Abstract
The present study sought to analyze malpractice cases related to gender affirming surgery to provide information to physicians as it may serve to minimize the risk of malpractice suits. The Westlaw and Lexis Nexis databases were queried for jury verdicts and settlements related to gender affirming surgery malpractice lawsuits. A total of 26 cases were identified between 1970 and 2020, five of which were determined relevant on further review. Motives included adverse surgical and medical outcomes, and failure to treat. All cases were decided in favor of the defendant and resulted in $0 compensatory damages.
Keywords: Gender Affirming Surgery, Gender Affirming Care, Malpractice in Plastic Surgery, Litigation in Gender Affirming Surgery
Introduction
Gender affirming surgery has been increasingly performed by plastic and reconstructive surgeons over the past decade.1 To assess the malpractice landscape around these emerging procedures, the present study sought to analyze malpractice cases related to gender affirming surgery.
Methods
The Westlaw and Lexis Nexis databases were queried from 1970 to 2020 for jury verdicts and settlements related to gender affirming surgery malpractice lawsuits. The Westlaw database is a comprehensive online collection of court documents and records from over 40,000 legal databases in the United States.2 The Lexis Nexis search engine contains a global legal and news database that has 139 billion documents and records.3 The Boolean terms included “gender affirming”, “confirmation surgery”, “gender& reassignment w/malpractice”, and “transgender w/malpractice” for both databases. Cases that did not meet the inclusion criteria, duplicate cases, and cases with insufficient information were excluded. Collected data included motives, outcomes, and monetary outcomes of litigations, as well as defendant specialty, location, year, and plaintiff demographics.
Results
A total of 26 cases were identified in the Westlaw and Lexis Nexis databases. Following review, five cases between 2007 and 2020 were ultimately included (Figure 1). Three of the 5 cases (60%) involved surgeons (Figure 2). One surgical case named a urologist as the defendant. The surgeon was sued for negligence in a feminizing genital surgery which caused permanent and painful injuries to the defendant. Another case involved a plastic surgeon who performed a penile inversion vaginoplasty. The defendant claimed urethral stricture and misalignment, loss of the vaginal cavity, protruding proboscis, labial scar tissue and clitoral sensitivity, infection, inability to engage in sexual intercourse, psychological trauma, and gender dysphoria. A third case involved a gynecologist and plastic surgeon. The plaintiff accused the defendants of causing bilateral compartment syndrome and bilateral foot drop subsequent to gender affirming surgery. The two remaining cases (40%) involved non-surgical specialties. One case was brought against a radiologist and oncologist and involved the excessive use of radiation during a gender affirming operation which later led to cancer of the vulva and neovagina. In another case, an endocrinologist was sued for failing to provide a transgender patient with hormone treatment. All 5 of these cases were decided in favor of the defendant physician(s) and all compensatory damages were $0.
Figure 1.
Flowchart of cases which were included in the final analysis.
Figure 2.
Specialty of physicians who were named in gender affirming surgery malpractice lawsuits.
Discussion
Between 1970 and 2020, there were only 5 resolved malpractice cases that involved gender affirming surgery. This is a surprisingly low number of cases and may reflect the relative novelty of gender affirming surgery in the medical and surgical fields.4 In addition, the low number of cases resolved in favor of the plaintiff may indicate proper informed consent, or a thorough understanding of risk and complications associated with these different types of procedures.5 Based on the complaints presented in these cases as well as the outcomes, physicians should thoroughly explain the possible complications of surgery to patients undergoing gender affirming procedures and should thoroughly evaluate patients requesting hormonal gender affirming treatment.
Acknowledgments
This study did not receive any funding and none of the authors have no conflicts of interest to disclose.
Footnotes
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None of the authors has a financial interest in any of the products, devices, or drugs
As no human subjects were involved in this research and de-identified, publicly available data was reviewed, IRB exemption was provided by the institutional board.
References
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