title: Lawsuits against plastic surgeons: Does locale affect incidence of claims?
abstract: BACKGROUND
  Physicians continue to practice in a very litigious environment. Some physicians try to mitigate their exposure to lawsuits by avoiding geographical locations known for their high incidence of medical malpractice claims. Not only are certain areas of the United States known to have a higher incidence of litigation, but it is also assumed that certain areas of the hospital incur a greater liability. There seems to be a medicolegal dogma suggesting a higher percentage of malpractice claims coming from patients seen in the emergency room (ER), as well as higher settlements for ER claims.
  
  
  OBJECTIVE
  To determine if there is any validity to the dogma that a higher percentage of malpractice claims arise from the ER.
  
  
  METHODS
  An analysis of common plastic surgery consults that result in malpractice claims was performed. The location where the basis for the lawsuit arose - the ER, office (clinic) or the operating room (OR) - was evaluated. The value of the indemnity paid and whether its value increased or decreased based on the location of the misadventure was evaluated.
  
  
  RESULTS
  According to the data, which represented 60% of American physicians, there was a larger absolute number of malpractice claims arising from the OR, not the ER. However, the highest average indemnity was paid for cases involving amputations when the misadventure originated in the ER.
  
  
  CONCLUSIONS
  The dogma that a greater percentage of lawsuits come from incidents arising in the ER is not supported. However, depending on the patient's injury and diagnosis, a lawsuit from the ER can be more costly than one from the OR.
authors: Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
authors: Jonathan L
authors: JL
authors: Kaplan
authors: Warren C
authors: WC
authors: Hammert
authors: James E
authors: JE
authors: Zin