Malpractice Claims Regarding Corticosteroids

The relatively small number of claims for adverse events attributed to corticosteroids cited in the 10-year survey from Boston, Mass,¹ may require amplification. Among the nearly 40 cases I have reviewed (either on behalf of defendants or plaintiffs) as an "expert witness" over the past 30 plus years,² there were 21 malpractice claims for irreversible bone destruction, or avascular necrosis, following the administration of high doses of oral or parenteral corticosteroids for variable periods of time. Two of these were from the Boston area and may not have been included in the published survey that ended in 1999. Practically all the cases brought to my attention by legal counsels in several locations (only 1 from my own state of Colorado) could be considered what the authors label "preventable." Dosages exceeded 40 to 60 mg of prednisone, or the equivalent, per day—in some instances 250 to 500 mg of intravenous methylprednisolone—for conditions that were neither life-threatening nor potentially disabling. Lack of prompt improvement for mostly respiratory asthmalike illnesses and for 1 case of contact dermatitis led to ever increasing corticosteroid use when the underlying problem and the therapeutic unresponsiveness turned out to be due to an infection. In most cases the settlements and other expenditures were much above the costs reported from Massachusetts but still seemed inadequate to compensate for the iatrogenic disability and suffering of these relatively young patients.