Courthouses and Craniotomies: Medical Malpractice Indemnity Payments and Litigation Verdicts in Skull Base and Cerebrovascular Neurosurgical Practice in the 21st Century

Introduction: Rates of malpractice lawsuits have increased considerably since the start of the 21st century, and neurosurgery is not immune to this trend. This work offers analysis of the case characteristics and indemnity payments of malpractice lawsuits associated with skull base and cerebrovascular pathologies in the past 24 years.

Materials and Methods: Cases between January 2000 and present associated with skull base lesions or cerebrovascular pathologies were identified using WestLaw legal database. U.S. Circuit Courts were utilized for geographical analysis. Litigation outcome possibilities were either jury verdicts in favor of the plaintiff (patient) or defendant (physician), or settlement. Indemnity payments and case characteristics were documented, and univariate analysis as well as Kruskal–Wallis and ANOVA testing were performed.

Results: A total of 85 cases from 2000 to 2024 related to skull base or cerebrovascular pathologies were analyzed. The year 2000 had the highest number of cases (n = 11), and a trend of decline was noticed across the progression of the 21st century. Overall, a defense verdict, or a jury decision in favor of the physician, was awarded in 57.1% of cases (n = 48) while a plaintiff (patient) verdict was awarded in 33.3% of cases (n = 28). Settlement occurred in 9.6% of analyzed cases, with no significant difference in amount paid compared with plaintiff verdicts (p = 0.634). Of the 85 cases, 27 (31.7%) resulted in patient death. A defense verdict was ruled in 18 (66.7%) cases in which the patient died, whereas 6 (22.2%) were plaintiff rulings and 3 (11.1%) were settled. Most malpractice cases (53.1%) involved aneurysmal pathology. Claims were most commonly against neurological surgery specialty (41.7%) and radiology (15.5%). Circuit 9 had the highest number of cases with 22 (26.2%), with a majority of these occurring in the state of California (n = 16). The total amount owed from cases resulting in plaintiff verdict or settlement totaled to $171,387,558. The highest per single case paid to the plaintiff was $49,000,000, which occurred in New York (Circuit 2). The median amount paid per case that resulted in a plaintiff verdict or settlement was $11,750,000. The highest amount of plaintiff verdicts (9) and settlements (3) occurred in Circuit 9 as well. Kruskal–Wallis testing did not reveal any significant association between geographical circuit and amount paid, however (p = 0.42).

Conclusion: An average of $15.6 million in indemnity payments have been paid over the past 24 years because of medical malpractice claims related to skull base/cerebrovascular cases in the United States, with claims most commonly against the neurological surgery specialty (41.7%).

Fig. 1 U.S. Court circuits as divided per state.

Fig. 2 Temporal trends over the course of the 21st century. Overall, the amount of malpractice cases related to skull base and cerebrovascular pathologies decreased from 2000 (11) to 2024 (2).

Fig. 3 Graphical comparison of amount awarded per plaintiff verdict within each U.S. Court circuit (p = 0.42).

Fig. 4 A comparison of case characteristics and indemnity payments of 21st century skull base and cerebrovascular malpractice cases that resulted in plaintiff verdict.

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Artikel online veröffentlicht:
07. Februar 2025