Malpractice litigation following spine surgery

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Adverse events related to spine surgery sometimes lead to litigation. Few studies have evaluated the association between spine surgical complications and medical malpractice proceedings, outcomes, and awards. The aim of this study was to identify the most frequent causes of alleged malpractice in spine surgery and to gain insight into patient demographic and clinical characteristics associated with medical negligence litigation.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A search for “spine surgery” spanning February 1988 to May 2015 was conducted utilizing the medicolegal research service VerdictSearch (ALM Media Properties, LLC). Demographic data for the plaintiff and defendant in addition to clinical data for the procedure and legal outcomes were examined. Spinal cord injury, anoxic/hypoxic brain injury, and death were classified as catastrophic complications; all other complications were classified as noncatastrophic. Both chi-square and t-tests were used to evaluate the effect of these variables on case outcomes and awards granted.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>A total of 569 legal cases were examined; 335 cases were excluded due to irrelevance or insufficient information. Of the 234 cases included in this investigation, 54.2% (127 cases) resulted in a defendant ruling, 26.1% (61) in a plaintiff ruling, and 19.6% (46) in a settlement. The awards granted for plaintiff rulings ranged from $134,000 to $38,323,196 (mean $4,045,205 ± $6,804,647). Awards for settlements ranged from $125,000 to $9,000,000 (mean $1,930,278 ± $2,113,593), which was significantly less than plaintiff rulings (p = 0.022). Compared with cases without a delay in diagnosis of the complication, the cases with a diagnostic delay were more likely to result in a plaintiff verdict or settlement (42.9% vs 72.7%, p = 0.007) than a defense verdict, and were more likely to settle out of court (17.5% vs 40.9%, p = 0.008). Similarly, compared with cases without a delay in treatment of the complication, those with a therapeutic delay were more likely to result in a plaintiff verdict or settlement (43.7% vs 68.4%, p = 0.03) than a defense verdict, and were more likely to settle out of court (18.1% vs 36.8%, p = 0.04). Overall, 28% of cases (66/234) involved catastrophic complications. Physicians were more likely to lose cases (plaintiff verdict or settlement) with catastrophic complications (66.7% vs 37.5%, p &lt; 0.001). In cases with a plaintiff ruling, catastrophic complications resulted in significantly larger mean awards than noncatastrophic complications ($6.1M vs $2.9M, p = 0.04). The medical specialty of the provider and the age or sex of the patient were not associated with the case outcome or award granted (p &gt; 0.05). The average time to a decision for defendant verdicts was 5.1 years; for plaintiff rulings, 5.0 years; and for settlements, 3.4 years.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Delays in the diagnosis and the treatment of a surgical complication predict legal case outcomes favoring the plaintiff. Catastrophic complications are linked to large sums awarded to the plaintiff and are predictive of rulings against the physician. For physician defendants, the costs of settlements are significantly less than those of losing in court. Although this study provides potentially valuable data from a large series of postoperative litigation cases, it may not provide a true representation of all jurisdictions, each of which has variable malpractice laws and medicolegal environments.</jats:p></jats:sec>

Medical Malpractice Claims and Mitigation Strategies Following Spine Surgery

“… 10 Spine-related malpractice claims also frequently targeted private practices (19.6%) and hospitals(16.7%). 10 Similarly in their closed case review, Daniels et al 8 noted that hospitals and nonsurgical providers were named in 40.6% and 8% of cases, respectively. The inclusion of nonsurgical providers and institutions, such as hospitals and private practices, reflects a system where surgeons are not the only entities incurring financial risk during litigation.…”

“…Orthopedic spine surgeons face a similar malpractice environment. In separate reviews of medicolegal databases, Agarwal et al 10 (23.8% vs 17.3%) and Daniels et al 8 (58.1% vs 33.8%) noted that orthopedic spine surgeons were named as defendants in a higher percentage of cases than neurosurgeons. These studies highlight the elevated risk of litigation both orthopedic surgeons and neurosurgeons face when performing spine procedures.…”

“…Though surgeons represent the most common group named in cases stemming from spine procedures, other subspecialties and numerous governing bodies also face litigation from these cases. 8 , 10 Agarwal noted that physicians from 8 nonsurgical specialties and various governing entities were named as defendants in litigation following spine surgery. 10 In this review emergency medicine providers (4.8%), radiologists (4.2%), and neurologists (3.6%) represented the most common nonsurgical subspecialties involved in spinal litigation.…”

“… 4 In response, a growing body of spine literature attempts to quantify the incidence and costs of litigation as well as its most common causes. 3 , 5 - 11 In this comprehensive narrative review, we detail the current incidence, common case characteristics, and economic burden of medical litigation in spine surgeries occurring within the US health care system. Further through examination of available literature, we hope to define reasonable strategies that the practicing spine surgeon can employ to reduce the risk of claims and subsequent litigation.…”

Medical Malpractice Litigation Following Spine Surgery in Beijing: The Past 6 Years.

“…Epstein 16 reviewed 78 cervical spine related litigation cases and 38.4% claims were found successfully defended by surgeons. Daniels et al 13 reviewed 234 spine surgery related legal cases, 54.2% of them resulted in a defendant ruling. Agarwal et al 12 analyzed 98 litigation cases pertaining to spine surgery from 2010 to 2015 and rulings went in favor of the defendant surgeons in a majority (63.3%) of cases.…”