Object: Neurosurgeons are a high-risk group for allegations of malpractice. To determine the kinds of cases and the neurosurgical practice patterns associated with the highest proportion of litigation, the authors examined the experience over a 5-year period of a major physician-owned and -administered insurance company dealing with this issue, the Medical Liability Mutual Insurance Company (MLMIC) of New York. With the MLMIC cases as a basis, the authors also analyzed areas of physician vulnerability and determined the steps neurosurgeons can take to reduce potential litigation.
Methods: All cases closed against MLMIC-insured neurosurgeons from January 1, 1999, through December 30, 2003, were reviewed. Variables examined included allegation, anatomical site, and the ultimate resolution of the case. Of the 280 cases against neurosurgeons that were closed during the study period, 156 (56%) involved the spine, 109 (39%) involved the head and/or brain, and 15 (5%) reflected miscellaneous allegations. These proportions are relatively similar to the 1999 procedural statistics for neurosurgical practices. Of the cases examined, 98 were closed with a total loss indemnity of approximately $50 million, and 182 resulted in no indemnity payment.
Conclusions: A neurosurgeon's chances of being sued for malpractice are not necessarily related to the medical complexity of a particular case but rather to the types of cases with which the physician is involved. Elective spinal surgery cases constitute the majority of litigation. Neurosurgeons can take steps to reduce their vulnerability to potential litigation and to increase the odds of a successful defense.