title: Lasers and losers in the eyes of the law: liability for head and neck procedures.
abstract: OBJECTIVE
  Although some have noted that malpractice litigation may be "plateauing," defensive medical practices are pervasive and make up a considerable proportion of the "indirect" costs medicolegal issues contribute toward our health care system. Accordingly, these trends have spurred considerable interest in characterizing factors that play a role in alleged medical negligence, along with outcomes and awards.
  
  
  OBJECTIVE
  To conduct a focused examination of malpractice litigation regarding laser procedures in the head and neck and to determine the reasons for initiating litigation as well as outcomes and awards.
  
  
  METHODS
  Retrospective analysis of the WestlawNext legal database, encompassing publicly available federal and state court records, to identify malpractice cases involving laser procedures in the head and neck.
  
  
  METHODS
  Outcomes, awards, defendant specialty, and other allegations.
  
  
  RESULTS
  Most cases (28 [82%]) included in this analysis involved female plaintiffs. Of 34 cases, 19 (56%) were resolved with a defendant verdict. The median indemnity was $150 000, and dermatologists, otolaryngologists, and plastic surgeons were the most commonly named defendants. The most common procedures were performed for age-related changes, acne scarring, hair removal, and vascular lesions, although there were also several rhinologic and airway cases. Of all cases, 25 (74%) involved cutaneous procedures, and common allegations noted included permanent injury (24 cases [71%]), disfigurement/scarring (23 [68%]), inadequate informed consent (17 [50%]), unnecessary/inappropriate procedure (15 [44%]), and burns (11 [32%]). Noncutaneous procedures had higher trending median payments ($600 000 vs $103 000), although this comparison did not reach statistical significance (P = .09).
  
  
  CONCLUSIONS
  Procedures using lasers represent a potential target for malpractice litigation should an adverse event occur. Although cutaneous/cosmetic procedures were noted among cases included in this analysis, as well as other head and neck interventions, otolaryngologists were more likely to be named as defendants in the latter category. Although cases had modest indemnities compared with prior analyses, the potential for significant amounts was present. Inclusion into the informed consent process of specific factors detailed in this analysis may potentially decrease liability. In addition, physicians and patients should undergo comprehensive discussion regarding expectations as well as contingencies should adverse events occur.
  
  
  METHODS
  4.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Svider
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan2Section of Otolaryngology, Department of Surgery, John D. Dingell VA Medical Center, Detroit, Michigan.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Carron
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan2Section of Otolaryngology, Department of Surgery, John D. Dingell VA Medical Center, Detroit, Michigan.
authors.forename: Giancarlo F
authors.initials: GF
authors.lastname: Zuliani
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark4Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark5Center for Skull Base and Pituitary Surgery, Rutgers New Jersey Medical School, New.
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
authors.affiliation: Rhinology Section, North Shore University Hospital, Manhasset, New York7Department of Otolaryngology, New York University School of Medicine, New York.
authors.forename: Michael
authors.initials: M
authors.lastname: Setzen
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan8Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Folbe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D003880:Dermatology / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D005260:Female; D006257:Head; D006801:Humans; D007223:Infant; D053685:Laser Therapy / Q000009:adverse effects; D016365:Liability, Legal; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D008875:Middle Aged; D009333:Neck; D010036:Otolaryngology / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013518:Surgery, Plastic / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult