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Medical malpractice and anesthesiology: literature review and role of the expert witness

Fautes médicales et anesthésiologie: revue de la littérature et rôle du témoin expert

Abstract

Purpose

To provide a narrative review of the physician experience of medical malpractice litigation applied to an anesthesiology case with particular emphasis on the role played by medical expert witnesses.

Sources

Literature searches were conducted of English-language medical publications published between 1996 – 2006 using both Medline and Pubmed databases. Key words included: “medical malpractice”; “medical malpractice litigation”; “medical expert witness”; “expert witness liability”, “expert witness bias”; “hindsight bias”; and “outcome bias”.

Principal findings

Patient injury resulting from medical care is common but most injured patients do not sue. Implicit review of medical files is biased to an important degree by the occurrence of severe injury; care is more often deemed substandard when the resulting injury is severe. Expert analysis of medical mal-occurrences is influenced by both hindsight and outcome bias. Compensation for those who do sue is influenced by the severity of injury and the degree of disability. The activity of experts is not commonly subject to review by peers, professional groups or licensing authorities.

Conclusions

The legal process for resolving patient claims against physicians is well delineated and transparent; its operational features are complex and prejudiced by severe outcomes. Bias is pervasive in the analysis of medical occurrences and may result in findings against caregivers which are unfair.

Résumé

Objectif

Fournir une revue narrative de l’expérience du médecin face à un litige pour faute médicale appliqué à un cas d’anesthésiologie, en soulignant le rôle joué par les témoins experts médicaux.

Sources

Des recherches de littérature ont été effectuées dans les publications médicales anglophones publiées entre 1996 et 2006 en utilisant les bases de données Medline et Pubmed. Les mots-clés suivants ont été recherchés: « medical malpractice » (faute médicale); « medical malpractice litigation » (litige de faute médicale); « medical expert witness » (témoin expert médical); « expert witness liability » (responsabilité du témoin expert); « expert witness bias » (préjugé du témoin expert); « hindsight bias » (préjugé en rétrospective); et « outcome bias » (préjugé de résultat).

Constatations principales

Les lésions aux patients résultant de soins médicaux sont courantes; toutefois, la plupart des patients lésés n’engagent pas de poursuites. La révision implicite des dossiers médicaux est biaisée de façon importante par l’incidence de lésions graves; lorsque la lésion est grave, les soins sont souvent jugés non conformes aux normes. L’analyse experte des incidences de fautes médicales est influencée par les jugements rétrospectifs et par rapport aux résultats. Le dédommagement aux patients qui engagent des poursuites est influencé par la gravité du tort et le degré de handicap. L’activité des experts n’est en général pas sujette à la révision par des pairs, des groupes professionnels ou les autorités réglementaires.

Conclusions

Le processus légal qui gère les revendications des patients contre les médecins est clairement défini et transparent; ses aspects fonctionnels sont complexes et partiaux aux résultats graves. Les préjugés sont omniprésents dans l’analyse des incidences médicales et pourraient avoir pour conséquences des injustices contre certains soignants.

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Correspondence to Edward Crosby.

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Funding: Support for this work was derived from departmental and institutional resources

The author is an elected member of the Council of the Canadian Medical Protective Association (CMPA). All opinions expressed in this article are his own and are not those of the CMPA

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Crosby, E. Medical malpractice and anesthesiology: literature review and role of the expert witness. Can J Anesth 54, 227 (2007). https://doi.org/10.1007/BF03022645

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Keywords

  • Expert Testimony
  • Expert Witness
  • Medical Malpractice
  • Legal Liability
  • Hindsight Bias