Medical malpractice litigation involving otolaryngology residents and fellows: A case-based 30-year review

Table 1 30-yr summary of litigation involving otolaryngology trainees (1990-2020)

Outcome	State	Plaintiff award ($)	Precipitating Medical Outcome	Allegations	Case summary	Case reference
Plaintiff	MA	32654	Right sided hearing loss	3, 4	Pt underwent surgery for middle ear cholesteatoma. Resident/attending performed surgery. Stapes and oval window were violated	1991; Jury Verdicts LEXIS 50361
Plaintiff	PA	12876069	Vegetative state secondary to anoxic encephalopathy	2, 3, 7	Pt with goiter underwent surgery. Pt given pain meds post-op. Pt vomited and developed neck hematoma. Resident was unable to do a trach and waited for attending to complete it. While waiting, pt became comatose	2012; Jury Verdicts LEXIS 5466
Plaintiff	VA	750000	Permanent blindness in right eye secondary to retro-orbital hematoma	5, 6	Surgeon consented pt with CF to FESS to remove mucocele. Residents performed procedure and attending left OR. Ethmoid artery was severed; bleeding was stopped. Rebleed in post-op recovery causing a retro-orbital hematoma compressing the optic nerve	2004; Dolan Media Jury Verdicts LEXIS 4472
Plaintiff	VA	2200000	Bilateral recurrent laryngeal nerve injury and tracheostomy dependence	3, 5, 7	Pt underwent total thyroidectomy for PTC. Both recurrent laryngeal nerves were severed	2019; Jury Verdicts LEXIS 104401
Plaintiff	OH	14460000	Vegetative state secondary to anoxic encephalopathy	3, 5, 6, 7	Pt underwent surgery for deviated septum performed by resident. Pt was prematurely taken off ventilator resulting in cardiac arrest	1997; OH Trial Rptr. LEXIS 1361
Plaintiff	MI	1003764	Death secondary to airway obstruction	2, 3	Pt was intubated due to diabetic condition. Nasal packing was placed in both nostrils. During extubation, nasal packing went down pt's throat. Laryngoscope pushed packing deeper into trachea causing suffocation	1995; Jury Verdicts LEXIS 60765
Plaintiff	NY	300000	Facial nerve paralysis	3, 4, 5	Facial nerve severed by resident during mastoidectomy	1993; Jury Verdicts LEXIS 54896
Plaintiff	GA	2350000	Death secondary to traumatic vocal cord injury	1, 2, 9	Pt underwent lung wedge resection for nodule. Pt had episodes of aspiration. Nasopharyngoscopy showed significant glottal gap. Vocal cord injury was not recognized. Pt aspirated and died	2020; Jury Verdicts LEXIS 318581
Plaintiff	OH	17050000	Anoxic encephalopathy leading to spastic quadriparesis and mental retardation	2	Pt with bacterial tracheitis was admitted. Pt suffered temporary respiratory arrest. Pt treated with racemic epi but went into cardiac arrest. Pt was resuscitated but had brain injury with quadriparesis. Pt claimed defendants were negligent to order a bronchoscope and intubate to protect airway	1992; Jury Verdicts LEXIS 50387
Settlement	NY	1100000	Death secondary to malignancy	2	Pt presented with ear pain. Resident attributed pain to odontogenic origin. Oral surgeon removed teeth. Neurologist suspected trigeminal neuralgia. Neurosurgery then referred to ENT. MRI showed SCC. Missed cancer had spread, resulting in death	2004; Jury Verdicts LEXIS 48892
Settlement	NY	5150000	Anoxic encephalopathy; subglottic stenosis/tracheal stenosis due to prolonged intubation	2, 9	Pt had pulsatile mass noted on fiberoptic exam. CT revealed sphenoid mass, possible angiofibroma. Pt had heavy bleeding form nose with perforated carotid artery. Pt claimed resident never informed attending of pulsatile mass and did not act with urgency to embolize	2004; Jury Verdicts LEXIS 47843
Settlement	MI	485000	Vegetative state secondary to anoxic encephalopathy	1	Pt underwent surgery for cholesteatoma. CPAP was discontinued post-op. Continuous pulse ox was not monitored. Pt became non-responsiveness but breathing. Fellow ordered to recheck vitals in 30 min. Pt stopped breathing in 15 min	2003; MI Trial Rptr. LEXIS 922
Settlement	NY	4700000	Vegetative state secondary to anoxic encephalopathy	1, 2	Pt underwent elective thyroidectomy. Hypocalcemia was unnoticed in post-op. Pt went into respiratory failure and cardiac arrest. Resident opened surgical site, which revealed airway compromise due to post-thyroidectomy hematoma	2008; Jury Verdicts LEXIS 31978
Settlement	TX	225000	Death secondary to ARDS	3, 7, 8	Pt developed post-op ARDS secondary to aspiration following glottis-dilating surgery	1995; Jury Verdicts LEXIS 72772
Settlement	NY	450000	Spinal accessory nerve damage	3, 4	Pt underwent excisional biopsy of left cervical node. Pt developed winged scapula and inability to lift shoulder post-op	1999; Jury Verdicts LEXIS 55907
Defense	TN	0	Vegetative state secondary to anoxic encephalopathy	3	Pt scheduled for tracheotomy. CRNA paralyzed pt rather than sedating. Defendants were unable to secure airway for 6-8 min	2000; TN Jury Verdicts & Sett. LEXIS 564
Defense	LA	0	Permanent hearing deficit, facial pain and numbness	2, 6, 9	Pt c/o hearing loss. Resident diagnosed sinusitis rather than CN deficit failing to prescribe steroids. Pt was prescribed steroids 3 d later. Delay caused permanent hearing deficit and facial pain	2019; LA JURY VERDICTS & SETT. LEXIS 247
Defense	OH	0	Permanent lateral diplopia bilaterally	3, 4, 5	Pt underwent FESS complicated by a breach of lamina papyracea. Pt claimed possibility of vision compromise was not mentioned during consent, and resident should not have been on the case	2003; OH Trial Rptr. LEXIS 1107
Defense	MA	0	Injury to the face during rhinoplasty	3, 6	Negligent supervision of resident performing rhinoplasty resulting in retained foreign object from broken surgical instrument	2010; Jury Verdicts LEXIS 93443
Defense	CA	0	CSF leak, photophobia, and meningitis	3, 5, 6, 7	Pt underwent FESS complicated with a CSF leak. Photophobia and meningitis were noted post-op. Pt underwent subsequent surgeries. Defendants claimed pt had Munchausen’s syndrome	1997; Jury Verdicts LEXIS 66164

Allegations: 1: Delay in evaluation; 2: Incorrect diagnosis or treatment; 3: Procedural error; 4: Improper informed consent of procedure; 5: Lack of knowledge of trainee involvement; 6: Failure to supervise trainee; 7: Inexperienced trainee; 8: Prolonged operation; 9: Trainee did not communicate or inform attending. Pt: Patient; Post-op: Post-operation; Trach: Tracheostomy; CF: Cystic fibrosis; FESS: Functional endoscopic sinus surgery; OR: Operating room; PTC: Papillary thyroid cancer; Epi: Epinephrine; ENT: Ear nose throat surgeon; MRI: Magnetic resonance imaging; SCC: Squamous cell carcinoma; CT: Computed tomography; CPAP: Continuous positive airway pressure; Pulse ox: Pulse oximetry; ARDS: Acute respiratory distress syndrome; CRNA: Certified registered nurse anesthetist; C/O: Complaining of; CN: Cranial nerve; CSF: Cerebrospinal fluid.

Table 2 Allegations observed in 20 cases against otolaryngology trainees

Allegation	n (%)
Delay in evaluation	3 (6.4)
Incorrect diagnosis or treatment	8 (17.0)
Procedural error	12 (25.5)
Improper informed consent of procedure	4 (8.5)
Lack of knowledge of trainee involvement	6 (12.8)
Failure to supervise resident	5 (10.6)
Inexperienced trainee	5 (10.6)
Prolonged operation	1 (2.1)
Trainee did not communicate or inform attending	3 (6.4)
Total	47 (100)

Table 3 Adverse outcomes in 20 cases against otolaryngology trainees

Outcome	n (%)
Anoxic encephalopathy	7 (35)
Death	4 (20)
Hearing loss	2 (10)
Vision loss	2 (10)
Facial nerve injury	2 (10)
Recurrent laryngeal nerve injury	1 (5)
Cerebrospinal fluid leak	1 (5)
Accessory nerve injury	1 (5)
Total	20 (100)