Tracheotomy: When the Patient Sues

In many medical fields, malpractice has driven changes in the way physicians practice medicine. In the surgical field, tracheotomies are often crucial, but are associated with a high risk of morbidity and mortality. A quick look at the results when one enters “tracheotomy” and “lawsuit” into any search engine shows that patients, dissatisfied with myriad aspects of breathing through a tube, often sue after this procedure. Researchers from Wayne State University School of Medicine and Dingell VA Medical Center in Michigan conducted a review of jury verdicts and settlements related to tracheotomy. The journal Head & Neck has published their findings ahead of print.

These researchers engaged the Westlaw legal database and identified 43 jury verdicts and settlements related to tracheotomy that concluded between 1987 and 2013. Note that many cases are withdrawn or settled early and do not become public; this database does not address these.

They identified a distinct difference between settlements and verdict awards, although both were large. Settlements to plaintiffs averaged $500,000. In cases that went to trial, the average verdict award was much larger averaging $2,000,000. This is consistent with other types of medical litigation.

Patients alleged post-operative negligence most often (81%; mucous plug, dislodged tracheotomy tube, and bleeding). Other allegations included intra-operative negligence (27.9%) and permanent injury (18.6%). Permanent injury was associated with higher award amounts. In other medical procedures, patients often allege improper informed consent, but this was not the case with tracheotomies, probably because they are not elective procedures.

One-quarter of defendants were otolaryngologists, making physicians from this specialty the most frequent defendants.

Nurses were named second most often (18%), independently and in conjunction with physicians and facilities. This highlights a need for specialized training for nurses who care for tracheotomy patients.

Pediatric cases had significantly higher awards and were more likely to end in favor of the plaintiff. Although pediatricians are the least likely to be sued of all specialties, when they are sued, judgment in favor of the plaintiff is likely and often the financial award is high.

The authors conclude that awareness of tracheotomy malpractice litigation can help physicians avoid future litigation and improve patient safety.