What Neurosurgeons Need to Know about Liability
Neurosurgery is a medical specialty that focuses on the nervous system, including the brain, spine, and nerves throughout the body, and the diagnosis and treatment of disorders that affect it. In the U.S., neurosurgeons must complete a one-year internship before a five or six-year residency in neurosurgery, and then pass an exam to become board certified in neurosurgery.
Neurosurgeons are classified by medical malpractice insurers as having a very high likelihood of facing lawsuits for malpractice. Accordingly, physicians in the specialty must pay premiums that are among the highest of any specialty. In 2005, the average premium across the nation was more than $100,000 and in some states premiums were over $300,000. Premiums vary widely based on the location of the practice; states with hostile legal climates carry the highest premiums, while rural states and states with tort reform come in at the low end of the spectrum. Neurosurgery cases also pay the most to claimants of any specialty.
Exorbitant medical malpractice insurance premiums for neurosurgeons have a direct effect on the practice of the specialty. A study published jointly by the American Association of Neurological Surgeons and Congress of Neurosurgeons, two leading American specialty organizations, examined these effects. Half of all neurosurgeons in the study had limited their activities because the fear of being sued, taking actions like eliminating emergency care or restricting surgery to the spine only. The same study found that a third of neurosurgeons were considering early retirement in the face of steeply rising insurance premiums. 20% of the doctors were considering relocating to a state with a less hostile legal climate. These trends might portend a serious shortage of neurosurgeons in the future, and a dangerous problem for patient access to neurosurgical care around the country (1). In 2004, the governor of Florida ordered an investigation into the state’s neurosurgeon shortage after a patient died because no neurosurgeon was available in her area. The investigation found that the shortage was in large part a result of the state’s skyrocketing medical malpractice insurance premiums. Another study, conducted in 2008, did not observe a mass relocation of neurosurgeons, as was expected, but did find that there are significant gaps in emergency neurological care, which can be deadly, as witnessed in Florida.
Neurosurgeons should become familiar with the most common origins of malpractice lawsuits in the specialty. In spinal surgery, these common causes include lumbar laminectomies for discetomies, posterior cervical laminectomies, and lumbar decompression for stenosis. When performing these procedures, physicians should take extraordinary care to practice good risk management.
Neurosurgeons should master risk management techniques, which can greatly reduce the likelihood of a lawsuit. Effective communication is vital; physicians should develop a clear, straightforward style of communicating with patients and make sure that the patient’s expectations of a treatment are realistic. Communication with colleagues and other members of the treatment team is also very important – consider using a prepared checklist so that nothing will be overlooked. If a mistake does occur, tell the patient directly and express sincere empathy and concern. Patients appreciate this type of candor, and expressing sympathy is never an admission of malpractice.
Thorough documentation is also important. It is not a good idea to rely on memory rather than documentation. Neurologists should document every case completely, including their thought processes and all relevant details. Records should be organized and legible. Good documentation can make all the difference if a lawsuit is filed. Visit this site to read some examples of malpractice cases involving neurosurgeons.
With premiums in the specialty so high, neurosurgeons will want to do everything possible to help stabilize the medical liability legal climate and bring down premiums. Physicians should support efforts to establish tort reform measures, like statutes of limitations for malpractice suits and limits on awards to plaintiffs for non-economic damages.
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This write-up for Neurosurgeons was put together by Michael Matray, the Editor of the Medical Liability Monitor
Important Resources for Neurosurgeons
Journal of Neurosurgery
Women in Neurosurgery
American Association of Neurological Surgeons
Congress of Neurological Surgeons
Journal of Neurology, Neurosurgery & Pshychiatry
Clinical Neurology and Neurosurgery