title: Physician accountability in iatrogenic cerebrospinal fluid leak litigation.
abstract: BACKGROUND
  The potentially severe complications resulting from cerebrospinal fluid (CSF) leak makes iatrogenic injury a medicolegal area of concern for otolaryngologists and neurosurgeons. The objectives of this analysis were to study legal outcomes as well as medical and nonmedical elements affecting malpractice litigation.
  
  
  METHODS
  Public court records available in the Westlaw legal database (Thomson Reuters, New York, NY) were searched for medical malpractice litigation related to iatrogenic CSF leak. Of the 18 jury verdicts and settlements included, outcomes and awards, patient demographic data, and other factors instrumental in determining legal responsibility were recorded for comparison.
  
  
  RESULTS
  Ten (55.6%) cases were resolved in the defendant's favor, 2 (11.1%) resulted in damages awarded by a jury, and 6 (33.3%) were settled out of court before resolution of trial. Mean damages awarded were $1.1 million, while out of court settlements averaged $966,887. Malpractice stemming from patients who underwent endoscopic sinus surgery comprised 77.8% of cases analyzed. The most frequent alleged factors cited for litigation included having to undergo additional surgery (88.9%), developing meningitis (50.0%), and failing to recognize complications in a timely manner (44.4%). Perceived deficits in informed consent were alleged in one-third of cases.
  
  
  CONCLUSIONS
  Although a slight majority of cases were resolved in the defendant's favor, payments made were considerable, averaging approximately $1 million. Strategies to decrease liability and allow patients to make more informed decisions should include clear communication with patients that explicitly states potential risks, such as meningitis, and possible need to undergo additional reparative surgery.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ.
authors.forename: Olga
authors.initials: O
authors.lastname: Kovalerchik
authors.forename: Leila J
authors.initials: LJ
authors.lastname: Mady
authors.forename: Peter F
authors.initials: PF
authors.lastname: Svider
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Mauro
authors.forename: Soly
authors.initials: S
authors.lastname: Baredes
authors.forename: James K
authors.initials: JK
authors.lastname: Liu
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology* / Q000517:prevention & control; D035881:Compensation and Redress / Q000331:legislation & jurisprudence*; D004724:Endoscopy / Q000009:adverse effects / Q000331:legislation & jurisprudence*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D016365:Liability, Legal / Q000191:economics; D008297:Male; D008318:Malpractice / Q000191:economics / Q000331:legislation & jurisprudence*; D008875:Middle Aged; D010036:Otolaryngology / Q000331:legislation & jurisprudence*; D055815:Young Adult
keywords: iatrogenic cerebrospinal fluid leak; liability; malpractice; malpractice trial; negligence; rhinologic procedures