Original ArticleMedical Malpractice in Neurosurgery: A Comprehensive Analysis
Introduction
Rising malpractice premiums and fear of litigation are imposing both an economic and psychological toll on US physicians and the healthcare system as a whole.1 A recent study assessing malpractice risk by physician specialty found that 19.1% of practicing neurosurgeons face a malpractice claim each year, the highest proportion among the 25 specialties surveyed. In the suits that were won by plaintiffs, indemnity payments averaged nearly $350,000.2 These factors contribute to physician burnout and may impact physician behavior, resulting in the practice of “defensive medicine,” which is estimated to contribute an additional $60 billion in healthcare expenditures each year.3
In a survey of more than more than 1000 practicing neurosurgeons across the U.S., researchers found that nearly three-quarters of respondents order extraneous imaging studies and laboratory tests in an effort to reduce the perceived risk of medical malpractice claims.1, 4 This adds a tremendous economic burden on the healthcare system (nearly 2.4% of the annual budget),5 without necessarily improving the quality of care delivered by the health system. This problem has become increasingly significant as governments and funders of healthcare emphasize value-based healthcare solutions. Given the highly litigious environment in which neurosurgeons function, an assessment of why patients and/or plaintiffs decide to pursue legal action may help surgeons avoid such claims in the future. Here we queried a comprehensive legal database to examine neurosurgical medical malpractice claims, paying attention to differences among the various neurosurgical subspecialties. This is the first study to date to qualitatively assess medical malpractice claims across the field of neurosurgery.
Section snippets
Search Methodology
The Westlaw legal research service (Thomson Reuters, Eagan, Minnesota, USA), a collection of 40,000 online legal databases that provide access to court documents and records compiled by individual attorney editors and commercial vendors, was used to locate state and federal jury verdicts and settlements (court decisions) related to malpractice litigation in neurosurgery. The database is widely used by lawyers and law students for use in legal research, and is one of the largest and most
Search Results and Patient Demographics
A total of 516 cases were identified using the initial search parameters. Following removal of 33 duplicate case files and 140 claims unrelated to neurosurgical conditions, 343 cases spanning from 1985 to 2015 remained for analysis. Among these, claims related to spine (n = 199; 58.0%), general (n = 54; 15.7%), and cerebrovascular (n = 38; 11.1%) procedures were most common (Table 1). The median age of the plaintiff(s) and/or patients referenced in all claims was 45.0 years. One hundred and
Discussion
Political attempts to curb the incidence of medical malpractice in the U.S. and to reduce the frequency with which defensive medicine practices occur fall within a class of proposed changes in the legal system collectively referred to as tort reform.18 Such changes have aroused significant interest among policymakers and physicians, and have spurred contentious debates among trial lawyers, insurance companies, and medical professionals. Whereas physicians claim that more than one-third of
Conclusions
Our analysis shows that malpractice claims related to the management and treatment of neurosurgical conditions received a defendant's verdict in nearly one-half of the cases, although this comes at the expense of significant court and attorney fees, lost wages and earnings, and anxiety. Procedural error was the most commonly cited basis for litigation. Failure to diagnose and failure to treat a preexisting condition were the next 2 most commonly alleged reasons for malpractice. Significant
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Ranjit Thomas and Raghav Gupta contributed equally to this work.