title: A single-institution experience of hand surgery litigation in a major replantation center.
abstract: BACKGROUND
  Bellevue Hospital Medical Center is a level 1 trauma center in New York and a major referral center for complex hand injuries and amputations. These injuries typically occur at the workplace and are thought to be highly litiginous in nature. This study was conducted to analyze the cases involving hand surgery litigation related to trauma over the last 8 years at this institution.
  
  
  METHODS
  The authors performed a retrospective chart review of all claims filed against Bellevue Hospital Medical Center after treatment for a hand injury during 2001 to 2009. Twenty-three patients in total were identified and reviewed for age, mechanism/type of injury, complications, decision to replant, average time after injury to post claim, and whether settlement was obtained.
  
  
  RESULTS
  One of 23 patients who filed suit against Bellevue Hospital Medical Center received a successful settlement involving an incident surrounding the loss of a nonreplantable part. Of 168 patients in whom 219 replantations/revascularizations were performed, five patients filed claims, all surrounding a failed attempt. In total, there were seven complications: five failed replants, one failed thenar flap, and one patient who needed a revision completion amputation.
  
  
  CONCLUSIONS
  The majority of the patients who filed claims did so because of the decision not to replant. Only 2.98 percent (five of 168) of all attempted revascularization/replantation patients filed claims against the authors' institution; all claims were notably dropped. The legal system appears to support physicians and institutions that treat these complex injuries. Better patient understanding of the decision-making process and complications involving treatment of traumatic hand injuries may decrease the number of future lawsuits.
authors.affiliation: New York, N.Y. From the New York University Institute of Reconstructive Plastic Surgery, Bellevue Hospital Health and Hospitals Corporation.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Bastidas
authors.forename: Lindsey
authors.initials: L
authors.lastname: Cassidy
authors.forename: Laurel
authors.initials: L
authors.lastname: Hoffman
authors.forename: Sheel
authors.initials: S
authors.lastname: Sharma
mesh_terms: D000293:Adolescent; D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D002648:Child; D003657:Decision Making; D006225:Hand / Q000098:blood supply / Q000601:surgery; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D007603:Jurisprudence; D008318:Malpractice / Q000331:legislation & jurisprudence; D008875:Middle Aged; D009519:New York City; D012092:Replantation / Q000331:legislation & jurisprudence*; D012189:Retrospective Studies; D014193:Trauma Centers / Q000331:legislation & jurisprudence*; D017211:Treatment Failure