(S026) Medical Malpractice in Radiation Oncology

April 15, 2016

To promote legal decisions in favor of the radiation oncologist, we recommend: accreditation by the American Society for Radiation Oncology (ASTRO) Accreditation Program for Excellence (APEx); use of the ASTRO Radiation Oncology Incident Learning System (RO-ILS); and physician-patient discussion about treatment toxicity (eg, timing, etiologies, and risk of morbidity and mortality), with diligent documentation.

Nicholas G. Zaorsky, MD, Anthony G. Ricco, BS, Thomas M. Churilla, MD, Eric M. Horwitz, MD, Robert B. Den, MD; Fox Chase Cancer Center; Thomas Jefferson University

PURPOSE: To comprehensively analyze federal and state court records of malpractice trials related to radiation oncologists and characterize factors important in determining outcomes. 

METHODS: We systematically reviewed the Westlaw database using the advanced search function, from 1985 to 2015. The outcome measures were (1) dismissal of a case (ie, no trial initiated) and (2) patient receiving indemnity payment, either by jury or settlement. Covariates included treatment modality, alleged malpractice claim, rationale of defendants, characteristics of plaintiffs and defendants, and county-level data from the Area Health Resource Files. Fisher’s exact and Mann-Whitney U tests were used; odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.

RESULTS: There were 34 cases identified. Litigation cases at highest risk of nondismissal involved male patients (OR, 0.17 [95% CI, 0.03–0.72]; P = .03) with prostate or head and neck cancers (OR, 0.15 [95% CI, 0.04–0.81]; P = .03) where there is failure to recognize the claim (OR, 0.22 [95% CI, 0.05–0.98]; P = .046) or patient death (OR, 0.70 [95% CI, 0.54–0.94]; P = .04). Statute of limitations (OR, 8.1 [95% CI, 1.3–50]; P = .02) and insufficient evidence (P = .04) defenses were predictive of case dismissal and jury ruling in favor of the radiation oncologist, respectively. Type of radiation therapy (RT) used, specialists involved, academic vs private practice setting of the defendants, resident involvement, and county-level data were not predictive of case dismissal, award, or settlement.

CONCLUSIONS: To promote legal decisions in favor of the radiation oncologist, we recommend: accreditation by the American Society for Radiation Oncology (ASTRO) Accreditation Program for Excellence (APEx); use of the ASTRO Radiation Oncology Incident Learning System (RO-ILS); and physician-patient discussion about treatment toxicity (eg, timing, etiologies, and risk of morbidity and mortality), with diligent documentation.

Proceedings of the 98th Annual Meeting of the American Radium Society - americanradiumsociety.org