An Analysis of Medical Malpractice Litigation Involving Gender Affirmation Surgery

Background
Gender affirmation surgery has been increasingly performed over the past decade. The present study sought to analyze malpractice cases related to gender affirmation surgery to provide information to physicians as it may serve to minimize the risk of malpractice suits. Specifically, the aim was to focus on the reasons a suit is brought, the outcomes, and the compensatory damages of litigation.

Methods
The Westlaw and Lexis Nexis databases were searched for jury verdicts and settlements related to gender affirmation surgery malpractice lawsuits. The keywords "gender affirming", "confirmation surgery", "gender& reassignment w/malpractice", "transgender w/malpractice" were searched in the Lexis Nexis database. The keywords "gender affirming", "confirmation surgery", "gender & reassignment w/malpractice" and "transgender w/malpractice" were searched in the Westlaw database. Cases that did not meet the inclusion criteria, duplicate cases, and those for which enough information was not available were excluded. The data included reasons, outcomes, and compensatory damages of litigations, as well as defendant specialty, location, year, and plaintiff demographics.

Results
A total of 26 cases were identified in Westlaw and Lexis Nexis databases. Following review of the cases, five between 2007 and 2020 were included. Three of the 5 cases (60%) involved surgeons. The surgical first case involved a urologist who was sued for a negligently performed male to female reassignment surgery which caused permanent and painful injuries to the defendant. The second 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, and inability to engage in sexual intercourse, psychological trauma, and gender dysphoria. The third case involved a gynecologist and plastic surgeon. The plaintiff accused the defendants of bilateral compartment syndrome and bilateral foot drop that was caused by a gender reassignment procedure The two remaining cases (40%) involved non-surgical specialties. The first case was brought against a radiologist and oncologist and involved the excessive use of radiation during a transgender operation which later led to cancer of the vulva and neovagina. In the second 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.

Conclusions
Between 1970 and 2020, there were only 5 resolved malpractice cases that involved gender affirmation surgery. This is a surprisingly low number of cases and could be related to the fact that gender affirming surgeries have only become more common of late. In addition, the low number of resolved cases could also have to do with the fact that patients understand and accept the possible complications and outcomes of undergoing these kinds of procedures. 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.

Practice Management

Plastic Surgery 2023