From Rutgers: Obstructive Sleep Apnea: Strategies for Minimizing Liability and Enhancing Patient Safety

http://www.ncbi.nlm.nih.gov/pubmed/24025916

Otolaryngol Head Neck Surg. 2013 Sep 11. [Epub ahead of print]

Obstructive Sleep Apnea: Strategies for Minimizing Liability and Enhancing Patient Safety.

Svider PF, Pashkova AA, Folbe AJ, Eloy JD, Setzen M, Baredes S, Eloy JA.

Source

Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.

Abstract

Objective

To characterize malpractice litigation regarding obstructive sleep apnea (OSA) and educate physicians on frequently cited factors.

Study Design and Setting

Analysis of the Westlaw legal databaseMethodsJury verdict and settlement reports were examined for outcome, awards, patient demographic factors, defendant specialty, and alleged causes of malpractice

Results

Out of 54 identified cases, 33 (61.1%) cases were resolved in favor of defendants, 12 (22.2%) via settlement, and 9 (16.7%) through jury award. Median settlement and jury awards did not significantly differ ($750,000 vs $550,000, P > .50). Age and gender did not affect outcome. Otolaryngologists and anesthesiologists were the most frequently named defendants. Forty-seven cases (87.1%) stemmed from OSA patients who underwent procedures with resultant perioperative adverse events. Common alleged factors included death (48.1%), permanent deficits (42.6%), intraoperative complications (35.2%), requiring additional surgery (25.9%), anoxic brain injury (24.1%), inadequate informed consent (24.1%), inappropriate medication administration (22.2%), and inadequate monitoring (20.4%).

Conclusion

Litigation related to OSA is frequently associated with perioperative complications more than nonoperative issues such as a failure to diagnose this disorder. Nonetheless, OSA is considerably underdiagnosed, and special attention should be paid to at-risk patients, including close monitoring of their clinical status and the medications they receive. For patients with diagnosed or suspected OSA with planned operative intervention, whether for OSA or an unrelated issue, a comprehensive informed consent process detailing the factors outlined in this analysis is an effective strategy to increase communication and improve the physician-patient relationship, minimize liability, and ultimately improve patient safety.