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Closed claim review shows common risks
Mariko Bird, MD, an anesthesiologist at the University of Washington in Seattle, recently studied the malpractice claims related to acute pain management and found 150 cases in the American Society of Anesthesiologists Closed Claims Project database, which has a total of 7,328 closed claims. The database contains standardized information on closed anesthesia malpractice claims from 35 professional liability insurance companies that insure more than one-third of practicing anesthesiologists.
"Our review found that nearly two-thirds of acute pain claims involved nerve damage, abscess, or hematoma, [most of] which were related to the neuraxial or peripheral nerve block," she says. "There is still much room for improvement to prevent nerve injury in acute pain patients and to understand why nerve injury occurs."
In analyzing the acute pain management cases, Bird categorized them as probable respiratory depression, possible respiratory depression, or no confirmed respiratory depression.1 The proportion of claims associated with acute postoperative pain management increased between the 1980s and the 1990s, with most postoperative pain management claims from the 1990s (86% from the 1990s, 8% from 2000 or later, and 6% from the 1980s). A payment was made in 55% of claims, and the median payment, when a payment was made, was $211,650. The range was $627 to $14.8 million. Forty percent of claims were for nerve damage, and one-third of all claims were for death and brain damage.
Evidence for probable or possible respiratory depression was present in a quarter of all acute pain management claims, Bird says. She found that 20% of neuraxial block claims involved probable or possible respiratory depression and in many of these claims, there was multimodal administration of opioids. Sixty-six percent of patient-controlled analgesia claims involved death or brain damage resulting from possible or probable respiratory depression.
1. Bird M. Acute pain management: A new area of liability for anesthesiologists. ASA Newsletter 2007; 8:71.