Billions Paid Out for Surgical “Never Events”

Surgical mishaps, such as leaving a sponge in a patient, have cost US healthcare professionals a minimum of USD 1.3 billion in malpractice payouts during the last two decades, according to a new report.

Researchers at Johns Hopkins University (JHU; Baltimore, MD, USA) gathered data on 9,744 paid malpractice settlements and judgments for surgical “never events” through the National Practitioner Data Bank (NPDB), a federal reserve of medical malpractice claims, between September 1, 1990, and September 30, 2010; “never events” were defined as retained foreign bodies inside the patient, surgery on the wrong site, surgery on the wrong patient, or the wrong surgical procedure carried out on the right patient. The researchers included malpractice payments, patient outcomes, and provider characteristics in their analysis.

The results showed that retention of foreign bodies was the most common event and occurred in nearly half of all cases (49.8%). Wrong procedure and wrong surgery site each occurred in roughly a quarter of cases (25.1% and 24.8%, respectively), and wrong-patient surgery occurred in less than half a percent of cases (0.3%). Although most patients experienced only temporary injury, permanent injury occurred in 32.9% of the cases, and 6.6% of cases resulted in death, which were more common in patients 60 and older than in those younger than 60 (14.8% versus 4%).

A great majority of "never event" malpractice claims were settled out of court (96%), while court judgments increased the odds of a higher-than average payment nearly threefold. The highest median payment was associated with wrong-procedure events (USD 106,777) and the lowest was associated with retained foreign bodies (USD 33,953). By healthcare professional characteristics, physicians aged 40-49 were responsible for the majority of reports, followed by those ages 60 and older. Nearly two-thirds of those involved in one malpractice case were also involved in at least one other; only 10% of those who were responsible for a "never event" were disciplined at least once by their state licensing board. The study was published early online on December 18, 2012, in Surgery.

“Surgical never events are costly to the health care system and are associated with serious harm to patients,” concluded lead author to Martin Makary, MD, and colleagues of the JHU School of Medicine, adding that the “payments do not capture the even greater financial burdens of legal fees, additional inpatient and disability care, lost work days, and harm to the provider and hospital reputation.”

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