A Single Institution Experience of Hand Surgery Litigation in a Major Replantation Center
Nick Bastidas, MD, Georges N. Tabbal, Sheel Sharma, MD
NYU Langone Medical Center and Bellevue Hospital Center, New York, NY
Introduction:  Bellevue Hospital Medical Center is a level one trauma center in New York and a major referral center for complex hand injuries and amputations.   Most patients who arrive in the emergency room assume that the surgeons will be able to replant their amputated part and often find it difficult to comprehend why surgery is sometimes not indicated.  Patients who undergo replantation are instructed of all the risks of the procedure, particularly replant failure and a possible poorly functional replant.   While most patients express understanding at the time of presentation, our legal staff has mentioned that many lawsuits that are filed are based on patient’s frustration with their proposed treatment.  This study was conducted to analyze the cases involving hand surgery litigation related to trauma, over the last eight years.
Method: We performed a retrospective chart review of all patients who filed suit against Bellevue hospital after being treated for a hand injury during 2001-2009.  23 patient’s charts in total were identified and reviewed for: age, mechanism / type of injury, complications, decision to replant, average time after injury to post claim, and whether settlement was obtained. 
Results:
Twenty three suits were filed against Bellevue hospital involving traumatic hand injuries between the years 2001-2009.  Two out of twenty three patients who filed suit against BHC received successful settlements.  The average age was 38yrs old (range 9-63), and average time from injury until filing a claim was 4.4 months (range 0.4 months – 27 months). 
Replantation or revascularization was performed in 168 patients during this time period.  Five patients out of twenty three who filed suit had attempted replants which were complicated by loss of the replanted part.  The remaining 18 patients who filed suit underwent completion amputations after replantation was determined to not be appropriate.  In total, there were seven complications: five failed replants, one failed thenar flap (for a fingertip reconstruction), and one patient who needed a revision completion amputation after subsequent infection.
As per the documentation, no patients expressed their anger or concern for their treatment during their hospital stay or during the post-operative clinic visits.
Conclusions:
The majority of the patients who filed claims (18/23) were because of the decision not to replant.  One of the two claims, which were settled by the institution, involved the disposal of an amputated part which the patient eventually wanted back due to religious reasons.  This lead us to construct a proper system for amputated part disposal from the emergency room.  Only 2.9 % (5/168) of all attempted revascularization/replantations filed claims against our institution, and all involved loss of the part.  8.7% (2/23) of claims were settled, suggesting a legal support of the circumstances surrounding replantation.  Better patient understanding of the decision making process and complications involving treatment of traumatic hand injuries may decrease the number of future law suits.