Mention to doctors who run their own practice or a hospital administrator that malpractice and American tort culture are probably the biggest reason for high health care costs, they will likely correct you and say that it is instead defensive medicine - running tests and engaging in efforts a doctor knows are unnecessary or useless to check off boxes that will prevent a lawsuit if something ever does go wrong.

And the belief that lawyers always win when they sue the medical community is also a false one. At least in some parts of the United States. And the type of treatment matters. It helps to be a lawyer in the right place at the right time if you are going to win, at least when it comes to a facial trauma lawsuit. A new analysis found Southern courts favor physicians in malpractice lawsuits over facial trauma treatment and dismissed more than 90 percent of cases while the Midwest only had 40 percent dismissed. There are a lot of confounders in that, perhaps lawyers in the south filed a lot more spurious lawsuits hoping for a settlement. 

Overall, facial trauma lawsuits are not fertile ground for lawyers, with nearly 75 percent being dismissed.

In 2016, nearly 43,000 cases totaling $3.8 billion in payouts were awarded for allegations surrounding diagnosis, treatment and surgery, with the top five defendant specialties being surgical. About 15 percent of plastic surgeons face at least one malpractice lawsuit annually. 

The researchers studied defendant data from facial trauma malpractice cases in the Westlaw federal litigations database. They reviewed 69 cases from 1913 to 2016. Most decisions occurred between 1965 to 2013, with half processed through legal systems in the South, 29 percent in the Midwest, 11 percent in the West and less than 9 percent in the Northeast.

About 75 percent of the plaintiffs were males with injuries to the jaw or with multiple facial fractures. A complaint of delay or failure to diagnose accounted for 50 percent of the lawsuits, which were significantly more likely to be brought against an emergency physician who failed to diagnose a fracture.

The researchers found that patients who had an initial X-ray that was followed by imaging with a computed tomography (CT) scan or other, more sensitive scan were more likely to be diagnosed with a fracture. "This tells us that emergency medicine physicians may be able to reduce their risk of malpractice by using sensitive radiography, like CT scans, while evaluating potential facial fractures," said corresponding author Boris Paskhover of Rutgers New Jersey Medical School. 

Of the cases that went to court, 58 percent were tried by a judge and 38 percent by a jury. Three-quarters of the examined cases were decided on behalf of the defendants, 19 percent on behalf of the plaintiff, 3 percent were settled and 3 percent had an unknown outcome. Awards ranged from $14,437 to more than $1.8 million.

"An overwhelming majority of cases decided in the favor of the plaintiff were jury trials," said Paskhover. "This finding is understandable given the overall litigation structure of the United States court system, where it is a constitutional right for persons to be initially tried by a jury of their peers and not experts within the field."