Malpractice claims associated with foot surgery

Abstract

Surgery of the foot constitutes a sub-stantial portion of orthopedic procedures, performed by both orthopedic surgeons and doctors of podiatric medicine. Little research exists on the medicolegal implications of foot surgery amongst these special-ties. This study seeks to investigate the different medical and legal factors associated with foot surgery-based malpractice litiga-tion. Malpractice data between 2004 and 2017 was collected using the VerdictSearch legal database. Cases involving foot surgery were identified, and case information including physician specialty, procedure, medical outcome, verdict, and payment amount were obtained. A total of 72 cases were analyzed. A majority of lawsuits involved podiatrists (76.4%), with orthopedic surgeons accounting for 15.3%. Lawsuits against podiatrists primarily occurred over elective procedures (94.5%) and most frequently involved plaintiff com-plaints of persistent pain (41.8%) or defor-mation (27.3%). Podiatrist cases most often involved allegations of failure to treat (45.5%) or inappropriate surgical procedure (27.3%). Orthopedic surgeons saw higher rates of urgent cases (45.5%), with surgical complications (27.3%) occurring at higher rates than podiatrists. Despite different trends in case types, similar rates ofNoplaintiff victories, and mean payments were seen between podiatrists (25.5%, $911,884 ± 1,145,345) and orthopedic surgeons (27.3%, $975,555 ± 448,795). This investi-gation is the first to analyze malpractice trends amongst podiatrists and orthopedic surgeons. Differing factors related to medical and legal outcomes can suggest quality improvement targets for both specialties. This data may assist in reducing malpractice risk and refining patient care, particularly with regards to outlining risks, bene-fits, and alternatives during pre-operative counselling. Injuries and degenerative conditions involving the foot are common, with as much as a third of the US population suffer-ing foot and ankle pain.1,2 Surgical and non-surgical treatments of these injuries can be complicated both medically and legally due to anatomical and procedural complexities unique to the foot.3-6 Due to its primary elective nature, as well as the wide variety of surgical procures and documented difficul-ties with obtaining informed patient consent7,8 there can be a range of malpractice lawsuits related to foot and ankle surgery. Orthopedic surgeons, who frequently per-form these procedures, are one of the most frequently litigated medical subspecialties.9 Adding to the legal complexity, similar foot and ankle procedures are likewise performed by Doctors of Podiatric Medicine (DPMs) who have different training and credentialing pathways.10 There is limited research on malpractice trends in foot surgery, particularly compared to other orthopedic subspecialties.11-15 Research on malpractice litigation in then-commercialUnited Kingdom by Ring et al.16 found that 12.6% of settled orthopedics claims uswere related to foot and ankle, with allegations related to diagnosis the most frequent. Research concerning malpractice trends amongst podiatrists is further lacking in the literature, even as podiatrists continue to assume greater roles in both inpatient and outpatient treatment of foot conditions.17 Given the volume of procedures performed by both podiatrists and orthopedic surgeons and the high potential for litiga-tion, investigations into malpractice trends can provide valuable information to all specialties involved in foot surgery. This inves-tigation sought to observe characteristics of malpractice litigation cases concerning foot surgery, with focus on differences in medical and legal outcomes between specialties, as well as what types of medical error most commonly result in successful claims. This information can better inform physicians with regards to their consent process and pre-surgical counseling, and provide insight for hospitals and other facilities during the credentialing and privileging process.