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VOS 66th Annual Meeting
May 3-5, 2013
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VOS Announces Partnership with Mag Mutual:
A New Member Benefit

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Orthopaedic Claims Causes: Common, and Not So

By Zach Sinclair
MAG Mutual Insurance Company
Richmond

Nationwide, according to a respected insurance industry source, orthopaedic surgery is the 5th most frequently sued medical specialty, and fifth also in total amount of indemnity payments.

The Physician Insurers Association of America is the national organization of medical professional liability insurance companies. Since 1985 the PIAA has compiled claims loss statistics from its member companies, and each year issues a comprehensive report based on claims closed and reported.

The chart below, based on PIAA closed claims data, 1985-2010, shows that orthopaedists are nationally ranked fifth both in terms of number of closed claims and total payments to plaintiffs.

Specialty

# closed claims

# paid claims

Total indemnity paid

Internal medicine

34,993

  8,754

$1,935,138,567

Obstetrics/gynecology

34,649

12,118

$3,520,758,273

Family medicine

29,031

  9,215

$1,559,541,627

General surgery

26,549

  9,088

$1,758,364,685

Orthopaedic surgery

23,786

  6,949

$1,200,688,380

Radiology

14,770

  4,299

$   927,277,300

Anesthesiology

  9,906

  3,149

$   744,371,202

Most Prevalent Medical Misadventures
We in the insurance business avoid the term “malpractice.” The usual industry word is misadventure. In the PIAA data, the most common orthopaedic misadventures involve improper performance of a procedure:
--operative procedures on joint structures (exclusive of spinal fusion);
--open reduction of dislocation;
--closed reduction of fractures;
--operative procedures on bones;
--operative procedures on cranial and peripheral nerves

A Not-So-Common Claims Cause
Joints and the spine are common sites in orthopaedic lawsuits, but suits can result from seemingly the most unpredictable circumstances. Following are the details of an actual closed claim.

The case involved a 60-year-old female with a history of hypertension, abdominal aortic aneurysm, and a 3-4 pack per day smoking history. On 9/6 the patient was diagnosed with a non-small cell carcinoma of the upper lobe of her left lung. On 9/27 a thoracic surgeon successfully removed the carcinoma.

The patient progressed well over her first several days postoperatively, until she began experiencing right knee pain and swelling on 9/30. By 10/1 the patient’s pain and swelling had spread to her left knee and elbow. Because a rheumatologist was not on call that weekend, an orthopaedic surgeon was consulted. The surgeon evaluated and confirmed a history of gout, ordered x-rays of both knees and the institution of IV Colchicine therapy, 0.6 mg every six hours until the patient achieved relief. The surgeon’s order did not specify a maximum cumulative dose of Colchicine to be administered, a maximum number of doses, nor a specific end-date for the drug. When the order was received in the hospital pharmacy, the pharmacist manually overrode the single warning regarding Colchicine generated by pharmacy software and dispensed the drug.

Unbeknownst to the orthopaedist, the patient was transferred to the floor on 10/2. The attending physician signed the transfer form indicating that the patient was to continue receiving .6 mg IV Colchicine every six hours. On 10/3 the orthopaedist went to the ICU to evaluate the patient, but was told that the patient had been discharged.

On 10/6 the patient’s condition took a sudden, dramatic downturn. She was found to have pancytopenia—abnormally low levels of all types of blood cells due to bone marrow failure. It was determined that the patient had received a total dose of 12 mg Colchicine — three times the maximum 4 mg dose for a single gout attack. The patient quickly became septic, followed by a stormy downward course, and died on 10/13 due to multiple organ failure.

The plaintiff alleged that the orthopaedic surgeon failed to indicate maximum dose or a stop-date for the IV Colchicine. Ultimately the case was settled for a large sum.

Events such as these remind us of the purpose of liability insurance. You don’t know when you’ll need it, but it’s important to have when you do.

Note: Zach Sinclair will be attending and exhibiting at the VOS Annual Meeting, May 4-6 in Williamsburg. Please stop by and see about getting a quote. It could save you and your practice thousands of dollars.


Group Billing Available
for VOS Members

The Virginia Orthopaedic Society (VOS) would like to invite your practice/institution to participate in our Group Billing program.  The program was implemented two years ago, and we already have 21 participating practices/institutions:

Advanced Orthopaedic Centers
Atlantic Orthopaedic Specialists

Carilion Clinic Orthopaedics
Colonial Orthopaedics
Countryside Orthopaedics, PC
Hess Orthopaedics & Sports Medicine, PLC  
Jordan Young Institute
National Sports Medicine Institute
Nirschl Orthopaedic Center
Northern Virginia Orthopaedic Specialists
Orthopaedic Associates, Ltd.
Orthopaedic Center of Central Virginia
Sports Medicine & Orthopaedic Center
Tidewater Orthopaedic Associates
Tuckahoe Orthopaedic Associates
UVA Department of Orthopaedic Surgery
VCU/MCV
Virginia Institute for Sports Medicine
Virginia Orthopaedics & Sports Medicine
West End Orthopaedic Clinic
Winchester Orthopaedic Associates, Ltd.

This program is a great deal for your group because you receive discounts on membership dues for all eligible physicians, physician assistants, and nurse practitioners in your practice.  New members receive a 25% discount on their first year of membership dues, and all current members receive a 10% discount on dues.  There is one comprehensive renewal notice for all members in your practice or institution, and only one check for membership dues needs to be issued.  There must be at least three eligible physicians, PAs or NPs in your practice.

If a physician leaves the practice and moves out of state, the VOS membership will be transferable to a new physician in the group. Any new members will immediately begin receiving benefits such as the e-newsletter, legislative updates, reduced registration fees at meetings, the online "Find a Doc" feature, and much more. 

We will screen the list of physicians in your practice so that any members in your group who have already paid will not have to pay again this cycle.  It’s not too late to add your practice to the growing list and save on VOS membership dues!  Please contact Greg Leasure, Membership Manager, at (804) 565-6305 or greg@societyhq.com with questions or to enroll in the group billing program.

Thank you for considering membership in the Virginia Orthopaedic Society for the physicians in your practice!


Welcome New Members!

Active
Jacqueline M. Fogarty, MD – South Boston, VA

Fellow     
Rupal Patel, MD – Richmond, VA

Resident
Brandon Bucker, MD – Richmond, VA
George Chloros, MD – Richmond, VA
William Daner, MD – Richmond, VA
Chesley Durgin, MD – Richmond, VA
Ashton Goldman, MD – Richmond, VA
Jarod Goodrich, MD – Richmond, VA
Ryan Graves, MD – Richmond, VA
Anjan Kaushik, MD – Charlottesville, VA
Tom Keller, MD – Charlottesville, VA
Barrett Little, MD – Richmond, VA
Ashlee MacDonald, MD – Norfolk, VA
Pramote Malasitt, MD – Richmond, VA
Jon Mason, MD – Charlottesville, VA
Abby Maxwell, MD – Richmond, VA
John McMurtry, MD – Richmond, VA
Colin Mudrick, MD – Richmond, VA
Anthony Owusu, MD – Richmond, VA
Tejas Patel, MD – Richmond, VA
Boyd Rawles, MD – Charlottesville, VA
Ashkon Razavi, MD – Richmond, VA
Jacob Riis, MD – Richmond, VA
Jeremy Ross, MD – Richmond, VA
Jesse Seamon, MD – Charlottesville, VA
Phillip Taylor, MD – Richmond, VA
Matthew Thompson, MD – Richmond, VA
Clarence Toney, MD – Richmond, VA
Jeff Tuman, MD – Charlottesville, VA
Larry Waldrop, MD – Richmond, VA
Adam Wilson, MD – Charlottesville, VA

Physician Assistant    
Katherine Daly, PA-C – Roanoke, VA

Student
Daniel Young, MD – Norfolk, VA


Discounted Dues for Military

VOS offers a discount on membership dues for our members currently active in the military. To be eligible for this discount, a member must be an individual in the US Armed Forces engaged in the practice of orthopaedic surgery within any of the military medical installations in Virginia. The 2012 rate of $187.50 applies to new and current members.

Contact Greg Leasure at vosmembership@societyhq.com to arrange for this discount.


Support your PAs and NPs
for VOS Membership

The Virginia Orthopaedic Society is pleased to offer a membership category especially for Nurse Practitioners and Physician Assistants. The applicant must be sponsored by a current VOS member. Nurse Practitioners and Physician Assistants dues are 50% of active physician member dues, or $125. For more information and a membership application, please visit the VOS website, www.vos.org.


Online Dues Payment!

We are pleased to offer convenient online dues payment through the Society website. You will need your UserName and Password to access this portion of the website. If this is your first time logging in, your UserName is your member number and your password is your last name (in lower case letters). If you need assistance with your log in information, please contact vosmembership@societyhq.com.


Member Benefit! Online Job Bank

Please check it out HERE. Posting an opening is FREE to VOS members (a practice must have at least two-thirds of their doctors as members to qualify). Job postings can be made by non-members for $300 and listings remain on the website for 60 days. Please spread the news of this new service to all of your colleagues.