ASA Annual Meeting Materials

2008 Materials

1. Lee, LA, Fligner CL, Stephens LS, Cheney FW, Domino KB: Role of Autopsy in the ASA Closed Claims Project. Anesthesiology 109: A372, 2008. [Full Abstract Text]
   1. Autopsy was performed in approximately half of all claims associated with death, especially in healthy, younger persons. Autopsy results were useful in detecting unexpected pathology, and identifying significant non-anesthetic contributions to death. Pathological findings from autopsy were frequently useful in the medico-legal defense of anesthesiologists.
2. Sandnes DL, Stephens LS, Posner KL, Domino KB: Liability Associated with Medication Errors in Anesthesia: Closed Claims Analysis. Anesthesiology 109: A770, 2008. [Full Abstract Text]
   1. Claims related to medication errors had a higher proportion of pediatric patients compared to other claims. Medication errors commonly involved incorrect doses and medication substitution by syringe swaps. Claims related to medication errors had more permanent brain damage compared to other claims and were more often judged to be preventable, representing substandard care.
3. Morray J, Ramamoorthy C, Haberkern C, Bhanaker S, Posner K: Anesthesia-Related Cardiac Arrest in Children with Heart Disease: Data from the POCA Registry. Anesthesiology 109: A11, 2008. [Full Abstract Text]
   1. Single ventricle and obstructive lesions (particularly aortic stenosis) were the most common type of heart disease in the POCA Registry. Without the necessary denominators, we cannot provide CA incidence for each heart disease lesion. It is noteworthy that CA in heart disease patients was reported more often in the general OR than in the cardiac OR or the cath lab. Such information may aid anesthesiologists in case assignments for infants and children with heart disease.

2007 Materials

1. Bird M, Caplan RA, Lee LA, Stephens LS, Domino KB: Liability Associated with Acute Pain Management. Anesthesiology 107: A1743, 2007. [Full Abstract Text]
   1. Claims related to acute pain management are a new source of liability for anesthesiologists. While claims for nerve damage, hematomas, and abscesses were more common with regional blocks used for postoperative pain control, claims for death or brain damage formed a third of acute pain claims. Respiratory depression was an important damaging event, and injuries may have been prevented by better use of respiratory monitoring devices.
2. Liau DW, Fitzgibbon DR, Posner KL, Stephens LS, Domino KB: Trends in Chronic Pain Management Malpractice Claims. Anesthesiology A1892, 2007. [Full Abstract Text]
   1. Liability associated with chronic pain management increased in 1995-2004 compared to 1985-94, with more chronic pain claims and higher payment amounts. Nerve injury (peripheral and spinal cord) increased. Modes of pain management changed, with an increase in medication management and a decrease in blocks and injections.

2006 Materials

1. Bhananker SM: On-Patient Fires During Monitored Anesthesia Care: Causation and Prevention. VIDEO: On-Patient Fires during Monitored Anesthesia Care. Windows Media File: Streaming / 32MB Download
2. Davies JM, Posner KL, Cheney FW, Domino KB: Anesthesia Malpractice Claims for Newborn Brain Injury in the 1990s. Anesthesiology 105: A7, 2006. [Full Abstract Text]
   1. The findings of this analysis show that anesthesia care is often not in question, reflected by the proportion of claims resulting in no payment. Alleged anesthesia delay is usually based on the 30-minute decision to delivery rule, which may not have been applicable in all the claims. In 2003, the ACOG Task Force introduced modified criteria to help define the causal relationship between acute intrapartum events and cerebral palsy.4 Hopefully, these new criteria will be positively reflected in future malpractice claims.
3. Posner KL, Cheney FW, Domino KB: Anesthesia vs. Neurosurgery Malpractice Liability. Anesthesiology 105: A144, 2006. [Full Abstract Text]
   1. PIAA data suggests that neurosurgery claims resulted in higher payments than anesthesia claims. This may reflect the higher proportion of neurosurgery claims for permanent and disabling injuries, which typically result in compensation for lifelong care. ASA Closed Claims Project data compared favorably to PIAA data.
4. Liau DW, Kooner PK, Posner KL, Cheney FW, Domino KB: Injuries and Liability Related to Peripheral Catheters: A Closed Claims Analysis. Anesthesiology 105: A945, 2006. [Full Abstract Text]
   1. Although limits inherent to the Closed Claims Project exist,1,2 this analysis of peripheral catheter claims has identified important mechanisms of injury and types of complications. Arm tucking and the inability to monitor IV catheters during cardiac surgery may explain why this was the most common surgical group among IV claims. Thiopental was the most commonly reported drug in skin slough claims; reduction in its use may result in fewer IV-related claims. There were few claims secondary to A-lines. Burn injuries from heat compresses used to treat IV infiltrations should be easily preventable.
5. Kent CD, Posner KL, Cheney FW, Lee LA, Domino KB: Update on Closed Claims for Awareness during General Anesthesia. Anesthesiology 105: A1548, 2006. [Full Abstract Text]
   1. Payments for recall and awake paralysis were not increased over the 1990s, and were similar to those from previous decades. Awake paralysis continues to be a low frequency but preventable problem as the majority of these claims are due to syringe swap errors. More claims for recall were associated with cardiac surgery than previously reported

2005 Materials

1. Lee LA, Roth S, Posner, KL, Cheney, FW, Domino, KB: "An Analysis of 71 Spine Cases with Ischemic Optic Neuropathy from the ASA Postoperative Visual Loss Registry." Anesthesiology 103: A1, 2005. [Full Abstract Text]
   1. Although most ION cases in the ASA POVL Registry were associated with prolonged prone spine surgery (≥ 6 hrs), large blood loss (≥ 1 L), and SBP ≤ 100 mm Hg, the wide ranges in these variables suggests a multi-factorial etiology for ION, and may include unseen patient factors.
2. Bhananker SM, Ramamoorthy R, Posner, KL, Domino KB, Morray JP: Changing Profile of Anesthesia-Related Cardiac Arrests in Children: Update from Pediatric Peri-Operative Cardiac Arrest (POCA) Registry. Anesthesiology 103: A1310, 2005. [Full Abstract Text]
   1. We observed a reduction in the proportion of medication-related arrests in the last 6 years of the POCA Registry and a decrease in the proportion of infants. The reasons for these changes are unclear.
3. Jimenez N, Posner KL, Domino KB, Cheney FW: "Trends in Pediatric Anesthesia Malpractice Claims over Three Decades." Anesthesiology 103: A1309, 2005. [Full Abstract Text]
   1. Pediatric anesthesia malpractice claims suggest a reduction in death and permanent brain damage over time. Respiratory events also declined. These changes may reflect increased safety or changing legal strategies.

2004 Materials

1. Davies JM, Ross BK, Posner KL, Domino KB: Trends in Obstetric Anesthesia Malpractice Claims over the Last Three Decades. Anesthesiology 101: A1231, 2004. [Full Abstract Text]
   1. The proportion of OB anesthesia claims associated with regional anesthesia increased over the decades. This may reflect changes in practice and may account for the reduction in maternal death and newborn brain injury claims and the increase in claims for maternal nerve injury and back pain.
2. Kressin KA, Posner KL, Lee LA, Cheney FW, Domino KB: Burn Injury in the OR: A Closed Claims Analysis.Anesthesiology, 101: A1282, 2004. [Full Abstract Text]
   1. Burn injuries in the Closed Claims database continue to occur primarily from cautery, warming devices and airway fires. Burns from cautery fires, especially to the face, have increased in the 1990s.
3. Posner KL, Domino KB, Polissar NJ, Conrad DA, Cheney FW: Trends in Anesthesia Malpractice Lawsuit Payments. Anesthesiology, 101: A1405, 2004. [Full Abstract Text]
   1. Payments in anesthesia malpractice lawsuits declined between the 1970s and 1990s, even when adjusted for changes in standard of care and outcome.

2003 Materials

1. Bhananker SM, Posner KL, Domino KB, Lee LA, Cheney FW: Liability Associated with Monitored Anesthesia Care: ASA Closed Claims Project. Anesthesiology, 99: A1356, 2003. [Full Abstract Text]
   1. Litigation associated with MAC increased in the 1990s, perhaps reflecting an increase in surgery performed under MAC. Injuries during MAC were as severe and payments to the plaintiff were as high as for injuries during GA. These data suggest that MAC poses significant risk, especially for elderly and chronically ill patients.
2. Lee LA, Posner KL, Cheney FW, Domino KB: ASA Closed Claims Project: An Analysis of Claims Associated with Neurosurgical Anesthesia. Anesthesiology, 99: A362, 2003. [Full Abstract Text]
   1. Neurosurgical cases comprised only 7% of claims in the ASA Closed Claims database, but had higher liability compared to Other Claims. Death and brain damage, eye and nerve damage, air emboli, inadequate fluids, and positioning injuries were more common in neurosurgical claims compared to Other Claims.
3. Peterson GN, Posner KL, Domino KB, Lee LA, Cheney FW: Management of the Difficult Airway in Closed Malpractice Claims. Anesthesiology, 99: A1252, 2003. [Full Abstract Text]
   1. Difficult airway claims are associated with severe injury, death and high levels of liability payment. Severe outcomes were more common in the setting of difficult mask ventilation, “can’t intubate/can’t ventilate”, and persistent intubation attempts.
4. Sharar SR, Tsai YK, Posner KL, Domino KB, Cheney FW: Do Liability and Patient Injuries for Anesthetic Care of Acute Trauma Differ from Those of Non-Trauma Care?: A Closed Claims Analysis. Anesthesiology, 99: A1362, 2003. [Full Abstract Text]
   1. The ASA Closed Claims Project database was analyzed for liability related to acute trauma care. Compared to non-trauma claims, trauma claims involved more emergent and critically ill patients, and resulted in higher mortality and greater median claim payment.

2002 Materials

1. Spitellie PH, Bowdle TA, Posner KL, Cheney FW, Domino KB: Injuries from Central Lines: A Closed Claims Analysis. Anesthesiology 97: A1124, 2002.
2. Lee LA, Posner KL, Caplan RA, Domino KB, Cheney FW: ASA Closed Claims Project: An Analysis of Claims Associated with Regional Anesthesia in the Operative Setting 1980-1999. Anesthesiology 97: A-1126, 2002.

2001 Materials

1. Fitzgibbon DR, Posner KL, Lee LA, Domino KB, Cheney FW: ASA Closed Claims Project: Pain Management in the Non-Surgical Setting 1970-1998. Anesthesiology 95: A957, 2001.

2000 Materials

1. Uppal M, Posner K, Roth S: Visual Loss Complicating Surgery: Review of 21 Cases. Anesthesiology 93: A1136, 2000.

 

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