Litigation after Laparoscopic Cholecystectomy: An Evaluation of the Dutch Arbitration System for Medical Malpractice

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Abstract
Medical liability is a great concern in current surgical practice. The medical liability system in the US is under discussion in surgical literature, as the system is associated with high costs and expensive liability premiums. The aim of this study was to evaluate the Dutch arbitration system for claims filed after bile duct injury (BDI). Data were extracted from the largest Dutch insurance company for medical liability. Outcomes of the claim and factors associated with awarded financial compensation were determined. BDI litigation after laparoscopic cholecystectomy occurred in 0.08% (± 0.02% SD) without a substantial increase. Currently, 88 of 133 claims are closed after a median duration of 2 years (range 5 months to 6.5 years). In 61 of 88 cases (69%) liability was rejected, and in 16 cases (18%) liability was acknowledged. Median compensation (in Euros) was €9.826,07 (range €15,88 to €55.301,06). Rejection of liability increased from 50% in the period 1994 to 1998 versus 72% in 2004 to 2006 (p = 0.023). Factors associated with recognition were patient employment (p = 0.005) and patient death (p = 0.01). Factors associated with an increase in financial compensation are delay in imaging (p = 0.033), delay in diagnosis (p = 0.009), and relaparotomy with repair in the initial hospital (p = 0.028). The Dutch arbitration system for medical liability after BDI is associated with a short time to resolution and high rejection rates, and payments to BDI patients are low.