The Increasing Growth of Plastic Surgery Lawsuits in Brazil

Medical lawsuits have reached endemic proportions in many countries [1, 2]. The value of financial compensation also has increased [3], causing harm to patients and physicians [1, 2]. Very commonly, plastic surgeons access lawsuits through nonmedical media. Objective data and actual numbers about the growth of medical lawsuits should be evaluated by professional societies. These societies should be responsible for collecting and analyzing the numbers, displaying the findings to the plastic surgeons, and developing ethical strategies aimed at reducing the number of lawsuits, thus preventing losses for plastic surgeons and patients. Our group searched the data for all final sentences of lawsuits between patients and physicians to evaluate the number of lawsuits that evolved from plastic surgeries from January 2000 to December 2008 at the Court of Justice of the Brazilian State of Rio Grande do Sul. The type of surgery on which the patient based the lawsuit and the costs (pecuniary reimbursement to the successful party for the expenses of litigation) paid by the physician sued, even if considered not guilty, also were evaluated. A total of 98 lawsuits involving plastic surgery were evaluated. From these, 59 lawsuits were excluded because they were lawsuits against health medical organizations, and the data on the reviewed court’s database system were incomplete. As a result, 39 lawsuits were analyzed. Two periods were compared: period 1 (January 2000 to June 2004) and period 2 (July 2004 to December 2008) (Fig. 1). Cosmetic surgery was involved in 91% of the cases. Abdominoplasty, rhynoplasty, and liposuction were associated most frequently with litigation. The number of lawsuits increased during period 2. The average number of lawsuits per year was 2.44 in period 1 and 6.22 in period 2. The average costs and expenses of each lawsuit per year totaled R$10,256.12 (US$5,997.73) in period 1 and R$12.312,87 (US$7,200.51) in period 2. The greatest proportion of plastic surgery lawsuits involved cosmetic surgeries; a high number of patients, who were undergone cosmetic surgery and were disappointed, sued the plastic surgeon [3–5]. When patients search for cosmetic surgery, they want to change the way they think, feel, and behave regarding some discordant feature [6]. However, this condition can hide an unreal expectation of damaged self-perception and psychosexual issues that reach far beyond plastic surgery [7–9]. Thus, the plastic surgeon, in addition to selecting the best surgical technique, must know how to identify this condition [9]. The surgeon should be aware of the most litigated procedures in this study, namely, abdominoplasty, rhynoplasty, and liposuction. It is important to remember that food intake disorders and corporal dismorphic disorders are very prevalent among candidates for these operations [10]. A comparison of the two periods showed that the growth in the number of lawsuits has more than doubled, similar to what has happened in different fields of medicine [3]. An even more important result was found. The average cost of lawsuits increased in period 2, which may stimulate patients to sue their physicians. Every physician sued, even those considered not guilty, had to spend a considerable amount of money in costs and expenses generated by the lawsuits. D. B. Vila-Nova da Silva F. X. Nahas (&) R. A. Bussolaro M. J. A. de Brito L. M. Ferreira Plastic Surgery Postgraduation Program, Federal University of São Paulo, Rua Napoleão de Barros, 715, 4o Andar, Vila Clementino, CEP: 04024-002 São Paulo, Brazil e-mail: fabionahas@uol.com.br