title: Alleged malpractice in anesthesiology: analysis of a series of private insurance claims.
abstract: BACKGROUND
  Medical malpractice is currently a crucial topic and anesthesia is a key specialty for the improvement of patient safety. However, death and permanent impairment due to anesthesia still occur and studies of insurance analysis data are increasing. We investigated the main features of a major Italian insurance broker's archive in order to identify possible recurrent pitfalls in this critical field of medicine.
  
  
  METHODS
  Three hundred seventeen Italian claims were analyzed, filling out a standardized form that recorded information on patient and physician's characteristics, procedures, sequence and location of events and outcomes. The operative setting, the type of anesthesia performed the origin of the multidisciplinary team malpractice hypothesis, the final clinical outcome and the malpractice investigation results were also analyzed.
  
  
  RESULTS
  In 225 malpractice claims, the adverse event was surgery-linked, either intraoperatively (114 cases) or postoperatively (111 cases): abdominal surgery (26%), orthopedics (22%), gynecology (20%), heart surgery (11%) and neurosurgery (9.5%) were the most frequently involved surgical specialties. In 92 cases, the claim was unlinked to a surgeon's activity, with dental damage in oral intubation procedures as the greatest contributor (42.3%). Anesthetists' malpractice was technically ascertained in 39% of cases, 74.8% resulting in permanent impairment.
  
  
  CONCLUSIONS
  Malpractice was mainly suspected in surgery-linked procedures. Most of the claims were settled for procedural error in performing locoregional anesthesia and oral intubation procedures. 60% of all closed claims resulted in no malpractice ascertained. Confirmed malpractice typically deals with non surgery-linked and non multidisciplinary team cases, causing permanent impairment.
authors.affiliation: Laboratorio di Responsabilità Sanitaria, Dipartimento di Scienze Biomediche per la Salute, Istituto di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Milan, Italy - umberto.genovese@unimi.it.
authors.forename: Umberto
authors.initials: U
authors.lastname: Genovese
authors.forename: Alberto
authors.initials: A
authors.lastname: Blandino
authors.forename: Riccardo
authors.initials: R
authors.lastname: Midolo
authors.forename: Michelangelo B
authors.initials: MB
authors.lastname: Casali
mesh_terms: D000328:Adult; D000368:Aged; D000776:Anesthesiology / Q000331:legislation & jurisprudence*; D005260:Female; D005554:Forensic Medicine; D013502:General Surgery / Q000331:legislation & jurisprudence; D006801:Humans; D007345:Insurance Claim Review; D007558:Italy; D008297:Male; D008318:Malpractice; D008875:Middle Aged; D012189:Retrospective Studies