Wow-so easily preventable: Over 1/3 of med mal cases for radical prostatectomy involved informed consent

J Urol. 2013 Dec 10. pii: S0022-5347(13)06084-9. doi: 10.1016/j.juro.2013.12.003. [Epub ahead of print]

Influencing Factors Leading to Malpractice Litigation in Radical Prostatectomy.

Colaco M1, Sandberg J2, Badlani G2.

Author information

• 1Department of Urology, Wake Forest School of Medicine-Winston-Salem, NC. Electronic address: mcolaco@wakehealth.edu.
• 2Department of Urology, Wake Forest School of Medicine-Winston-Salem, NC.

Abstract

BACKGROUND::

The litigious nature of the medical-legal environment is a major concern for American physicians with an estimated cost of $10 billion. The purpose of this study is to identify the causes of litigation in cases of radical prostatectomy, as well as what factors contribute to verdicts or settlements resulting in indemnity payments.

MATERIALS AND METHODS::

Publicly available verdict reports were recorded using the Westlaw legal database (Thomson Reuters, New York, NY). In order to identify pertinent cases we used the search terms "medical malpractice" and "prostate" or "prostatectomy" with date ranging from 2000 to 2013. Cases were evaluated for alleged cause of malpractice, resulting injury, findings and indemnity payment (if any).

RESULTS::

Database search yielded 222 cases, with 25 being relevant to radical prostatectomy. 24.0% of cases were settled out of court and the remaining 76.0% went to trial. Of those cases that went to trial, 20.8% saw patients awarded damages. There was no significant difference in awards between verdict and settlement. 36.0% of patients claimed that they did not receive proper informed consent. 16.0% of cases claimed that the surgery was not the proper standard of care. Thirteen of the cases claimed negligence in the performance of the surgery with the bulk of these claims being the result of rectal perforation.

CONCLUSIONS::

The main issues that arise in radical prostatectomy malpractice litigation are those of informed consent and clinical performance. Comprehensive preoperative counseling, when combined with proper surgical technique, may minimize the impact of litigation.