Litigation as an Underutilised Quality Feedback Indicator: A Review of Court Cases in a Small Resource-Limited Country.

Objective Litigation cases provide important feedback for healthcare providers. However, this method has been underutilised. This study provides a descriptive analysis of completed court cases, exploring case characteristics, reasons for litigation, and judicial outcome. It also looks at expected standards of care based on best practice and provides feedback for quality improvement.  Methods This is a retrospective study of court judgements on health issues from 1990 to 2023. The cases were generated from the court library services and judiciary of the Republic of Trinidad and Tobago. Data were collected using an 18-item, pilot-tested questionnaire tested on 20 cases to ensure clarity and adequate descriptive information on relevant topics for the objectives of the study. The inclusion criteria were persons of all ages and residents or citizens of Trinidad and Tobago. The exclusion criteria were cases regarding health-related but non-clinical issues, incomplete/ambiguous court reports, healthcare staff/employment matters, and cases involving motions to strike out evidence, as the full cases are not available for analysis. This questionnaire was then itemised based on patient demographics, case characteristics, outcomes and court recommendations and analysed using SPSS Statistics version 21 (IBM Corp., Armonk, NY, USA). Results Following the application of the inclusion and exclusion criteria, a total of 52 cases were selected to be analysed. Most litigants were female Afro-Trinidadians in the public sector. The most common reasons for litigation were delayed diagnosis/inadequate treatment (n = 23; 44.2%), followed by misdiagnosis (n = 9; 17.3%) and prescribing the wrong dosage or medication (n = 7; 13.5%). The main lawsuit outcome was of medical negligence (n = 27; 51.9%), with the obstetrics speciality having the highest number of cases convicted (n = 9/27; 33.3%). The most common patient/defendant outcome was physical in nature (n = 38; 73.1%), followed by monetary compensation (n = 18; 34.6%); disciplinary action against the healthcare provider occurred only in one case (n = 1; 1.9%). Regarding medical error in those cases that were convicted, inadequate care standards were most commonly related to inappropriate drug dosage and usage (n = 5/27; 18.5%), followed by poor listening and communication (n = 1/27; 3.7%), improper blood transfusion procedures (n = 1/27; 3.7%), and poor sterilisation of surgical instruments (n = 1/27; 3.7%). Conclusion Most medical negligence cases occurred in public institutions, particularly in obstetric departments, followed by emergency departments. Litigation mainly resulted from delayed diagnoses/inadequate treatments and breaching care standards. Ongoing litigation analysis is a useful tool for quality feedback and improvement.