Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
JAMA Dermatol. 2019 Jul 1;155(7):812-818. doi: 10.1001/jamadermatol.2019.0430.
The prevalence of keratinocyte carcinoma (KC) exceeds that of all other malignant neoplasms combined. Despite the steady rise of payments for medical malpractice liability claims over time, data regarding the characteristics of malpractice litigation for KC are scarce.
To identify state and federal appellate medical malpractice liability cases for KC and determine the factors associated with the verdicts.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective review of KC-related malpractice litigation under state or federal jurisdiction reviewed the LexisNexis Academic database of state and federal cases, legal reviews, and case law. All appellate medical malpractice cases at the state and federal levels involving basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) from January 1, 1968, through December 31, 2018, were identified.
Demographic characteristics of the cases and plaintiffs, verdict, health care specialty of the defendant, setting of the litigation, rationale for the lawsuit and verdict, factors associated with the case outcome, and monetary payout in cases won by the plaintiff.
In total, 83 cases were included in our analysis (34 BCC cases and 49 SCC cases; 47 [57%] male plaintiffs). Sixty-two cases (75%) were decided in favor of the defendant. More KC-related malpractice cases were won by defendants in more recent years than were won by plaintiffs (mean year, 2004 [SD, 11 years] vs 1998 [SD, 14 years]; P = .03). Twenty-five cases (30%) each occurred in the Northeast and the South, and 45 (54%) involved private practices. Most cases involved KCs occurring on the face, head, and/or neck (39 [47%]), the genitalia (22 [27%]), or the extremities (15 [18%]). More than half of defendants were dermatologists (19 [23%]), family medicine physicians (15 [18%]), or oncologists (8 [10%]). Jurisprudence for KC-related malpractice cases most often occurred at the state level (49 [59%]). The most common causes of litigation were failure to diagnose (18 [22%]), misdiagnosis (18 [22%]), and delay in treatment (11 [13%]). More female than male plaintiffs won their malpractice cases (11 of 35 [31%] vs 5 of 43 [12%]; P = .03). More cases involving SCC than BCC led to a decision favoring the plaintiff (13 of 47 [28%] vs 3 of 31 [10%]; P = .05). In cases won by the plaintiff, the median monetary payout was $179 654 and the mean payout was $909 801 (range, $11 537-$5 320 161).
This study sheds light on the characteristics and settings of KC malpractice litigation claims, which is vital information for discovering potential areas of quality improvement, patient safety initiatives, and education for patients and health care professionals.
角化细胞癌 (KC) 的患病率超过所有其他恶性肿瘤的总和。尽管随着时间的推移，医疗事故责任索赔的支付稳步上升，但关于 KC 医疗事故诉讼特点的数据却很少。
确定州和联邦上诉医疗事故责任案件的 KC，并确定与判决相关的因素。
设计、地点和参与者：这项对州或联邦管辖下与 KC 相关的医疗事故诉讼的回顾性研究，审查了 LexisNexis Academic 数据库中的州和联邦案例、法律评论和案例法。从 1968 年 1 月 1 日至 2018 年 12 月 31 日，确定了所有涉及基底细胞癌 (BCC) 或鳞状细胞癌 (SCC) 的州和联邦级别医疗事故责任案件。
案件和原告的人口统计学特征、判决、被告的医疗专业、诉讼地点、诉讼理由和判决、与案件结果相关的因素以及原告胜诉的赔偿金。
共纳入 83 例进行分析（34 例 BCC 病例和 49 例 SCC 病例；47 例 [57%] 为男性原告）。62 例（75%）的判决有利于被告。与原告胜诉相比，近年来 KC 相关医疗事故案件更多地被被告胜诉（平均年份为 2004 年 [标准差，11 年] 与 1998 年 [标准差，14 年]；P = .03）。25 例（30%）各发生在东北部和南部，45 例（54%）涉及私人诊所。大多数病例涉及发生在面部、头部和/或颈部的 KC（39 例 [47%]）、生殖器（22 例 [27%]）或四肢（15 例 [18%]）。超过一半的被告是皮肤科医生（19 例 [23%]）、家庭医学医生（15 例 [18%]）或肿瘤学家（8 例 [10%]）。与 KC 相关的医疗事故案件的司法判决大多发生在州一级（49 例 [59%]）。诉讼的最常见原因是未能诊断（18 例 [22%]）、误诊（18 例 [22%]）和治疗延误（11 例 [13%]）。与男性原告相比，更多的女性原告赢得了她们的医疗事故案件（35 例中的 11 例 [31%] 与 43 例中的 5 例 [12%]；P = .03）。涉及 SCC 的案件比 BCC 更有利于原告的判决（47 例中的 13 例 [28%] 与 31 例中的 3 例 [10%]；P = .05）。在原告胜诉的案件中，赔偿金中位数为 179654 美元，平均赔偿金为 909801 美元（范围为 11537 美元至 5320161 美元）。
这项研究揭示了 KC 医疗事故诉讼索赔的特点和环境，这是发现潜在质量改进、患者安全举措以及为患者和医疗保健专业人员提供教育的重要信息。
