title: Factors influencing judicial decisions on medical disputes in plastic surgery.
abstract: BACKGROUND
  Recently, more lawsuits have been filed by patients against their plastic surgeons, often leading to social and financial losses for the physicians involved.
  
  
  OBJECTIVE
  The authors sought to determine the factors that influence judicial decisions against plastic surgeons.
  
  
  METHODS
  Data from 98 malpractice claims filed between January 1 2000 and December 31 2008 were obtained from a state court of justice in Brazil. The authors selected 39 closed cases for this study. The following parameters were reviewed for each case: date of decision, complaint(s), conclusions of expert report, presence/absence of informed consent, medical records, and judicial decision. The chi-square test, Cramer's V coefficient, Fisher's exact test, and Cochran-Armitage test were utilized to compare data. Significance was defined as P ≤ .05.
  
  
  RESULTS
  Most lawsuits pertained to breast surgery (32%), abdominoplasty (24%), rhinoplasty (22%), and liposuction (22%). The most common complaints were scars and resulting contour (48.9%), general dissatisfaction (25.6%), and complications (25.2%). In all cases with medical records considered of "good quality" by the judge (n = 17), the surgeon was acquitted. There was a significant correlation between decisions favoring the surgeon and the presence of written informed consent documentation. "Not guilty" verdicts also were associated with expert report conclusions favoring the physician. Surgeons were found guilty of malpractice in cases that failed to meet at least 2 of these 3 conditions (good-quality medical record, informed consent, expert report favoring the surgeon).
  
  
  CONCLUSIONS
  Factors that heavily influenced judicial decisions were the quality of medical records, informed consent, and expert report conclusions.
authors.affiliation: Dr Vila-Nova da Silva is a graduate student in the Graduate Program in Plastic Surgery, Dr Nahas is an Associate Professor in the Division of Plastic Surgery, Department of Surgery, and Dr Ferreira is a Full Professor in the Division of Plastic Surgery, Department of Surgery, all at the Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
authors.forename: Dione Batista
authors.initials: DB
authors.lastname: Vila-Nova da Silva
authors.affiliation: Dr Vila-Nova da Silva is a graduate student in the Graduate Program in Plastic Surgery, Dr Nahas is an Associate Professor in the Division of Plastic Surgery, Department of Surgery, and Dr Ferreira is a Full Professor in the Division of Plastic Surgery, Department of Surgery, all at the Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
authors.forename: Fábio Xerfan
authors.initials: FX
authors.lastname: Nahas
authors.affiliation: Dr Vila-Nova da Silva is a graduate student in the Graduate Program in Plastic Surgery, Dr Nahas is an Associate Professor in the Division of Plastic Surgery, Department of Surgery, and Dr Ferreira is a Full Professor in the Division of Plastic Surgery, Department of Surgery, all at the Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
authors.forename: Lydia Masako
authors.initials: LM
authors.lastname: Ferreira
mesh_terms: D001938:Brazil; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence*; D008318:Malpractice / Q000331:legislation & jurisprudence*; D010820:Physicians / Q000331:legislation & jurisprudence* / Q000592:standards; D019651:Plastic Surgery Procedures / Q000331:legislation & jurisprudence* / Q000592:standards
keywords: aesthetics; judicial decisions; lawsuits; plastic surgery