Descriptive Analysis of Federal and State Interventional Pain Malpractice Litigation in the United States: A Pilot Investigation

Background: The aim of this study was to examine and appreciate characteristics of malpracticelawsuits brought against interventional pain specialists.Objectives: To examine and appreciate characteristics of malpractice lawsuits brought againstinterventional pain specialists.Study Design: Retrospective review.Setting: Jury verdicts and settlement reports of state and federal malpractice cases involvinginterventional pain practitioners from January 1, 1988, to January 1, 2018 were gathered fromthe Westlaw online legal database.Methods: Jury verdicts and settlement reports of state and federal malpractice cases involvinginterventional pain practitioners from January 1, 1988, to January 1, 2018 were gathered fromthe Westlaw online legal database. Data collected for each case included year, state, patient age,patient gender, defendant specialty, legal outcome, award amount, alleged cause of malpractice,and factors in plaintiff’s decision to file. After elimination of duplicates and applying inclusion/exclusion criteria to our initial search yielding over 1,500 cases, a total of 82 cases were includedin this study.Results: A total of 57.3% of cases resulted in a jury verdict in favor of the defendant, whereas41.5% favored the plaintiff. When comparing cases that were performed in the operating roomto cases performed outside the operating room, we found the jury verdicts to favor the plaintiff83.3% of the time for operating room procedures (P = 0.003). In other words, interventional painpractitioners were more likely to be found at fault for complications from procedures performed inthe operating room. To eliminate confounders, a logistical regression was performed and confirmedoperating room procedures were an independent predictor of a verdict awarded to the plaintiff (P= 0.008). The median amount awarded to the plaintiff for all cases was $333,000, and the singlehighest award amount was $36,636,288. The median payout for operating room procedures was$450,000 (P = 0.010), which was significantly different from the median payout for nonoperatingroom procedures. Procedure categorization demonstrated a statistically significant difference in juryverdicts (P = 0.01411) and procedural error was the leading reason for pursuing litigation, followedby lack of informed consent and unnecessary procedure performed.Limitations: There is more than one database that captures medicolegal claims brought againstpractitioners. Westlaw, which has been previously utilized by other studies, is only one of them andthe extent to which overlap exists in unclear. For each, data input are not necessarily consistent anddata capture are not complete. As a result, there could exist a skew toward more severe complicationsand the details of individual cases likely vary. During data extraction, we found that all details of theprocedure were not always included. For example, not all cases specified the type of injectate utilizedfor epidural injection (i.e., local anesthetic, steroid, mixture, and others) or route of injection (i.e.,transforaminal vs. interlaminar). Moreover, as previously mentioned, cases that are settled out of court or finalized prior to trial are not necessarily reported by the Westlaw database, and therefore were not always included inour data search.Conclusions: Overall, interventional pain medicine physicians were favored by jury verdicts for malpractice claims. However,when filtering by procedure or setting, jury verdicts favored the plaintiff in some cases.Key words: Interventional pain, medical, malpractice, anesthesiology