Identifying Avoidable Adverse Events in Medicine

The 330 malpractice cases involving orthopedic surgery that reached the Appellate Court and occurred between 1910 and 1972 were examined for determining medical events that could be considered by the profession as highly avoidable. When these cases were reviewed, they were sorted to eliminate those that were not by their very character evident of relatively highly avoidable adverse events. The remaining cases, which numbered approximately 117, were placed into categories of causes of adverse events with illustrative cases for each category. A committee of orthopedic specialists and legal scholars was convened to reflect on this listing of untoward outcomes in order to evaluate the considerations of making such determinations and to arrive at a final list of broad avoidable events for which the orthopedic profession should be held accountable. Although this was viewed as a pilot endeavor, it was felt that avoidable adverse events may be identifiable and could serve as the basic structure for an effective mechanism of quality control and patient compensation. The next step should be a more quantitative assessment of the degree of avoidability of the events selected by the committee.