title: Medical malpractice and sarcoma care--a thirty-three year review of case resolutions, inciting factors, and at risk physician specialties surrounding a rare diagnosis.
abstract: BACKGROUND
  We reviewed medico-legal cases related to extremity sarcoma malpractice in order to recognize those factors most commonly instigating sarcoma litigation.
  
  
  METHODS
  Over one million legal cases available in a national legal database were searched for malpractice verdicts and settlements involving extremity sarcoma spanning 1980-2012. We categorized verdict/settlement resolutions by state, year, award amount, nature of the complaint/injury, specialty of the physician defendant, and academic affiliation of defendant-amongst other variables.
  
  
  RESULTS
  Of the 216 cases identified, 57% of case resolutions favored the plaintiff, with a mean indemnity payment of $2.30 million (range $65,076-$12.66 million). Delay in diagnosis (81%), unnecessary amputation (11%), and misdiagnosis (7%) accounted for the majority of complaints. The greatest numbers of claims were filed against primary care specialties (34%), orthopaedic surgeons (23%), and radiologists (12%). Individual state tort reform measures were not protective against case resolution outcome.
  
  
  CONCLUSIONS
  Reported medico-legal claims involving sarcoma care continue to rise, with mean indemnity payments approaching 10 times that for other reported medical/surgical specialties. Primary care and orthopaedic specialties are the most commonly named physician defendants, citing a delay in diagnosis. This suggests further education in the front line diagnosis and management of sarcomas is needed.
authors.affiliation: Investigation Performed at Vanderbilt University Medical Center, Department of Orthopaedic Surgery, Musculoskeletal Oncology Division, Nashville, Tennessee.
authors.forename: Nathan W
authors.initials: NW
authors.lastname: Mesko
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Mesko
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Gaffney
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Halpern
authors.forename: Herbert S
authors.initials: HS
authors.lastname: Schwartz
authors.forename: Ginger E
authors.initials: GE
authors.lastname: Holt
mesh_terms: D057210:Delayed Diagnosis; D005121:Extremities; D006801:Humans; D008318:Malpractice; D010820:Physicians; D012306:Risk; D012509:Sarcoma / Q000175:diagnosis / Q000628:therapy*
keywords: delay in diagnosis; medical malpractice; sarcoma