The medicolegal aspect of error in pathology: a search of jury verdicts and settlements

Identifying medical errors is a topic of current attention. Among the various approaches is the study of medical malpractice cases. To identify the most common medical errors involving the practice of pathology from a medicolegal perspective by analysis of published jury verdict and settlement reports. Search approximately 50 publications that gather jury verdict and settlement information using LexisNexis, an on-line searchable archive, for pathology-related cases. One hundred seventy-one legal cases were identified from 1988 through 2005. Nearly one-half involved surgical pathology; among the remainder, cytology cases slightly outnumbered those pertaining to clinical pathology. Among the surgical pathology cases and overall, based on this database, the most common reason for a medical malpractice lawsuit related to pathology was the alleged missed diagnosis of melanoma on a skin biopsy specimen. Less commonly, the surgical pathology cases involved breast biopsy specimens, gynecological specimens, lung, genitourinary system, technical or preanalytic errors (eg, mixed-up specimens), soft tissue, hematopathology, head and neck, gastrointestinal/hepatobiliary system, or thyroid. Among the 48 cases related to cytology, 37 involved false-negative Papanicolaou smears. Less common were cases related to fine-needle aspirates of the breast or thyroid or cytology specimens of the lung. Among the 36 cases involving clinical pathology, 32 related to the blood bank--usually transfusion-acquired human immunodeficiency virus infection. These data are in agreement with other publications as to the most frequent causes of medical malpractice allegations related to pathology. As these issues are addressed, the number of errors should decrease. Studying the jury verdict and settlements data may provide additional insight into medical errors and patient safety.