Canada: Medical Legal Aspects of Regional Anesthesia Practice

Key PointsLegal action against anesthesiologists in Canada rarely results in a court decision; in these cases, approximately 2/3 of the decisions were in favor of the physician. Most litigious claims stem from the use of newer anticoagulants, incorrect dosage of medications, incorrect medication given, allergies, and issues surrounding informed consent.The portion of medical legal actions related to regional anesthesia has increased in recent years. Recent reports show that 80 % were dismissed and 10 % were settled. Most regional anesthesia claims (75 %) are related to complications of neuraxial blocks, 1/3 of which are obstetric cases.The Canadian Medical Protective Association is a physician-funded entity that pays current and past claims and assists with a variety of issues related to legal action lodged against physicians. The most recent analysis of the CMPA database revealed 77 cases related to regional anesthesia over a 20-year period. Twenty-five involved epidurals, 11 involved spinal anesthesia, and the remainder involved various pain blocks and peripheral nerve blocks. The majority (60/77) of these cases were dismissed.Forty-one obstetric cases were analyzed from the CMPA database; several of these involved serious complications, including death. Litigation costs associated with obstetric claims vary but can be in the millions of dollars range, in situations with catastrophic outcomes or a compromised baby.