Litigation and Malpractice in Carpal Tunnel Surgery: An Analysis of 60 Successful Claims Over a 10-Year Period (2002–2012)

Abstract

Introduction Carpal tunnel surgery represents a significant source of litigation in hand surgery. The aim of this work was to evaluate the burden of successful litigation relating to this type of hand surgery in England. Secondary measures looked at identifying the most common causes of successful legal action.

Material and Methods A retrospective review was conducted on the National Health Service Litigation Authority (NHSLA) database. All successful carpal tunnel surgery-related claims over a 10-year period from 2002 to 2012 were identified. A total of 60 claims were retrieved and analyzed.

Results The total cost of successful claims to the NHS was £3.9 million. This compromised £2.4 million in damages, with £1.5 million in legal costs (22% in NHS legal costs, the remainder the claimants costs). The mean cost of settling a claim was £65,440 (range £350–£397,134). The commonest cause of the claim was nerve damage. The average damages paid in relation to this injury was £55,460. Additional surgery and poor outcome were the next commonest cause of successful proceedings, with average damages of £28,984.

Conclusion Legal action in relation to carpal tunnel surgery is a considerable source of cost to hand surgeons and the NHS. The complexity of resolving these cases is reflected in the associated legal costs, which represent a significant proportion of payouts. With improved understanding of factors instigating successful legal proceedings physicians can recognize areas, where practice and training can be improved, and steps can be taken to minimize injury.

Keywords

carpal tunnel - malpractice - litigation - hand surgery

• References

• 1 NHSLA. Factsheet 1: Basic Information. London, United Kingdom. NHSLA (NHS Litigation Authority); 2014. Available at http://www.nhsla.com/currentactivity/Documents/NHS%20LA%20Factsheet%201%20-%20basic%20information%202014 . Accessed on April 26, 2016
• 2 Khan IH, Giddins G. Analysis of NHSLA claims in hand and wrist surgery. J Hand Surg Eur Vol 2010; 35 (1) 61-64
• 3 Khan IH, Jamil W, Lynn SM, Khan OH, Markland K, Giddins G. Analysis of NHSLA claims in orthopedic surgery. Orthopedics 2012; 35 (5) e726-e731
• 4 Agee JM, McCarroll Jr HR, Tortosa RD, Berry DA, Szabo RM, Peimer CA. Endoscopic release of the carpal tunnel: a randomized prospective multicenter study. J Hand Surg Am 1992; 17 (6) 987-995
• 5 Agee JM, McCarroll HR, North ER. Endoscopic carpal tunnel release using the single proximal incision technique. Hand Clin 1994; 10 (4) 647-659
• 6 Agee JM, Peimer CA, Pyrek JD, Walsh WE. Endoscopic carpal tunnel release: a prospective study of complications and surgical experience. J Hand Surg Am 1995; 20 (2) 165-171 , discussion 172
• 7 Johnson SP, Adkinson JM, Chung KC. Addressing medical errors in hand surgery. J Hand Surg Am 2014; 39 (9) 1877-1882
• 8 Storey PA, Akhtar S, Bradley MJ, Kay NR, Lindau T, Burke FD. Compensation claims and carpal tunnel decompression. Ann R Coll Surg Engl 2008; 90 (8) 714-715
• 9 McDonald III AP, Lourie GM. Complex surgical conditions of the hand: avoiding the pitfalls. Clin Orthop Relat Res 2005; (433) 65-71
• 10 Boeckstyns ME, Sørensen AI. Does endoscopic carpal tunnel release have a higher rate of complications than open carpal tunnel release? An analysis of published series. J Hand Surg [Br] 1999; 24 (1) 9-15
• 11 Jebson PJ, Agee JM. Carpal tunnel syndrome: unusual contraindications to endoscopic release. Arthroscopy 1996; 12 (6) 749-751
• 12 Pappas ND, Moat D, Lee DH. Medical malpractice in hand surgery. J Hand Surg Am 2014; 39 (1) 168-170