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Iqbal J, Shafique MA, Mustafa MS, Covell MM, Fatima A, Saboor HA, Nadeem A, Iqbal A, Iqbal MF, Rangwala BS, Hafeez MH, Bowers CA. Neurosurgical Malpractice Litigation: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 188:55-67. [PMID: 38685351 DOI: 10.1016/j.wneu.2024.04.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Neurosurgery has 1 of the highest risks for medical malpractice claims. We reviewed the factors associated with neurosurgical malpractice claims and litigation in the United States and reported the outcomes through a systematic review of the literature. METHODS We conducted a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines using the Medline, Embase, Cochrane, PubMed, and Google Scholar databases. We sought to identify pertinent studies containing information about medical malpractice claims and outcomes involving neurosurgeons in the United States. RESULTS We identified 15 retrospective studies spanning from 2002 to 2023 that reviewed over 7890 malpractice claims involving practicing neurosurgeons in the United States. Disparities were evident in neurosurgical litigation, with 474 cases linked to brain-related surgeries and a larger proportion, 1926 cases, tied to spine surgeries. The most commonly filed claims were intraprocedural errors (37.4%), delayed diagnoses (32.1%), and failure to treat (28.8%). Less frequently filed claims included misdiagnosis or choice of incorrect procedure (18.4%), occurrence of death (17.3%), test misinterpretation (14.4%), failure to appropriately refer patients for evaluation/treatment (14.3%), unnecessary surgical procedures (13.3%), and lack of informed consent (8.3%). The defendant was favored in 44.3% of claims, while in 31.3% of lawsuits were dropped, 17.7% of verdicts favored the plaintiff, and 16.6% reached an out of court settlement. Only 3.5% of lawsuits found both parties liable. CONCLUSION Neurosurgery is a high-risk specialty with 1 of the highest rates of malpractice claims. Spine claims had a significantly higher rate of filed malpractice claims, while cranial malpractice claims were associated with higher litigation compensation. Predictably, spinal cord injuries play a crucial role in predicting litigation. Importantly, nonsurgical treatments are also a common source of liability in neurosurgical practice.
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Affiliation(s)
- Javed Iqbal
- Department of Neurosurgery, King Edward Medical University, Lahore, Pakistan.
| | | | | | - Michael M Covell
- Department of Neurosurgery, Georgetown University School of Medicine Washington, Washington, District of Columbia, USA
| | - Afia Fatima
- Department of Neurosurgery, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Hafiz Abdus Saboor
- Department of Neurosurgery, King Edward Medical University, Lahore, Pakistan
| | - Abdullah Nadeem
- Department of Neurosurgery, Dow University of Health Sciences, Karachi, Pakistan
| | - Ather Iqbal
- Department of Neurosurgery, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | | | | | | | - Christian A Bowers
- Department of Neurosurgery, Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, New Mexico, USA
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Gerstl JVE, Gupta S, Stenberg CE, Chabros J, Nonnenbroich LF, Lindberg R, Altshuler MS, Seaver D, Mooney MA, Frerichs KU, Smith TR, Arnaout O. From Operating Room to Courtroom: Analyzing Malpractice Trajectories in Cranial Neurosurgery. Neurosurgery 2024:00006123-990000000-01237. [PMID: 38916340 DOI: 10.1227/neu.0000000000003052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 04/26/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Nearly all neurosurgeons in the United States will be named defendants in a malpractice claim before retirement. We perform an assessment of national malpractice trends in cranial neurosurgery to inform neurosurgeons on current outcomes, trends over time, benchmarks for malpractice coverage needs, and ways to mitigate lawsuits. METHODS The Westlaw Edge and LexisNexis databases were searched to identify medical malpractice cases relating to open cranial surgery between 1987 and 2023. Extracted data included date of verdict, jurisdiction, outcome, details of sustained injuries, and any associated award/settlement figures. RESULTS Of 1550 cases analyzed, 252 were identified as malpractice claims arising from open cranial surgery. The median settlement amount was $950 000 and the average plaintiff ruling was $2 750 000. The highest plaintiff ruling resulted in an award of $28.1 million. Linear regression revealed no significant relationship between year and defendant win (P-value = .43). After adjusting for inflation, award value increased with time (P-value = .01). The most common cranial subspecialties were tumor (67 cases, 26.6%), vascular (54 cases, 21.4%), infection (23 cases, 9.1%), and trauma (23 cases, 9.1%). Perioperative complications was the most common litigation category (96 cases, 38.1%), followed by delayed treatment (40 cases, 15.9%), failure to diagnose (38 cases, 15.1%), and incorrect choice of procedure (29 cases, 11.5%). The states with most claims were New York (40 cases, 15.9%), California (24 cases, 9.5%), Florida (21 cases, 8.3%), and Pennsylvania (20 cases, 7.9%). CONCLUSION Although a stable number of cases were won by neurosurgeons, an increase in award sizes was observed in the 37-year period assessed. Perioperative complications and delayed treatment/diagnosis were key drivers of malpractice claims.
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Affiliation(s)
- Jakob V E Gerstl
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Saksham Gupta
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Program for Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jeremy Chabros
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Rebecca Lindberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marcelle S Altshuler
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David Seaver
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael A Mooney
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kai U Frerichs
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy R Smith
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Omar Arnaout
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Pecorari IL, Agarwal V. Medical malpractice and epidural hematomas: a retrospective analysis of 101 cases in the United States. Ann Med Surg (Lond) 2024; 86:1873-1880. [PMID: 38576915 PMCID: PMC10990362 DOI: 10.1097/ms9.0000000000001581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/22/2023] [Indexed: 04/06/2024] Open
Abstract
Background Neurosurgeons face particularly high rates of litigation compared to physicians in other fields. Malpractice claims are commonly seen after mismanagement of life-threatening medical emergencies, such as epidural haematomas. Due to the lack of legal analysis pertaining to this condition, the aim of this study is to identify risk factors associated with litigation in cases relating to the diagnosis and treatment of epidural haematomas. Materials and methods Westlaw Edge, an online database, was used to analyze malpractice cases related to epidural haematomas between 1986 and 2022. Information regarding plaintiff demographics, defendant specialty, reason for litigation, trial outcomes, and payouts for verdicts and settlements were recorded. Comparative analysis between cases that returned a jury verdict in favour of the plaintiff versus defendant was completed. Results A total of 101 cases were included in the analysis. Failure to diagnose was the most common reason for litigation (n = 64, 63.4%), followed by negligent care resulting in an epidural haematoma (n = 44, 43.6%). Spine surgery (n = 29, 28.7%), trauma (n = 28, 27.7%), and epidural injection/catheter/electrode placement (n = 21, 20.8%) were the primary causes of haematomas. Neurosurgeons (n = 18, 17.8%) and anesthesiologists (n = 17, 16.8%) were the two most common physician specialties cited as defendants. Most cases resulted in a jury verdict in favour of the defense (n = 54, 53.5%). For cases ending in plaintiff verdicts, the average payout was $3 621 590.45, while the average payment for settlements was $2 432 272.73. Conclusion Failure to diagnose epidural haematomas is the most common reason for malpractice litigation, with neurosurgeons and anesthesiologists being the most common physician specialties to be named as defendants. More than half of all cases returned a jury verdict in favour of the defense and, on average, settlements proved to be more cost-effective than plaintiff verdicts.
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Affiliation(s)
- Isabella L. Pecorari
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York
- Department of Neurological Surgery Albert Einstein College of Medicine, Bronx, NY
| | - Vijay Agarwal
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York
- Department of Neurological Surgery Albert Einstein College of Medicine, Bronx, NY
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Pecorari IL, Agarwal V. Medical malpractice and cerebrospinal fluid shunts: An analysis of 36 cases. Med Leg J 2024:258172231214902. [PMID: 38334711 DOI: 10.1177/00258172231214902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Many physicians, particularly neurosurgeons, face malpractice claims during their career. The aim of this paper is to identify which factors increase the risk of litigation and influence legal outcomes relating to cerebrospinal fluid shunt management. Westlaw, an online legal database, was used to identify all medico-legal cases pertaining to cerebrospinal fluid shunts. Information regarding plaintiff demographics, defendant specialties, reasons for litigation, and trial outcomes were analysed. Thirty-six cases met criteria for inclusion. Most cases returned a defence verdict (44.4%), with delayed treatment or failure to appropriately treat patients with shunts the most common reason for litigation (66.7%). The average plaintiff verdict payout was $4,888,136.75 and average settlement $1,362,307.69. Delay or failure to treat resulted in the largest average payouts for plaintiff verdicts and settlements ($5,329,299.14 and $1,531,500.00, respectively).
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Affiliation(s)
- Isabella L Pecorari
- Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA
| | - Vijay Agarwal
- Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA
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Joudar I, Nasri S, Aichouni N, Kamaoui I, Skiker I. Is vestibular schwannoma really a benign tumor? Case report and review. Ann Med Surg (Lond) 2023; 85:6206-6210. [PMID: 38098578 PMCID: PMC10718345 DOI: 10.1097/ms9.0000000000001418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/09/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction Vestibular schwannoma (VS) is a benign tumor that develops from Schwann cells of the eighth cranial pair, mainly in the cerebellopontine angle. Case Presentation We report the case of a 30-year-old female patient who developed left otalgia associated with neglected tinnitus, the evolution of which was marked by the development of a static cerebellar syndrome and a behavioral disorder, whose brain MRI revealed a locally advanced process in the cerebellopontine angle at the expense of the vestibulocochlear nerve, in favor of a VS, complicated by involvement of the tonsils, which unfortunately led to the patient's death. Discussion VS, formerly known as acoustic neuroma, is an extra-axial intracranial tumor that accounts for over 80% of pontocerebellar angle tumors, and is secondary in the majority of cases to inactivation of the neurofibromatosis type 2 (NF2) tumor suppressor gene, either by mutation of the NF2 gene or loss of chromosome 22q. In the majority of cases, it is unilateral and solitary, but in almost 8% of cases, it is associated with NF2. Cerebral MRI is the examination of choice for the detection, characterization, and diagnosis of VS without the need for biopsy, mainly with T1-weighted sequences before and after gadolinium injection. Treatment is based essentially on surgery or radiosurgery, depending on the size, impact, and expertise of the treatment team. Conclusion VS remains an important intracranial tumor entity, which can be life-threatening in cases of advanced local invasion.
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Affiliation(s)
- Imane Joudar
- Faculty of Medicine and Pharmacy
- Department of Radiology, Mohammed VI University Hospital, Mohammed I University
| | - Siham Nasri
- Faculty of Medicine and Pharmacy
- Department of Radiology, Mohammed VI University Hospital, Mohammed I University
- Faculty of Medicine and Pharmacy, Mohammed First University, LAMCESM, Oujda, Morocco
| | - Narjisse Aichouni
- Faculty of Medicine and Pharmacy
- Department of Radiology, Mohammed VI University Hospital, Mohammed I University
| | - Imane Kamaoui
- Faculty of Medicine and Pharmacy
- Department of Radiology, Mohammed VI University Hospital, Mohammed I University
| | - Imane Skiker
- Faculty of Medicine and Pharmacy, Mohammed First University, LAMCESM, Oujda, Morocco
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Davis W, Kichena S, Eckhoff MD, Childs BR, Rajani R, Wells ME, Kelly SP. Critical Review of Oncologic Medical Malpractice Claims Against Orthopaedic Surgeons. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202305000-00003. [PMID: 37141505 PMCID: PMC10155888 DOI: 10.5435/jaaosglobal-d-22-00169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 02/12/2023] [Indexed: 05/06/2023]
Abstract
INTRODUCTION The purpose of this study was to determine the most common allegations for malpractice litigation brought against orthopaedic surgeons for oncologic matters and the resulting verdicts. METHODS The Westlaw Legal research database was queried for malpractice cases filed against orthopaedic surgeons for oncologic matters in the United States after 1980. Plaintiff demographics, state of filing, allegations, and outcomes of lawsuits were recorded and reported accordingly. RESULTS A total of 36 cases met the inclusion and exclusion criteria and were subsequently included in the final analysis. The overall rate of cases filed remained consistent through the past four decades and was primarily related to a primary sarcoma diagnosis in adult women. The primary reason for litigation was failure to diagnose a primary malignant sarcoma (42%) followed by failure to diagnose unrelated carcinoma (19%). The most common states of filing were primarily located in the Northeast (47%), where a plaintiff verdict was also more commonly encountered as compared with other regions. Damages awarded averaged $1,672,500 with a range of $134, 231 to $6,250,000 and a median of $918,750. CONCLUSION Failure to diagnose primary malignant sarcoma and unrelated carcinoma was the most common reason for oncologic litigation brought against orthopaedic surgeons. Although most of the cases ruled in favor of the defendant surgeon, it is important for orthopaedic surgeons to be aware of the potential errors that not only prevent litigation but also improve patient care.
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Affiliation(s)
- William Davis
- From the Texas Tech University Health Sciences Center El Paso, El Paso, TX (Dr. Davis, Ms. Kichena, Dr. Eckhoff, Dr. Childs, and Dr. Wells); the Department of Orthopedic Surgery, William Beaumont Army Medical Center, El Paso, TX (Dr. Eckhoff, Dr. Childs, and Dr. Wells); the Department of Orthopedic Surgery, Texas Tech University Health Sciences Center El Paso, El Paso, TX (Dr. Eckhoff, Dr. Childs, Dr. Rajani, and Dr.Wells); and the Department of Orthopedic Surgery, Tripler Army Medical Center, Honolulu, HI (Dr. Kelly)
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