Bariatric-related medical malpractice experience: survey results among ASMBS members

doi:10.1016/j.soard.2013.04.015

Surgery for Obesity and Related Diseases

Volume 10, Issue 1, January–February 2014, Pages 121-124

https://doi.org/10.1016/j.soard.2013.04.015 Get rights and content

Abstract

Background

The medicolegal aspects of bariatric surgery are very difficult to analyze scientifically because there is no central, searchable database of closed case claims and little incentive for malpractice insurers to divulge data. Examining medicolegal data may provide insight into the financial and psychological burden on physicians. Detailed data also may be used to improve patient safety and determine common causes of negligence.

Methods

All U.S.-based members of the American Society of Metabolic and Bariatric Surgeons were asked to complete a survey regarding their bariatric-related medical malpractice experience.

Results

Of the 1672 eligible members that received the survey, 330 responded (19.7%). Mean years in practice was 15.3±9. Mean annual cost of malpractice insurance was $59,200±$52,000 (N = 197). The respondent surgeons experienced 1.5±3.2 lawsuits on average over the course of their practice. Of the 330 respondents, 144 (48%) did not report a bariatric-related lawsuit filed against them. Of the 464 lawsuits reported by 156 surgeons, 126 were settled out of court (27%), 249 were dropped (54%), and 54 (18%) went to trial. Seventy-two percent of cases that went to trial were found to be in favor of the defense. The mean lifetime amount paid for suits was $250,000±$660,000. The probability of a bariatric surgeon experiencing a lawsuit was independently associated with the years in practice (P = .03) and number of total cases the surgeon has performed (P = .01). The annual cost of malpractice insurance was independently predicted by the amount paid in previous claims (P = .01).

Conclusions

The probability of a medical malpractice lawsuit correlates positively to the number of procedures performed and the number of years the surgeon has been in practice.

Section snippets

Methods

To develop an understanding of the current medical malpractice climate specific to U.S. bariatric surgeons, a detailed survey was developed by the patient safety committee (formerly the Professional Liability Committee), the Executive Committee, and the legal counsel of the ASMBS. This survey (Table 1) was distributed via email to all members of the ASMBS in the spring of 2011. A follow-up email was sent a month later to nonrespondents, and all responses were de-identified.

From the survey, we

Results

The response rate to the survey was 19.7% (330/1675) from 46 states and the District of Columbia. Descriptive statistics are delineated in Table 2. These data represent a cumulative total of 5042 years of bariatric-specific liability exposure. Of the 330 surgeons, 9 chose not to have professional liability insurance. The mean reported annual cost of professional liability insurance was $54,500±$52,500 (N = 197) (range $7,000–$300,000). The distribution of the number of liability lawsuits each

Discussion

The number of years in practice (OR 1.03; P = .03) and greater career volume (OR 8.5; P = .01) were independently associated with an increased likelihood of having a bariatric-related medical malpractice claim at some point in their careers. Although the odds ratio is relatively weak, these statistically significant trends are of interest to the practicing bariatric surgeon as their years in practice and patient volume continue to increase. Our findings are not unexpected and are consistent

Conclusions

Nearly all bariatric surgeons will have a bariatric-related medical malpractice claim at some point in their careers. Our findings correlate with the current literature, which reports low likelihood of lawsuits despite common occurrences of patient harm, and we furthermore suggest that prolonged exposure to low probability events is associated with medical claims.

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Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures – 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists
2020, Surgery for Obesity and Related Diseases
Citation Excerpt :
Thus, the question arises of whether selection of a bariatric surgery procedure should, in some fashion, depend on availability of a surgeon with competency versus mastery for the specific procedure. The likelihood of malpractice lawsuits was also found to correlate with the number of procedures performed and years in practice by the bariatric surgeon [384]. Nevertheless, there does not appear to be correlation of hospital charges with improved bariatric surgery outcomes [385].
The development of these updated clinical practice guidelines (CPG) was commissioned by the American Association of Clinical Endocrinologists, The Obesity Society, the American Society of Metabolic and Bariatric Surgery, the Obesity Medicine Association, and the American Society of Anesthesiologists boards of directors in adherence to the American Association of Clinical Endocrinologists 2017 protocol for standardized production of CPG, algorithms, and checklists.
Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts.
New or updated topics in this CPG include contextualization in an adiposity-based, chronic disease complications–centric model, nuance-based, and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current healthcare arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest).
Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision–making should be evidence-based within the context of a chronic disease. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.
Clinical Practice Guidelines For The Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored By American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society For Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists
2019, Endocrine Practice
The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society, American Society of Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists.
Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts.
New or updated topics in this CPG include: contextualization in an adiposity-based chronic disease complications-centric model, nuance-based and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health-care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest).
Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues. (Endocr Pract. 2019;25:1-75)
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Original articleBariatric-related medical malpractice experience: survey results among ASMBS members

Abstract

Background

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Conclusions

Surgery

J Am Coll Surg

Malpractice risk according to physician specialty

N Engl J Med

Claims, errors, and compensation payments in medical malpractice litigation

N Engl J Med

Original article
Bariatric-related medical malpractice experience: survey results among ASMBS members