Malpractice litigation following spine surgery

Alan H. Daniels Brown University, Providence, Rhode Island
Division of Spine Surgery,

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Roy Ruttiman Brown University, Providence, Rhode Island
Alpert Medical School of

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Adam E. M. Eltorai Brown University, Providence, Rhode Island
Alpert Medical School of

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J. Mason DePasse Brown University, Providence, Rhode Island
Department of Orthopaedic Surgery, and

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Bielinsky A. Brea Brown University, Providence, Rhode Island

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Mark A. Palumbo Brown University, Providence, Rhode Island
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OBJECTIVE

Adverse events related to spine surgery sometimes lead to litigation. Few studies have evaluated the association between spine surgical complications and medical malpractice proceedings, outcomes, and awards. The aim of this study was to identify the most frequent causes of alleged malpractice in spine surgery and to gain insight into patient demographic and clinical characteristics associated with medical negligence litigation.

METHODS

A search for “spine surgery” spanning February 1988 to May 2015 was conducted utilizing the medicolegal research service VerdictSearch (ALM Media Properties, LLC). Demographic data for the plaintiff and defendant in addition to clinical data for the procedure and legal outcomes were examined. Spinal cord injury, anoxic/hypoxic brain injury, and death were classified as catastrophic complications; all other complications were classified as noncatastrophic. Both chi-square and t-tests were used to evaluate the effect of these variables on case outcomes and awards granted.

RESULTS

A total of 569 legal cases were examined; 335 cases were excluded due to irrelevance or insufficient information. Of the 234 cases included in this investigation, 54.2% (127 cases) resulted in a defendant ruling, 26.1% (61) in a plaintiff ruling, and 19.6% (46) in a settlement. The awards granted for plaintiff rulings ranged from $134,000 to $38,323,196 (mean $4,045,205 ± $6,804,647). Awards for settlements ranged from $125,000 to $9,000,000 (mean $1,930,278 ± $2,113,593), which was significantly less than plaintiff rulings (p = 0.022). Compared with cases without a delay in diagnosis of the complication, the cases with a diagnostic delay were more likely to result in a plaintiff verdict or settlement (42.9% vs 72.7%, p = 0.007) than a defense verdict, and were more likely to settle out of court (17.5% vs 40.9%, p = 0.008). Similarly, compared with cases without a delay in treatment of the complication, those with a therapeutic delay were more likely to result in a plaintiff verdict or settlement (43.7% vs 68.4%, p = 0.03) than a defense verdict, and were more likely to settle out of court (18.1% vs 36.8%, p = 0.04). Overall, 28% of cases (66/234) involved catastrophic complications. Physicians were more likely to lose cases (plaintiff verdict or settlement) with catastrophic complications (66.7% vs 37.5%, p < 0.001). In cases with a plaintiff ruling, catastrophic complications resulted in significantly larger mean awards than noncatastrophic complications ($6.1M vs $2.9M, p = 0.04). The medical specialty of the provider and the age or sex of the patient were not associated with the case outcome or award granted (p > 0.05). The average time to a decision for defendant verdicts was 5.1 years; for plaintiff rulings, 5.0 years; and for settlements, 3.4 years.

CONCLUSIONS

Delays in the diagnosis and the treatment of a surgical complication predict legal case outcomes favoring the plaintiff. Catastrophic complications are linked to large sums awarded to the plaintiff and are predictive of rulings against the physician. For physician defendants, the costs of settlements are significantly less than those of losing in court. Although this study provides potentially valuable data from a large series of postoperative litigation cases, it may not provide a true representation of all jurisdictions, each of which has variable malpractice laws and medicolegal environments.

OBJECTIVE

Adverse events related to spine surgery sometimes lead to litigation. Few studies have evaluated the association between spine surgical complications and medical malpractice proceedings, outcomes, and awards. The aim of this study was to identify the most frequent causes of alleged malpractice in spine surgery and to gain insight into patient demographic and clinical characteristics associated with medical negligence litigation.

METHODS

A search for “spine surgery” spanning February 1988 to May 2015 was conducted utilizing the medicolegal research service VerdictSearch (ALM Media Properties, LLC). Demographic data for the plaintiff and defendant in addition to clinical data for the procedure and legal outcomes were examined. Spinal cord injury, anoxic/hypoxic brain injury, and death were classified as catastrophic complications; all other complications were classified as noncatastrophic. Both chi-square and t-tests were used to evaluate the effect of these variables on case outcomes and awards granted.

RESULTS

A total of 569 legal cases were examined; 335 cases were excluded due to irrelevance or insufficient information. Of the 234 cases included in this investigation, 54.2% (127 cases) resulted in a defendant ruling, 26.1% (61) in a plaintiff ruling, and 19.6% (46) in a settlement. The awards granted for plaintiff rulings ranged from $134,000 to $38,323,196 (mean $4,045,205 ± $6,804,647). Awards for settlements ranged from $125,000 to $9,000,000 (mean $1,930,278 ± $2,113,593), which was significantly less than plaintiff rulings (p = 0.022). Compared with cases without a delay in diagnosis of the complication, the cases with a diagnostic delay were more likely to result in a plaintiff verdict or settlement (42.9% vs 72.7%, p = 0.007) than a defense verdict, and were more likely to settle out of court (17.5% vs 40.9%, p = 0.008). Similarly, compared with cases without a delay in treatment of the complication, those with a therapeutic delay were more likely to result in a plaintiff verdict or settlement (43.7% vs 68.4%, p = 0.03) than a defense verdict, and were more likely to settle out of court (18.1% vs 36.8%, p = 0.04). Overall, 28% of cases (66/234) involved catastrophic complications. Physicians were more likely to lose cases (plaintiff verdict or settlement) with catastrophic complications (66.7% vs 37.5%, p < 0.001). In cases with a plaintiff ruling, catastrophic complications resulted in significantly larger mean awards than noncatastrophic complications ($6.1M vs $2.9M, p = 0.04). The medical specialty of the provider and the age or sex of the patient were not associated with the case outcome or award granted (p > 0.05). The average time to a decision for defendant verdicts was 5.1 years; for plaintiff rulings, 5.0 years; and for settlements, 3.4 years.

CONCLUSIONS

Delays in the diagnosis and the treatment of a surgical complication predict legal case outcomes favoring the plaintiff. Catastrophic complications are linked to large sums awarded to the plaintiff and are predictive of rulings against the physician. For physician defendants, the costs of settlements are significantly less than those of losing in court. Although this study provides potentially valuable data from a large series of postoperative litigation cases, it may not provide a true representation of all jurisdictions, each of which has variable malpractice laws and medicolegal environments.

Medical malpractice litigation increasingly affects the delivery and cost of health care. In 2014, malpractice payments totaled $3.9 billion in the United States.18,20 The risk of malpractice encourages the defensive medicine practices of increased diagnostic testing, unnecessary referrals, and patient avoidance.4,5

Neurosurgeons have the highest annual rate of malpractice claims of any medical specialty, with 19.1% of neurosurgeons facing a claim annually.11,14 Spine surgery represents the majority of malpractice claims for neurosurgeons9 and leads to similarly high rates of malpractice cases for orthopedic spine surgeons. The considerable risk of morbidity and mortality associated with operative spine procedures combined with the growing use of spine surgery18 may continue to increase the potential for litigation.

It is important for spine surgeons to understand the risk factors for malpractice litigation. Few studies have evaluated the association between spine surgical complications and medical malpractice proceedings, outcomes, and awards. The aim of this study was to identify the most frequent causes of alleged malpractice in spine surgery and to gain insight into patient demographic and clinical characteristics associated with medical negligence litigation.

Methods

The “malpractice” subcategory of the legal research service VerdictSearch (ALM Media Properties, LLC), which includes cases from February 1988 to May 2015, was queried utilizing the term “spine surgery.” The demographic data collected for each plaintiff included age, sex, and state in which the lawsuit was filed. The type of surgical complication (death, anoxic/hypoxic brain injury, spinal cord injury, nerve root damage, malposition of instrumentation, wrong surgical site, and other intraoperative medical complications), operative site (cervical, thoracic, lumbar, multiple regions), surgical procedure performed, the presence of delayed diagnosis and/or treatment, and the medical specialty of the provider were also recorded. Spinal cord injury, anoxic/hypoxic brain injury, and death were classified as catastrophic complications. All other complications were classified as noncatastrophic. The litigation outcome of each case was categorized as a defense verdict (physician or hospital victory), plaintiff verdict (physician or hospital loss), or settlement; associated indemnity payments were documented, as was the time to case settlement or court ruling. The effects of the age of the plaintiff, sex of the plaintiff, surgical complications, operative site, specialty of the surgeon, hospital defendant named in the suit, delay in diagnosis, and delay in treatment were evaluated using chi-square testing (Microsoft Excel). Effect on the amount of indemnity payment was evaluated for all variables using Student’s t-tests and 1-way ANOVAs. Statistical significance was set at p < 0.05

Results

Case Characteristics

A total of 569 legal cases were examined; 335 cases were excluded due to irrelevance or insufficient information, leaving 234 cases available for review (Table 1). There were 99 male (42.3% of all cases) and 135 female (57.7%) patients included in this study. The average patient age was 48.1 ± 15.8 years (mean ± SD; 224 patients; age was not available for 10 cases). In total, 158 cases (67.5% all cases) were filed in 5 states: New York (57), California (49), Texas (26), Massachusetts (13), and Ohio (13). The remaining 76 cases were filed in 17 other states and Washington, DC.

TABLE 1.

Case characteristics for 234 spine surgery malpractice suits

VariableNo.
Mean age in yrs (SD)48.1 (15.8)
Age not provided (no. of cases)10
Sex (no. of cases)
 Male99 (42.3%)
 Female135 (57.7%)
State (no. of cases)
 California49
 Massachusetts13
 New York57
 Ohio13
 Texas26
 Other states*76
Procedure (no. of cases)
 Decompression33
 Discectomy44
 Foraminotomy6
 Fusion90
 Laminectomy53
 Other surgical procedure60
 Procedure not listed11
Spine region (no. of cases)
 Cervical61
 Thoracic41
 Lumbar73
 Multiple59
Complication (no. of cases)
 Death8
 Spinal cord injury60
 Anoxic/hypoxic brain injury2
 Nerve root injury37
 Malpositioned instrumentation6
 Incorrect surgical site11
 Other medical or anesthetic complications192
Delay in Dx (no. of cases)
 Yes22
 No212
Delay in Tx (no. of cases)
 Yes19
 No215
Profession sued (no. of cases)
 Orthopedic surgery136
 Neurosurgery79
 Nonsurgical19

Dx = diagnosis; Tx = treatment.

AR = 1 case; CO = 1; CT = 4; FL = 8; GA = 11; IL = 4; MD = 11; MI = 8; MO = 1; NJ = 4; NC = 1; OK = 1; OR = 1; PA = 10; SC = 3; VA = 4; WV = 1; Washington, DC = 2.

30.8% of patients underwent multiple procedures.

54.3% of cases listed more than 1 complication.

Ninety cases (38.5% of all cases) listed spinal fusion as a performed surgical procedure. Spinal decompression (33 cases), discectomy (44), foraminotomy (6), laminectomy (53), and other surgical procedures (60) were reported as well. Overall, 30.8% of patients underwent combined procedures (for example, fusion and decompression). Procedure type was not provided in 11 cases. Seventy-three cases (31.2% of all cases) included a surgical procedure in the lumbar spine region. Operations performed in the cervical, thoracic, or multiple spine regions were cited in 61 (26.1%), 41 (17.5%), and 59 (25.2%) cases, respectively.

Sixty-six patients (28.2% all cases) experienced catastrophic complications: death (8 cases), anoxic/hypoxic brain injury (2), and spinal cord injury (60). Noncatastrophic cases included nerve root damage (37 cases), malpositioned instrumentation (6), incorrect surgical site (11), and other perioperative medical or anesthetic complications (192). More than 1 complication was listed in 54.3% of cases.

A delay in diagnosis of the complication occurred in 10.4% of cases (22 cases) and a delay in its treatment in 8.1% of cases (19). Orthopedic surgeons were sued in 136 cases (58% of all cases), while neurosurgeons and nonsurgical specialties were sued in 79 (34%) and 19 (8%) cases, respectively.

Litigation Outcomes

Overall, 54.2% of cases (127 cases) resulted in a defendant ruling, 26.1% (61) in a plaintiff ruling, and 19.6% (46) in a settlement. The average time to a decision for defendant verdicts was 5.1 years; for plaintiff rulings, 5.0 years; and for settlements, 3.4 years. Total liabilities of the 234 cases were $335,550,287, with awards ranging from $125,000 to $38,323,196. The average award granted for plaintiff rulings ($4,045,205 ± $6,804,647 [mean ± SEM], range $134,000–$38,323,196) was significantly greater than the amount awarded in settlement cases ($1,930,278 ± $2,113,593, range $125,000–$9,000,000; p = 0.022; Table 2).

TABLE 2.

Amounts awarded in catastrophic versus noncatastrophic complications cases

OutcomeMean Award (SEM)Range of Awards
CatastrophicNoncatastrophicCatastrophicNoncatastrophic
Defense verdict$0$0$0$0
Plaintiff verdict$6.07M (1.57)$2.90M (1.01)$400,000–$26.8M$134,000–$38.3M
Settlement$2.35M (0.55)$1.54M (0.31)$125,000–$9.0M$225,000–$6.60M

Total of 234 cases: 66 (28.2%) catastrophic cases, 168 (71.8%) noncatastrophic cases. More than 1 complication was listed in 54.3% of cases.

The medical specialty of the provider and the age and sex of the patient were not statistically associated with case outcome or award granted (p > 0.05).

Hospital Defendant Analysis

Hospitals were named as a defendant in 40.6% (95/234) of suits. Cases filed against hospitals were more likely to result in a plaintiff verdict or settlement compared with cases in which a hospital was not named (53.7% vs 40.3%, p = 0.04). There was no statistical difference in the monetary award granted for plaintiff verdicts ($4,298,211 vs $3,766,025, respectively; p = 0.38) or settlement cases ($2,191,945 vs $1,690,417, respectively; p = 0.21) between cases filed against hospitals and those filed against individual physicians.

Delay in Diagnosis

A delay in diagnosis of the complication occurred in 4.7% of defendant rulings (6 cases), 11.5% of plaintiff rulings (7), and 19.6% of settlement cases (9). Compared with cases without a delay in diagnosis, those that did cite a delay were more likely to result in a plaintiff verdict or settlement (42.9% vs 72.7%, p = 0.007) than a defense verdict, and were more likely to settle out of court (17.5% vs 40.9%, p = 0.008; Table 3).

TABLE 3.

Case outcomes for a delay versus no delay in diagnosis and treatment of a complication

ParameterDefense VerdictPlaintiff Verdict & SettlementCourt CaseSettlement
Delay in Dx6 (27.3%)16 (72.7%)*13 (59.1%)9 (40.9%)
No delay in Dx121 (57.1%)91 (42.9%)175 (82.5%)37 (17.4%)
Delay in Tx6 (31.6%)13 (68.4%)12 (63.2%)7 (36.8%)§
No delay in Tx121 (56.3%)94 (43.7%)176 (81.9%)39 (18.1%)

p = 0.007, compared with cases without a delay in diagnosis.

p = 0.008, compared with cases without a delay in diagnosis.

p = 0.03, compared with cases without a delay in treatment.

p = 0.04, compared with cases without a delay in treatment.

There was no statistical difference between the monetary awards granted to cases with or without a delay in diagnosis for both plaintiff verdicts ($3,878,090 vs $4,066,868, respectively; p = 0.94) and settlement cases ($2,184,799 vs $1, 868,508, respectively; p = 0.69).

Delay in Treatment

A delay in treatment of the complication was present in 4.7% of defendant rulings (6 cases), 9.8% of plaintiff rulings (6), and 15.2% ending in settlements (7). Compared with cases without a delay in treatment, those with a delay were more likely to result in a plaintiff verdict or settlement (43.7% vs 68.4%, p = 0.03) than a defense verdict, and were more likelyto settle out of court (18.2% vs 36.8%, p = 0.04; Table 3).

There was no statistical difference between the monetary awards granted to cases with or without a delay in treatment for both plaintiff verdicts ($4,758,367 vs $3,967,405, respectively; p = 0.78) and settlement cases ($2,356,857 vs $1,853,713, respectively; p = 0.56).

Surgical Complications

In cases in which patients experienced catastrophic complications compared with those in which patients experienced noncatastrophic complications, physicians were more likely to lose (66.7% [44/66] vs 37.5% [63/168], p < 0.001) and to settle out of court (33.3% [22/44] vs 14.3% [24/168], p < 0.001; Table 4).

TABLE 4.

Outcomes in catastrophic versus noncatastrophic complications cases

ComplicationsDefense VerdictPlaintiff Verdict & SettlementCourt CaseSettlement
Catastrophic (66)22 (33.3%)44 (66.7%)*44 (66.7%)22 (33.3%)
Noncatastrophic (168)105 (62.5%)63 (37.5%)144 (85.7%)24 (14.3%)
Total127 (54.3%)107 (45.7%)188 (80.3%)46 (19.6%)

p < 0.001.

p < 0.001.

Catastrophic complications in cases with a plaintiff ruling resulted in awards significantly larger than those in noncatastrophic complications cases ($6,077,060 vs $2,899,030; p = 0.04). In cases resulting in a settlement, there was no statistical difference between awards granted for catastrophic complications and noncatastrophic complications ($2,351,491 vs $1,544,167, respectively; p = 0.09; Table 2).

Effects of Age

The average age of patients in defendant-verdict cases was 49.3 ± 14.5 years. Patients involved in plaintiff rulings and settlement cases averaged 49.1 ± 15.9 and 42.9 ± 18.2 years of age, respectively. Cases involving patients younger than 18 years of age were statistically more likely to end in settlement (p = 0.015; Table 5).

TABLE 5.

Case outcomes among age groups

Age Group (no.)Defense VerdictPlaintiff Verdict & SettlementCourt CaseSettlement
<18 yrs (10)2 (20.0%)8 (80.0%)4 (40.0%)6 (60.0%)*
19–30 yrs (20)11 (55.0%)9 (45.0%)17 (85.0%)3 (15.0%)
31–45 yrs (66)37 (56.1%)29 (43.9%)51 (77.3%)15 (22.7%)
46–60 yrs (79)45 (57.0%)34 (43.0%)66 (83.5%)13 (16.4%)
>60 yrs (49)28 (57.1%)21 (42.9%)42 (85.7%)7 (14.3%)
Total (224)123 (54.9%)101 (45.1%)180 (80.4%)44 (19.6%)

p = 0.015.

There was no statistical difference between awards granted to patients with an age of < 18, 19–30, 31–45, 46–60, or > 61 years in either plaintiff rulings or settlements (p = 0.27 and p = 0.66, respectively; Fig. 1).

FIG. 1.
FIG. 1.

Awards granted in plaintiff rulings and settlement cases among different age groups. There was no statistical difference between awards granted to patients with an age of < 18, 19–30, 31–45, 46–60, or > 61 years in either plaintiff rulings or settlements. Figure is available in color online only.

Effects of Sex

Male patients received a defendant ruling in 60.6% (77/127) of their cases, compared with female patients who received a defendant ruling in 39.4% (50/127) of their cases. Plaintiff verdicts involved 50.8% males (31/61) and 49.2% females (30/61), whereas settlements involved 58.7% males (27/46) and 41.3% females (19/46). The sex of the plaintiff did not have a significant effect on the legal outcome of the cases studied (p = 0.32). In addition, sex did not influence whether the involved parties went through with court proceedings or settled out of court (p = 0.87). There was no statistical difference between the monetary award granted to men and women in both plaintiff verdicts ($3,996,743 vs $4,095,282, respectively; p = 0.95) and settlement cases ($2,279,252 vs $1,434,368, respectively; p = 0.18).

Provider Specialty

The medical specialty of the provider was not associated with the legal outcome of the case (p = 0.41). Moreover, the provider’s specialty did not affect whether his or her case was handled in court or via settlement (p = 0.68). There was no statistical difference between awards granted to patients who sued orthopedic surgeons, neurosurgeons, or nonsurgical specialties in either plaintiff rulings or settlements (p = 0.56 and p = 0.09, respectively; Fig. 2).

FIG. 2.
FIG. 2.

Awards granted in plaintiff rulings and settlement cases among provider specialties. There was no statistical difference between awards granted to patients who sued orthopedic surgeons, neurosurgeons, or nonsurgical specialties in either plaintiff rulings or settlement cases. Figure is available in color online only.

Discussion

In this study, we evaluated the association between spine surgery complications and malpractice proceedings, outcomes, and awards. In the cases examined, catastrophic complications (death, anoxic/hypoxic brain injury, and spinal cord injury) were predictors of a medicolegal case outcome in favor of the plaintiff and were linked to large sums awarded to the plaintiff. Delays in the diagnosis and treatment of a postoperative complication were also significantly related to plaintiff rulings and settlements.

Previous studies have evaluated neurosurgical and orthopedic malpractice claims data;1,3–7,9–14,17,19,20 however, none has focused specifically on spine surgery. Past studies have been limited to physician surveys12,13,15,20 and single-institution experiences,5,14 have solely focused on the size of malpractice claims,5,7,12,14,17 or have been multicenter studies of specific US regions or data subgroups.3,12,17,19 In contrast, the present investigation specifically evaluated spine surgery data by including the specialties of neurosurgery and orthopedic surgery and by using claims data from litigation cases from around the country.

The current investigation revealed that 54.2% of spine malpractice cases concluded in a defense (physician) verdict. This percentage of cases with a ruling in favor of the physician is lower than the 75% reported national average,2,21 which may be attributable to the catastrophic nature of many spine complications.

An additional consideration is that awards were generally higher for younger plaintiffs, although not statistically significantly higher given the relatively small number of young patients in this sample. The reason for the larger settlements in young patients is probably related to actuarial methodology, which factors in the number of years remaining in a patient’s working life to calculate damage amounts. Our data also revealed that cases in which a hospital was named as a defendant were more likely to result in a plaintiff verdict or settlement. This outcome may be due to lawyers’ propensity to add the hospital as a defendant in more serious cases of malpractice and in cases in which awards are likely to be larger.

Although this study does provide potentially valuable data from a large series of postoperative litigation cases, it may not provide a true representation of all spine surgery lawsuits, as many cases are settled or rejected by the courts before court proceedings take place. Furthermore, jurisdictions may have varying lawsuit outcome profiles and may differ from those reported in this study because of variable local malpractice laws and medicolegal environments.

There are several potential limitations to this study. VerdictSearch cases are electively submitted by case attorneys, reviewed by the VerdictSearch editorial staff, published in their weekly newsletter, and ultimately incorporated into their database. VerdictSearch is not a comprehensive malpractice database and cannot be used to assess the prevalence of all spine procedure litigation. Furthermore, settlements that do not progress to court records are not included in this database, limiting the out-of-court data available for analysis. In addition, cases resulting in a plaintiff verdict, especially those ending in large awards, may be overrepresented in the database, while defendant verdicts could be underreported. Additionally, the level of medical detail for each case is variable based on court reports. Despite these limitations, VerdictSearch has been used in numerous studies7,8,16,17 and provides a unique and meaningful approach to analyzing the impact of malpractice in spine surgery.

Conclusions

As a high-risk malpractice specialty, spine surgery is particularly influenced by the current litigation climate. The well-recognized practice of defensive medicine substantially impacts the delivery and cost of health care. This study serves as a preliminary report regarding the factors that affect spine surgery litigation outcomes. Our results indicate that catastrophic complications and a delay in the diagnosis or treatment of a spine surgery complication are predictive of a plaintiff victory. Understanding what leads to litigation in spine surgery should help remind surgeons to work diligently to prevent avoidable complications, especially those caused by delayed diagnosis and delayed treatment.

Further research on legal outcomes in spine surgery is needed, including analyses of other similar legal databases. An enhanced understanding of the reasons for and outcomes of medical malpractice litigation may allow for the implementation of protocols to improve patient safety and reduce the risk of litigation.

Disclosures

Dr. Daniels is a consultant for Stryker and Orthofix and has received clinical or research support from Orthofix for the study described. Dr. Palumbo is a consultant for Stryker.

Author Contributions

Conception and design: all authors. Acquisition of data: all authors. Analysis and interpretation of data: all authors. Drafting the article: all authors. Critically revising the article: all authors. Reviewed submitted version of manuscript: all authors. Approved the final version of the manuscript on behalf of all authors: Daniels. Statistical analysis: all authors. Administrative/technical/material support: Daniels, Palumbo. Study supervision: Daniels, Palumbo.

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    Vidmar N: Juries and medical malpractice claims: empirical facts versus myths. Clin Orthop Relat Res 467:367375, 2009

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  • Awards granted in plaintiff rulings and settlement cases among different age groups. There was no statistical difference between awards granted to patients with an age of < 18, 19–30, 31–45, 46–60, or > 61 years in either plaintiff rulings or settlements. Figure is available in color online only.

  • Awards granted in plaintiff rulings and settlement cases among provider specialties. There was no statistical difference between awards granted to patients who sued orthopedic surgeons, neurosurgeons, or nonsurgical specialties in either plaintiff rulings or settlement cases. Figure is available in color online only.

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