Descriptive Analysis of Federal and State
Interventional Pain Malpractice Litigation in the
United States: A Pilot Investigation
Authors: Schwartz Ruben 
Published: March 2021

Background: The aim of this study was to examine and appreciate characteristics of malpractice
lawsuits brought against interventional pain specialists.
Objectives: To examine and appreciate characteristics of malpractice lawsuits brought against
interventional pain specialists.
Study Design: Retrospective review.
Setting: Jury verdicts and settlement reports of state and federal malpractice cases involving
interventional pain practitioners from January 1, 1988, to January 1, 2018 were gathered from
the Westlaw online legal database.
Methods: Jury verdicts and settlement reports of state and federal malpractice cases involving
interventional pain practitioners from January 1, 1988, to January 1, 2018 were gathered from
the Westlaw online legal database. Data collected for each case included year, state, patient age,
patient gender, defendant specialty, legal outcome, award amount, alleged cause of malpractice,
and factors in plaintiff’s decision to file. After elimination of duplicates and applying inclusion/
exclusion criteria to our initial search yielding over 1,500 cases, a total of 82 cases were included
in this study.
Results: A total of 57.3% of cases resulted in a jury verdict in favor of the defendant, whereas
41.5% favored the plaintiff. When comparing cases that were performed in the operating room
to cases performed outside the operating room, we found the jury verdicts to favor the plaintiff
83.3% of the time for operating room procedures (P = 0.003). In other words, interventional pain
practitioners were more likely to be found at fault for complications from procedures performed in
the operating room. To eliminate confounders, a logistical regression was performed and confirmed
operating room procedures were an independent predictor of a verdict awarded to the plaintiff (P
= 0.008). The median amount awarded to the plaintiff for all cases was $333,000, and the single
highest award amount was $36,636,288. The median payout for operating room procedures was
$450,000 (P = 0.010), which was significantly different from the median payout for nonoperating
room procedures. Procedure categorization demonstrated a statistically significant difference in jury
verdicts (P = 0.01411) and procedural error was the leading reason for pursuing litigation, followed
by lack of informed consent and unnecessary procedure performed.
Limitations: There is more than one database that captures medicolegal claims brought against
practitioners. Westlaw, which has been previously utilized by other studies, is only one of them and
the extent to which overlap exists in unclear. For each, data input are not necessarily consistent and
data capture are not complete. As a result, there could exist a skew toward more severe complications
and the details of individual cases likely vary. During data extraction, we found that all details of the
procedure were not always included. For example, not all cases specified the type of injectate utilized
for epidural injection (i.e., local anesthetic, steroid, mixture, and others) or route of injection (i.e.,
transforaminal vs. interlaminar). Moreover, as previously mentioned, cases that are settled out of court or finalized prior to trial are not necessarily reported by the Westlaw database, and therefore were not always included in
our data search.
Conclusions: Overall, interventional pain medicine physicians were favored by jury verdicts for malpractice claims. However,
when filtering by procedure or setting, jury verdicts favored the plaintiff in some cases.
Key words: Interventional pain, medical, malpractice, anesthesiology