Back to 2016 Annual Meeting Program

With the advent of expert witness testimonies in the 70’s and the media sensationalization of “big money” ordered by the courts, the number of malpractice claims exploded in the last few decades. What used to be a therapeutic relationship between doctor and patient has shifted to a transaction between healthcare provider and consumer. Numerous physicians are now sued daily, often with faulty claims, forcing them to practice defensive medicine. Excessive litigation lowers worker productivity, diminishes population health status, causes patient distrust, and creates emotional distress for physicians. We aim to examine the characteristics of carpal tunnel surgery claims and the qualifications of the expert witnesses testifying for each side. The legal database WestlawNext was accessed for jury verdict and settlement reports after 2004 through March 2015 using the terms “medical malpractice” and “hand surgery” OR “hand surgeon.” Board certification and hand surgery certification information was obtained from licensing medical board websites. Surgeon’s year of medical school graduation and academic position were obtained from hospital or personal websites. Academic productivity of expert witnesses was measured by using the h-index using the Scopus database (www.scopus.com). Data were collected in March 2015. Statistical analysis was performed with Mann-Whitney U-test and Student t-test. Power of significance was set at p< 0.05. STATA version 13.0 was used.
Of a total of 632 cases retrieved, 84 hand surgery litigations were identified. Among them, 26 (30.95%) cases involved carpal tunnel syndrome. Of the carpal tunnel syndrome cases, 18 out of 26 (69.23%) verdicts favored the defendant. The average age of plaintiff was 45.08 years old and the average amount awarded was ,884. Females made up 76.92% (20 out of 26) of the plaintiff. The most common type of alleged cause was due to median nerve damage (69.23%, 18 out of 26). Experts who testified on behalf of plaintiffs had significantly lower h-index compared to the experts testifying on behalf of defendants (2.44 vs. 11.84, p<0.05). There was no significant difference in duration of practice, board certification, and practice setting (academic or nonacademic) between the experts.
The surgical treatment of carpal tunnel syndrome is the most frequent subject of litigation in hand surgery. Improving intra-operative skills to minimize surgical errors and providing thorough informed consent for patient understanding of risks and benefits may help minimize the number of future lawsuits. Meticulous documentation of medical records and hiring credible expert witnesses may lead to favorable verdict in legal courts.