The medico-legal landscape of spine surgery: how do surgeons fare?

Publication date: Available online 30 June 2017
Source:The Spine Journal
Author(s): Melvin C. Makhni, Paul J. Park, Jesus Jimenez, Comron S. Saifi, Jon-Michael Caldwell, Alex Ha, Bianca Figueroa-Santana, Ronald A. Lehman, Mark Weidenbaum
Background ContextDue to the limited and confidential nature of most legal data, scarce literature is available to physicians about reasons for litigation in spine surgery. In order to optimally compensate patients while protecting physicians, further understanding of the medico-legal landscape is needed for high-risk procedures such as spine surgery. Based on these, surgeons can explore ways to better protect both their patients and themselves.PurposeTo characterize the current medico-legal environment of spine surgery by analyzing a recent dataset of malpractice litigation.Study DesignA retrospective study.Patient SampleAll malpractice cases involving spine surgery available to public query between the years of 2010 to 2014.Outcome MeasuresCase outcome for spine surgery malpractice cases between the years of 2010 to 2014.MethodsWestlawNext was used to analyze spine surgery malpractice cases at the state and federal level between the years 2010 and 2014. WestlawNext is a subscription based, legal search engine that contains publicly available federal and state court records. All monetary values were inflation adjusted for 2016. One hundred three (103) malpractice cases were categorized by case descriptors and outcome measures. Claims were categorized as either intraoperative complaints or preoperative complaints.ResultsRulings in favor of the defendant (surgeon) were noted in 75% (77/103) of the cases. Lack of informed consent was cited in 34% of cases. For the 26 cases won by the plaintiff, the average amount in settlement was $2,384,775 versus $3,945,456 in cases brought before a jury. Cases involving consent averaged a compensation of $2,029,884 while cases involving only intraoperative complaints averaged a compensation of $3,667,530. A significant correlation was seen between increased compensation for plaintiffs and cases involving orthopaedic surgeons (p = 0.020) or nerve injury (p = 0.005). Wrong level surgery may be associated with lower plaintiff compensation (p = 0.055). The length of cases resulting in defense verdicts averaged 5.51 years, which was significantly longer than the 4.34 years average length of settlements or verdicts in favor of plaintiffs (p = 0.016).ConclusionsSpine surgeons successfully defended themselves in 75% of lawsuits, although the cases won by physicians lingered significantly longer than those settled. Better understanding of these cases may help surgeons to minimize litigation. More than 1/3 of cases involved a claim of insufficient informed consent. Surgeons can protect themselves and optimize care of patients through clear and documented patient communication, education, and intraoperative vigilance to avoid preventable complications.



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