Over 100 million people in the U.S. seek treatment for neurological diseases. Every day, highly skilled neurosurgeons are saving patient lives and restoring quality of life by removing malignant brain tumors, treating traumatic brain injuries and strokes, alleviating seizures and tremors, and preventing paralysis from spinal cord injuries. Yet these life-saving surgeries also carry the highest risk for occurrences of surgical errors, iatrogenic injuries to the patient, and even death during the procedure.
As a result, neurosurgeons are among the top 10 medical specialists who are most likely to be sued for malpractice.
Statistics published in an article in The Journal of Neurosurgery indicate that nearly 20% of all practicing neurosurgeons in the U.S. are named as defendants in malpractice lawsuits each year. Also, malpractice payouts to plaintiffs rank among the highest among surgical specialties – an average of more than $439,000 for claims involving craniotomies, and nearly $280,000 for injuries suffered during spinal surgeries. While such judgments are covered by malpractice insurance, neurosurgeons can expect to pay higher premiums in excess of $100,000.
Neurosurgeons, Understand Your Malpractice Risk Factors
As a neurosurgeon, your first line of defense is to partner with a knowledgeable malpractice insurance broker who can research and recommend the best malpractice coverage and carrier options for your specialty. But it’s also vitally important for you to evaluate and understand the key risk factors for neurological surgeries and procedures that most often trigger lawsuits. Other occurrences of diagnostic errors and miscommunication outside of the operating room also come into play. Armed with this information, you can then apply them to risk management strategies to potentially reduce your vulnerability to malpractice claims while improving patient safety.
For example, a recent study of neurosurgery malpractice claims data between 2011 and 2020 by MedPro Group, an AM Best “A” rated insurance carrier, revealed some of the most common reasons that neurosurgeons have been sued:
1. Patient outcomes with high clinical severity
67% of the malpractice cases in the study resulted in significant, grave, or major permanent injury or patient death. Patient injuries included deafness, loss of limb, loss of eye or one kidney or lung; paraplegia, blindness, loss or two limbs, or brain damage; quadriplegia, severe brain damage resulting in lifelong care, or a fatal prognosis. Indemnity payments were typically higher and paid out more frequently in cases in which patients who suffered severe injuries, or to patients’ families when death occurred at the highest level of clinical severity.
2. Surgical-related errors
Surgical treatment errors were found to be the most common major trigger for malpractice lawsuits, resulting in higher payouts to plaintiffs in 76% of the claims reviewed. The top specific complaints among cases in this category included:
Improper performance of surgery
Improper management of the surgical patient
Also, in over 50% of the cases, allegations of patient injuries including pain, nerve damage, mobility loss, and the need for additional surgery were most often related to occurrences during specific surgical procedures:
Exploration/decompression of the spinal canal
Excision of the intervertebral disc
Cervical fusion, anterior
3. Diagnostic errors
Diagnostic delays and errors were cited as the second most common allegations, including misdiagnoses of cancer, infection, intraspinal abscess, and cauda equine. Malpractice cases reviewed in the study indicated failure to diagnose post-op complications and infections, inadequate assessment of the patient’s symptoms, and poor communication among providers when reporting diagnostic test results.
4. Communication-related errors
Allegations of errors or iatrogenic patient injuries brought about by miscommunication between physician and patient, physician and administrative staff, or with outside providers ranked as the third most common reason for malpractice suits in the MedPro study. Poor communication regarding surgical risks and expectations for patient outcomes, and lack of informed consent were leading factors in malpractice claims.
Another recent study of malpractice claims between 2014 and 2019 by The Doctors Company, an AM “A” rated malpractice insurance carrier, reiterated the need for improved physician communication patients, staff, and other providers. This data supports best practices for ensuring that standards of patient care are clearly communicated and met by professional staff before, during, and after surgery. The most common communication issues that contributed to malpractice claims included:
Failure or delay in ordering diagnostic tests
Misinterpretation of diagnostic tests
Incorrect or lack up post-operative assessment of the patient’s condition
Insufficient or lack of case documentation
Take proactive steps for improved neurosurgical risk management
Risk management strategies to improve patient care and potentially reduce the occurrences of malpractice suits encompass everything from surgical expertise to documentation procedures in your practice. The MedPro study offers these recommendations for neurosurgeons:
Continually evaluate and re-assess your surgical skills and competency with surgical equipment.
Establish and maintain a comprehensive and consistent procedure for post-surgical patient assessment. Reduce the risk of misdiagnosis by ensuring that all test results and evaluations are documented and have been reviewed.
Focus on active communication and collaboration with the entire surgical care team to coordinate patient care before, during, and after surgery.
Engage and communicate with the patient and patient’s family to build trust, and obtain a comprehensive patient history and informed consent for treatment.
Coordinate next steps in post-operative patient care to determine who is responsible for the patient if other specialists are involved in the case.
Be diligent in documenting records of pre-operative assessments, intra-operative steps, and the sequence of post-operative events. In case of a malpractice claim, having complete and comprehensive documentation will help your lawyers build a stronger defense.