Orthopaedic litigation in South Africa : a review of the Medical Protection Society data base involving orthopeadic members over the last 10 years

Abstract

BACKGROUND Medical litigation, especially against orthopaedic surgeons, is a worldwide phenomenon with a marked upward trend in the developed nations. There has been a 20% increase over the last five years in South Africa alone. The purpose of the study was to review the cases involvingMedical Protection Society (MPS). members in RSA, identify trends and review the literature to see what can be done to prevent litigation. METHODS A retrospective review was conducted (1 January 2000 to 31 December 2009) of all anonymised orthopaedic cases reported to the MPS. The total number of cases reviewed was 1 186. Furthermore, a review of the literature was conducted to identify possible strategies to reduce litigation cases. RESULTS The results revealed that spinal surgery was the group most commonly litigated against, accounting for 11.6% of all cases. Second most common were the cases in which the patient deemed to have had an unsatisfactory result (10.5%). Following these were cases of: communication problems (6.9%), billing problems (6.6%), missed diagnosis (5%), gross negligence/unavailability (4.7%), medical report problems (3.9%), wrong site surgery (3.5%), failed surgery (3.4%), nerve injury (3.4%), death (2.7%), infection (1.9%), arthroscopy (1.8%), retained instruments (1.6%), POP complications (1.5%), diathermy and other burns (1.3%), consent (1%), vascular (0.9%) and compartment syndrome (0.67%). The current international literature reveals that most of the cases leading to litigation are caused by poor communication between the surgeon and patient. This can be prevented by attending a communication skills workshop (as presented by the MPS).Wrong site surgery still occurs worldwide and is indefensible in a court of law but is easily prevented by following the universal protocol for preventing wrong site, wrong procedure and wrong person surgery (explained later in the article). Consent remains vital before any surgical case and a record of the discussion pertaining to the consent should be documented in your clinical notes.Missed vascular injury has a highmorbidity and by having a high index of suspicion and using the ankle brachial pulse index the incidence can be brought down. Product liability cases are surfacing as the law changes and orthopaedic surgeons start to help designing products.