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A Legal Database Review of Circumcision Related Litigation in the United States

Published:November 14, 2021DOI:https://doi.org/10.1016/j.urology.2021.09.036

      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.
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      References

        • Moffett P
        • Moore G.
        The standard of care: legal history and definitions: the bad and good news.
        West J Emerg Med. 2011; 12: 109-112
        • Sherer BA
        • Coogan CL.
        The current state of medical malpractice in urology.
        Urology. 2015; 86: 2-9https://doi.org/10.1016/j.urology.2015.03.004
      1. Mello MM, Studdert DM, Brennan TA. The new medical malpractice crisis. doi:10.1056/NEJMp030064 2021

        • Studdert DM.
        Defensive medicine among high-risk specialist physicians in a volatile malpractice environment.
        JAMA. 2005; 293: 2609https://doi.org/10.1001/jama.293.21.2609
        • Robinson JD
        • Ortega G
        • Carrol JA
        • et al.
        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
      2. American academy of pediatrics task force on circumcision. male circumcision.
        Pediatrics. 2012; 130: e756-e785https://doi.org/10.1542/peds.2012-1990
        • Morris BJ
        • Moreton S
        • Krieger JN.
        Critical evaluation of arguments opposing male circumcision: A systematic review.
        J Evid-Based Med. 2019; 12: 263-290https://doi.org/10.1111/jebm.12361
        • Rich BS
        • Shelton K
        • Glick RD.
        Litigation involving pediatric surgical conditions.
        J Pediatr Surg. 2020; 55: 602-608https://doi.org/10.1016/j.jpedsurg.2019.08.047
      3. Nexis Uni | Acad Res Tool Uni Lib. Accessed 2021. https://www.lexisnexis.com/en-us/professional/academic/nexis-uni.page

      4. AUA Sec Demograph - Am Urol Associat. Accessed 2021. https://www.auanet.org/membership/who-we-are/aua-sections-and-demographics

        • Vandenbroucke JP
        • von Elm E
        • Altman DG
        • et al.
        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
        • Sunaryo PL
        • Colaco M
        • Terlecki R.
        Penile prostheses and the litigious patient: a legal database review.
        J Sex Med. 2014; 11: 2589-2594https://doi.org/10.1111/jsm.12649
        • Awad MA
        • Osterberg EC
        • Chang H
        • et al.
        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
        • Nik-Ahd F
        • Souders CP
        • Zhao H
        • et al.
        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
        • Blazek AJ
        • Belle JD
        • Deibert MP
        • Deibert CM.
        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
        • Colaco M
        • Sandberg J
        • Badlani G.
        Influencing factors leading to malpractice litigation in radical prostatectomy.
        J Urol. 2014; 191: 1770-1775https://doi.org/10.1016/j.juro.2013.12.003
        • Bole R
        • Linder BJ
        • Gopalakrishna A
        • et al.
        Malpractice litigation in iatrogenic ureteral injury: a legal database review.
        Urology. 2020; 146: 19-24https://doi.org/10.1016/j.urology.2020.08.049
        • Paterick TJ
        • Carson GV
        • Allen MC
        • Paterick TE.
        Medical informed consent: general considerations for physicians.
        Mayo Clin Proc. 2008; 83: 313-319https://doi.org/10.4065/83.3.313
        • Canady MR.
        The verdict is in: surviving a medical malpractice trial.
        Physician Leadersh J. 2016; 3: 14-17
        • Vidmar N.
        Juries and medical malpractice claims: empirical facts versus myths.
        Clin Orthop. 2009; 467: 367-375https://doi.org/10.1007/s11999-008-0608-6
      5. 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