Claims insights: urologists

Members asked us for more information about compensation claims and complaints to regulators. In response the following is a retrospective review of routinely collected data.

Tuesday, 31 May 2022

1 in 8

Avant urologist members had a matter raised about the provision of their care in FY2021.

Data source: matters indemnified FY2021

Types of medico-legal matters

^{Data source: matters indemnified FY2017-21}

Main issue in claims and complaints

Procedural/surgical-related allegations

62% of procedural/surgical-related allegations arose with prostate (30%), kidney (18%) and bladder (14%) surgeries. Most common were procedures for:

Hyperplasia of the prostate
Malignant neoplasm of the prostate
Calculus of the kidney and ureter
Malignant neoplasm of the kidney

Diagnosis-related allegations

72% of diagnosis-related allegations involved malignant neoplasms. These cases related to a delayed diagnosis or a misdiagnosis. Most frequent sites and types were:

Malignant neoplasm of the prostate
Malignant neoplasm of the bladder

The stage of care during which procedural/surgical issues occurred

Pre-operative (15%) e.g. allegations of improper selection of procedure/surgery/surgical approach
Intra-operative (59%) e.g. allegations of poor surgical performance/skill/competence
Post-operative (26%) e.g. allegations of delay/failure to diagnose complications; poor post-operative performance; delay in revision procedure

The above retrospective review is of routinely collected and coded data. Our review is based on 217 regulatory complaints and compensation claims involving Avant members who are urologists across Australia. All matters were closed over the five-year period from July 2016 to June 2021 (FY2017-21).

Complaints: Outcomes for Urologists

^{Cases classified as no further action (e.g. discontinued, no further action), low severity (e.g. caution, resolution), medium/high severity (e.g. reprimand, conditions). Cases often incur significant legal costs and can take years to resolve. This includes cases that have been dismissed.}

Key points

The two most common reasons for claims and complaints were procedural/surgical and diagnosis-related issues.
The majority of procedural/surgical-related allegations involved prostate, kidney and bladder surgeries.
Most diagnosis-related allegations involved neoplasms.
The majority of complaints against urologists were dismissed.

Notes on the outcomes analysis

This analysis was conducted on regulatory complaints filed against urologists over the five-year period from July 2016 to June 2021 (FY2017-21). Only complaints with a known outcome were included.

The outcomes were classified based on the degree of severity for members. Shown below are some of the types of outcomes in each category.

No further action – e.g. discontinued, no further action
Low severity – e.g. counselled, caution, conciliation, resolution, fine
Medium and high severity – e.g. reprimand, conditions, registration changes, suspension, cancellation

Glossary

Claims refers to claims for money, compensation and civil claims.
Complaints relates to formal complaints to regulators.
Matters include: claims, complaints, coronial cases and other matters such as employment disputes and Medicare.
Employment disputes are matters where Avant defends members against complaints or supports members to resolve employment issues.
Medicare matters include Medicare investigations and audits.