Pituitary and skull-base lesions and the litigious patient

Alan C. Wang, Spencer Darlin, Wanda Lai, Peter F. Svider, Jeffrey T. Jacob, James K. Liu, Jean Anderson Eloy, Adam J. Folbe

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background: The objective of this research was to evaluate litigation relating to the diagnosis and management of pituitary and ventral skull base lesions and delineate allegations involved in the decision to pursue medicolegal proceedings. Methods: Publically available federal and court records were accessed via the Westlaw Next database. Jury verdict and settlement reports relevant to pituitary and anterior skull-base lesions were accessed, and litigation was reviewed for alleged injuries, defendant specialty, patient demographics, and other factors raised in proceedings. Results: Of 75 cases included, 50.7% were resolved in the defendant's favor. The most frequent physician specialties cited as defendants included primary care (20%), neurosurgery (17%), and radiology (16%), while otolaryngologists were defendants in only 5% of cases. Fifty-two (69%) did not involve surgical intervention; the most common allegations in these proceedings were misdiagnosis, permanent injury (19%), requiring additional procedures as a result of misdiagnosis (17%), permanent endocrine dysfunction (14%), and visual sequelae (12%). Among surgical cases, the most common allegations raised included permanent injury (17%), postoperative complications (14%), intraoperative complications (13%), and death (10%). Among cases resolved with payment, there was no statistical difference in payment between surgical cases ($5.7M) and nonsurgical cases ($4.8M). Conclusion: Misdiagnosis of endocrinopathy, failure to appropriately workup patients presenting with neurologic complaints, and radiologic misdiagnosis play important roles in the pursuit of litigation in nonsurgical cases. Sustaining permanent sequelae including endocrine and visual injury play an important role in surgical cases. Postoperative management appears to play just as important a role in the decision to pursue litigation as intraoperative considerations.

Original languageEnglish (US)
Pages (from-to)1022-1028
Number of pages7
JournalInternational Forum of Allergy and Rhinology
Volume7
Issue number10
DOIs
StatePublished - Oct 2017

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology

Keywords

  • anterior skull-base
  • informed consent
  • litigation
  • malpractice
  • meningioma
  • pituitary
  • pituitary adenoma
  • skull-base surgery
  • transsphenoidal
  • ventral skull-base

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