Abstract
Objective
To characterize circumcision-related litigation in the United States (US) and factors
predictive of lawsuit outcome. Circumcision is a common urologic procedure with medical
and ethical nuances.
Methods
We reviewed the Nexis Uni legal database for state and federal cases using the term
“circumcision” in combination with “medical malpractice” or “negligence” or “medical
error” or “complication” or "malpractice" or "tort". Litigation primarily related
to circumcision from 1939 to 2021 were reviewed for medical and legal details.
Results
We identified 77 unique cases. Most cases were processed in state (87%) or appellate
(59%) court systems with negligent surgical performance as the most common lawsuit
reason (49%). Of reported specialties, urology was the highest proportion represented
among named physicians (29%) and most patients were minors at time of circumcision
(64%) and lawsuit (59%). Common complications included aesthetic dissatisfaction (20%),
pain (19%), impaired sexual function (17%) and surgical trauma/injury (16%). Most
verdicts favored physicians (59%), but when against physicians, the median indemnity
was $175,000. Lawsuits due to negligent informed consent were significantly more likely
to result in verdict favoring the physician compared to those due to negligent surgical
performance.
Conclusions
Circumcision-related litigation in the US is rare and trial verdicts favor physicians,
particularly in federal court cases or when parties allege negligent informed consent.
Cases that favored plaintiffs successfully alleged negligent surgical technique. We
recommend physicians performing circumcisions receive proper training, clearly communicate
potential complications, and ensure appropriate indications for adult patients to
reduce malpractice risk.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The standard of care: legal history and definitions: the bad and good news.West J Emerg Med. 2011; 12: 109-112
- The current state of medical malpractice in urology.Urology. 2015; 86: 2-9https://doi.org/10.1016/j.urology.2015.03.004
Mello MM, Studdert DM, Brennan TA. The new medical malpractice crisis. doi:10.1056/NEJMp030064 2021
- Defensive medicine among high-risk specialist physicians in a volatile malpractice environment.JAMA. 2005; 293: 2609https://doi.org/10.1001/jama.293.21.2609
- Circumcision in the United States: Where Are We?.J Natl Med Assoc. 2012; 104: 455-458https://doi.org/10.1016/S0027-9684(15)30200-5
- American academy of pediatrics task force on circumcision. male circumcision.Pediatrics. 2012; 130: e756-e785https://doi.org/10.1542/peds.2012-1990
- Critical evaluation of arguments opposing male circumcision: A systematic review.J Evid-Based Med. 2019; 12: 263-290https://doi.org/10.1111/jebm.12361
- Litigation involving pediatric surgical conditions.J Pediatr Surg. 2020; 55: 602-608https://doi.org/10.1016/j.jpedsurg.2019.08.047
Nexis Uni | Acad Res Tool Uni Lib. Accessed 2021. https://www.lexisnexis.com/en-us/professional/academic/nexis-uni.page
AUA Sec Demograph - Am Urol Associat. Accessed 2021. https://www.auanet.org/membership/who-we-are/aua-sections-and-demographics
- Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration.Epidemiol Camb Mass. 2007; 18: 805-835https://doi.org/10.1097/EDE.0b013e3181577511
- Penile prostheses and the litigious patient: a legal database review.J Sex Med. 2014; 11: 2589-2594https://doi.org/10.1111/jsm.12649
- Urethral catheters and medical malpractice: a legal database review from 1965 to 2015.Transl Androl Urol. 2016; 5: 762-773https://doi.org/10.21037/tau.2016.08.02
- Robotic urologic surgery: trends in litigation over the last decade.J Robot Surg. 2019; 13: 729-734https://doi.org/10.1007/s11701-018-00905-y
- Legal review of vasectomy litigation and the variables impacting trial outcomes.Urology. 2019; 131: 120-124https://doi.org/10.1016/j.urology.2019.05.035
- Influencing factors leading to malpractice litigation in radical prostatectomy.J Urol. 2014; 191: 1770-1775https://doi.org/10.1016/j.juro.2013.12.003
- Malpractice litigation in iatrogenic ureteral injury: a legal database review.Urology. 2020; 146: 19-24https://doi.org/10.1016/j.urology.2020.08.049
- Medical informed consent: general considerations for physicians.Mayo Clin Proc. 2008; 83: 313-319https://doi.org/10.4065/83.3.313
- The verdict is in: surviving a medical malpractice trial.Physician Leadersh J. 2016; 3: 14-17
- Juries and medical malpractice claims: empirical facts versus myths.Clin Orthop. 2009; 467: 367-375https://doi.org/10.1007/s11999-008-0608-6
- Circumcision rates in the united states: rising or falling? what effect might the new affirmative pediatric policy statement have?.Mayo Clin Proc. 2014; 89: 677-686https://doi.org/10.1016/j.mayocp.2014.01.001
Article info
Publication history
Published online: November 14, 2021
Accepted:
September 30,
2021
Received:
July 30,
2021
Footnotes
Disclosure: None
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.