A nationwide analysis of successful litigation claims in neurological practice

Abstract

ObjectivesNeurological practice has previously been highlighted as a high-risk speciality with regard to malpractice claims. We set out to study the nature of these claims in order to inform physicians about hazardous areas within their speciality and potentially alter clinical practice.DesignNationwide retrospective analysis of successful neurology and neurosurgery claims over a 17-year period.SettingWe studied all successful claims occurring between 1995 and 2012 using the NHS Litigation Authority database, which collects data on claims made against clinicians practising in England and Wales.ParticipantsFour hundred and twenty-three successful claims were identified during the study period.Main outcome measuresThe errors involved, the patient groups affected, the resulting mortality and the litigation payments.Results63.1% of claims were due to negligence in neurosurgical care, whilst 36.9% were due to negligence in neurological care. Litigation payments were significantly higher in neurosurgery compared to neurology cases. Diagnostic error was the most common cause of litigation. The disease categories with the highest numbers of successful litigation claims were spinal pathology, cerebrovascular disease including subarachnoid haemorrhage, intracranial tumours, hydrocephalus and neuropathy/neuromuscular disease.ConclusionsThis is the first study of successful litigation claims against the NHS for negligent neurological or neurosurgical care and provides data to help reduce risk and improve patient safety.

Overdiagnosis of idiopathic intracranial hypertension

“…22 Diagnostic error almost universally ranks as the chief reason for malpractice claims, 23 with failure or delay in diagnosing cerebrovascular disease or brain tumors ranking as the highest causes of medical malpractice litigation and indemnity dollars in neurology and ophthalmology. 24,25 Increased education about the prevalence of misdiagnosis and missed diagnosis, combined with the fear of medical malpractice litigation, has caused a pendulum swing towards overtesting 26,27 and overdiagnosis.…”

Responsabilidad por pérdida de oportunidad asistencial en la medicina pública española

“…En otra revisión de 559 casos de quejas por negligencia en patologías neurológicas ocurridos en el Sistema Nacional de Salud del Reino Unido, entre los años 1995 y 2005, el error diagnóstico se citó un 44% de las veces, siendo la enfermedad discal degenerativa (27%), los tumores del sistema nervioso central (21%), las infecciones del sistema nervioso central (11%) y las hemorragias subaracnoideas (9%) las patologías más reclamadas 13 . Finalmente, en un estudio más reciente del Sistema Nacional de Salud del Reino Unido, pero hasta el año 2012 14 , el error diagnóstico seguía siendo la causa más frecuente de reclamación, pero, a diferencia, del anterior, las patologías habían cambiado, siendo la patología medular, la enfermedad cerebrovascular, los tumores intracraneales, la hidrocefalia y la patología neuromuscular las más frecuentes 14 . En conclusión, las sentencias dictadas por pérdida de oportunidad asistencial en el ámbito de la medicina pública española se han incrementado considerablemente estos últimos años, fundamentalmente por error diagnóstico y tratamiento inadecuado.…”

Professional Practice and Neurosurgery: What Every Neurosurgeon Should Know about Malpractice

“…9 Neurology and neurosurgery are identified as high-risk specialties for lawsuits in the literature of various countries. 9,15,[17][18][19][20][21] High-risk specialties treat patients with acute medical problems that require rapid decision-making and may have unfavorable outcomes. They usually rely on procedures that can be the subject of detailed analysis later on.…”

“…A retrospective national analysis of neurology and neurosurgery using the National Health Service Litigation Authority (NHSLA) database between 1995 and 2012 found 423 successful lawsuits in England and Wales, 267 (63.1%) of which were against neurosurgeons, with diagnostic error/ delay being the most common cause of a claim. 15 The second most common cause of litigation was negligence in performing the procedure; 36% of these claims involved either wrong-site surgery or a foreign body left during the procedure. Diseases resulting in the largest number of verdicts in favor of the plaintiffs were spinal disease (n ¼ 118), cerebrovascular disease (n ¼ 60), intracranial tumors (n ¼ 46), hydrocephalus (n ¼ 21), and neuromuscular disease/neuropathy (n ¼ 18).…”

“…Diseases resulting in the largest number of verdicts in favor of the plaintiffs were spinal disease (n ¼ 118), cerebrovascular disease (n ¼ 60), intracranial tumors (n ¼ 46), hydrocephalus (n ¼ 21), and neuromuscular disease/neuropathy (n ¼ 18). 15 The median litigation payout was higher in neurosurgery than in neurology. The locations where these patients were seen included hospitalization wards (n ¼ 167), surgical centers (n ¼ 121), outpatient clinics (n ¼ 86), and emergency rooms (n ¼ 30).…”