February 1998 Bulletin

Malpractice/Dale R. Butler, MD

Review of 182 closed liability claims

A review of 182 closed liability claims of children, ranging in age from birth to 16 years, disclosed that the most frequent anatomical areas for claims were knee/leg (45), hip/thigh (36), elbow/forearm (35) and ankle/foot (24). Reviewers believe that actual malpractice occurred in 15 hip/thigh, 14 knee/leg, and 13 elbow/forearm cases. The review by the Committee on Professional Liability found 52 (29 percent) of the claims were settled with average indemnity costs of $114,270 and defense costs of $17,715.

As was the case in several other studies, the common causes of suits in these cases included failure to effectively communicate cast care and skin injury when removing a cast.

Wrong-site surgery was noted for three surgeries for DDH done on the wrong hip and arthroscopy on two wrong knees. Claims also were made for other operating room problems: failure to assure appropriate instruments for hardware removal were available before anesthesia; failure to remove all hardware (count items or take an X-ray); reliance on inadequate operative X-rays; and failure to supervise house staff or technicians in the operating room.

The committee suggests:

Spine Look for spine injury in polytrauma cases (three of four cases). Always take an X-ray for complaints of back pain. Donít correct neurofibromatosis scoliosis, fuse in situ.

Elbow Accept no fracture deformity, even in young children, and follow supracondylar fractures closely.

Forearm Check carefully for wrist and elbow injuries in forearm fractures. Document parental consent if a cosmetic deformity is accepted in sub-teens.

Knee Donít operate on painful knees without a proven objective diagnosis; get a second surgical opinion, if possible. Six of 23 suits resulted from peroneal nerve injury.

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