The authors concluded that the severity of patient disability, not the occurrence of an adverse event or an adverse event due to negligence, was predictive of payment to the plaintiff and that the standard of medical negli
VOL.123, No. 5
• Primary vitrectomy without scleral buckling for rhegmatogenous retinal detachment. Heinmann H*, Bornfeld N, Friedrichs W, Helbig H, Kellner U, Korra A, Foerster MH. Graefes Arch Clin Exp Ophthalmol 1996;234:561-568.
A
CCEPTING THAT PARS PLANA VITRECTOMY IS THE
treatment of choice in complicated rhegmatoge nous retinal detachments, the authors questioned whether primary vitrectomy is the procedure of choice in less complicated forms of detachment. They per formed a retrospective analysis of 53 cases (followed up a mean of 17.8 months) undergoing primary vitrectomy and gas tamponade without additional scleral buckling at their hospital in Germany. The decision for primary vitrectomy was based on the surgeons' individual preferences. Preoperative findings included large retinal breaks, breaks with marked vitreous traction, unusual shape of breaks associated with lattice degeneration or radial extension posterior to the equator, multiple retinal breaks, vitreous hem orrhage, bullous detachment, preoperative proliferative vitreoretinopathy, and insufficient visibility of the fundus due to dense cataract or secondary cataract and miosis in pseudophakic eyes. Retinal reattachment was achieved in 64% of cases with one opera tion and in 92% with one or more operations.
ABSTRACTS
721
• Relation between negligent adverse events and the outcomes of medical-malpractice litigation. Brennan TA*, Sox CM, Burstin HR. N Engl J Med 1996;335:1963-1967.
T
gence performs poorly in malpractice litigation. — Thomas J. Liesegang * Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115.
HESE AUTHORS FROM THE HARVARD SCHOOL OF
Public Health have previously reported that the initiation of malpractice suits in New York State correlated poorly with the actual occurrence of ad verse events (injuries resulting from medical treat ment) and negligence as determined by independent physician reviewers. To assess the ability of malprac tice litigation to make accurate determinations, the authors studied 51 malpractice suits to identify factors that predict payment to plaintiffs. Forty-six of the 51 litigated cases studied over a 10-year period closed during the study period. Among these cases, 10 of the 24 that the authors had originally identified as involving no adverse event were settled for the plaintiffs (mean payment, $28,760), as were six of 13 cases classified as involving adverse events but no negligence (mean payment, $98,192) and five of nine cases in which adverse events due to negligence were found in the authors' assessment (mean payment, $201,250). In a multivariate analysis, disability (per manent vs temporary or none) was the only signifi cant predictor of payment (P = .03). There was no association between the occurrence of an adverse event due to negligence (P = .32) or an adverse event of any type (P = .79) and payment. The authors concluded that the severity of patient disability, not the occurrence of an adverse event or an adverse event due to negligence, was predictive of payment to the plaintiff and that the standard of medical negli
VOL.123, No. 5
• Primary vitrectomy without scleral buckling for rhegmatogenous retinal detachment. Heinmann H*, Bornfeld N, Friedrichs W, Helbig H, Kellner U, Korra A, Foerster MH. Graefes Arch Clin Exp Ophthalmol 1996;234:561-568.
A
CCEPTING THAT PARS PLANA VITRECTOMY IS THE
treatment of choice in complicated rhegmatoge nous retinal detachments, the authors questioned whether primary vitrectomy is the procedure of choice in less complicated forms of detachment. They per formed a retrospective analysis of 53 cases (followed up a mean of 17.8 months) undergoing primary vitrectomy and gas tamponade without additional scleral buckling at their hospital in Germany. The decision for primary vitrectomy was based on the surgeons' individual preferences. Preoperative findings included large retinal breaks, breaks with marked vitreous traction, unusual shape of breaks associated with lattice degeneration or radial extension posterior to the equator, multiple retinal breaks, vitreous hem orrhage, bullous detachment, preoperative proliferative vitreoretinopathy, and insufficient visibility of the fundus due to dense cataract or secondary cataract and miosis in pseudophakic eyes. Retinal reattachment was achieved in 64% of cases with one opera tion and in 92% with one or more operations.
ABSTRACTS
721