title: Trends in medical malpractice claims in patients with cleft or craniofacial abnormalities in the United States.
abstract: OBJECTIVE
  To describe medical malpractice trends in patients with cleft and/or craniofacial abnormalities.
  
  
  METHODS
  A modified Delphi approach was used to gather search terms. Search settings included "all jury verdicts and settlements", with jurisdiction of "all states" and "all federal courts" (by court and circuit). A retrospective review of WestLawNext legal database was conducted. Cases were excluded if they did not have a direct association from the patient's craniofacial anomaly or if they were not related to malpractice.
  
  
  RESULTS
  Forty-two cases met inclusion criteria. Cases closed between 1981 and 2014 were included. The mean payment among claims with an indemnity payment was $3.9 million. Of cases brought to trial, 62% were in favor of the plaintiff. Amongst physicians named as co-defendants, pediatricians were most commonly named (24%), followed by plastic surgeons (16%), obstetricians (7.8%), and radiologists (7.8%). "Missed diagnosis" was the most common type of negligent claim (45%), followed by "surgical error" (21%), and "medication error" (17%). "Anoxic brain injury" resulted in the highest median indemnity payment for complication of patient management ($3.5 million), followed by "wrongful birth" ($1.03 million), and "minor physical injury" ($520,000). No specific type of negligent claim (p = 0.764) nor complication of patient management (p = 0.61) was associated with a greater indemnity payment. Mean indemnity payment was $920,000 prior to 2001 and $4.4 million after 2001 (p = 0.058).
  
  
  CONCLUSIONS
  Mean indemnity payments were fourteen-fold greater in patients as compared to those in the overall population ($3.9 million versus $274,887) and seven-fold greater than those in the average pediatric population ($3.9 million versus $520,923). All healthcare providers should be aware of the associated medical malpractice claims that may be incurred when treating patients at risk for these conditions.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, University of North Carolina - Chapel Hill, 170 Manning Drive, CB #7070, Physician's Office Building Room G-190, Chapel Hill, NC 27599-7040, USA. Electronic address: rrawal@unch.unc.edu.
authors.forename: Rounak B
authors.initials: RB
authors.lastname: Rawal
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, University of North Carolina - Chapel Hill, 170 Manning Drive, CB #7070, Physician's Office Building Room G-190, Chapel Hill, NC 27599-7040, USA. Electronic address: lauren_kilpatrick@med.unc.edu.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Kilpatrick
authors.affiliation: Division of Plastic Surgery, University of North Carolina - Chapel Hill, 7040 Burnett-Womack, CB #7195 Chapel Hill, NC 27599-7040, USA. Electronic address: jeyhan_wood@med.unc.edu.
authors.forename: Jeyhan S
authors.initials: JS
authors.lastname: Wood
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, University of North Carolina - Chapel Hill, 170 Manning Drive, CB #7070, Physician's Office Building Room G-190, Chapel Hill, NC 27599-7040, USA. Electronic address: amelia_drake@unc.edu.
authors.forename: Amelia F
authors.initials: AF
authors.lastname: Drake
mesh_terms: D002971:Cleft Lip / Q000175:diagnosis* / Q000601:surgery; D002972:Cleft Palate / Q000175:diagnosis* / Q000601:surgery; D019465:Craniofacial Abnormalities / Q000175:diagnosis* / Q000601:surgery; D016208:Databases, Factual; D003951:Diagnostic Errors / Q000331:legislation & jurisprudence / Q000639:trends*; D019468:Disease Management; D005260:Female; D006282:Health Personnel; D006801:Humans; D007223:Infant; D016365:Liability, Legal; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence / Q000639:trends*; D019300:Medical Errors / Q000331:legislation & jurisprudence / Q000639:trends*; D009774:Obstetrics; D000072143:Pediatricians; D010372:Pediatrics; D010820:Physicians; D000072177:Radiologists; D012189:Retrospective Studies; D013518:Surgery, Plastic; D014481:United States; D015974:Wrongful Life
keywords: Cleft; Craniofacial; Litigation; Malpractice