CIRCUMCISION AND MEDICAL MALPRACTICE: A 35-YEAR REVIEW OF STATE APPELLANT CASES
Daniel A. Friedlander, BA&Sc, Timothy Baumgartner, MD, Ardavan Akhavan, MD.
Jeffs Division of Pediatric Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
BACKGROUND: Approximately 1.2 million neonatal circumcisions are performed in the US each year. While the majority of children achieve excellent functional and cosmetic outcomes, circumcision has also been a source of medical malpractice litigation. The purpose of this study is to evaluate causes and outcomes of lawsuits filed following infant and pediatric circumcision.
METHODS: Using the LexisNexis Academic national legal database, which contains state and federal level appellate cases, we queried all cases with the terms “circumcision” and “medical malpractice” from January 1980 to January 2016. All malpractice suits involving pediatric circumcision, age less than 18, with at least one physician named as a defendant were included in the study. We excluded adult circumcisions, cases involving penile cancer, and cases where a physician was not sued. The resultant cases were reviewed for medical and legal outcomes, including reason for litigation and outcome. Descriptive statistical analysis was performed to summarize the data.
RESULTS: We identified 23 cases, all at the state-level, that met inclusion criteria. The median patient age at time of circumcision was 2 days (range 1 day - 7 years). The mean number of providers sued was 1.14 (range 1-2) and the hospital was included in litigation in 14 (58.3%) cases. Circumcisions were performed by obstetricians (12 cases, 50%), pediatricians (7 cases, 29.2%), family medicine doctors (1 case), and urologists (1 case). Claims for malpractice most commonly included negligence (14 cases), outcomes/appearance (11 cases), consent issues (7 cases), and battery (3 cases). For the purposes of this review, we classified claims for negligence if the case specifically cited this as a cause for litigation. Ten cases cited multiple claims for the source of their litigation. Of the 12 cases where the lower court verdict was identified, all appellant court decisions affirmed the original verdict. The state appeal favored the defendant in 16 cases (69.6%), including 8 dismissals and 3 grants for summary judgment. One case awarded the defendants the costs of the appeal. Five cases favored the plaintiff including 2 denials for summary judgment and 2 awards for damages. The damages awarded were in the amount of $112,500 and $200,924.30 (lowered from $300,000).
CONCLUSIONS: To our knowledge, this study represents the first review of medical malpractice from pediatric circumcision. In this analysis, providers are sued in conjunction with hospitals in the majority of cases. While most malpractice claims were for negligence and/or outcomes, a large number included the lack of or improperly obtained consent, emphasizing the importance of obtaining informed consent prior to proceeding with any procedure. A majority of state appellant cases appear to favor the defendant, although it is important to note that not all of these represented dismissals of the litigation.
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