Therapeutic misadventure. An 11-year study from a metropolitan coroner's office

"Therapeutic misadventure" and its alternative forms is a controversial, though necessary, manner of ruling deaths that result from unexpected complications of medical procedures. Such cases must be brought to the attention of the medical-legal office so that they are thoroughly investigated and documented, and so that appropriate and consistent rulings are made. While it is not generally agreed that a ruling of therapeutic misadventure implies medical negligence, a number of such cases do become the bases for litigation. During an 11-year period in a metropolitan coroner's office that examines about 2,000 cases yearly, 44 cases were ruled therapeutic misadventure, an incidence of 0.46%. A recent increase in such cases is probably the result of improved case finding and investigation. The largest category was that of surgical complications, followed, in order, by complications of anesthesia and of therapeutic and diagnostic procedures, and by drug reaction. No case occurred in ambulatory surgery. There apparently has been a low incidence of attendant lawsuits. The study of cases of therapeutic misadventure is potentially of great value in identifying outcomes and trends, and for the prevention of such cases in the future.