MLMIC Insight: Neurosurgical Malpractice Risks

The Medical Professional Liability Association ( has reported that, among all medical specialties, neurosurgeons have the greatest likelihood of experiencing a malpractice claim during their career. In fact, by age 44, approximately 88% of neurosurgeons have been involved in malpractice litigation, and by age 65 nearly all neurosurgeons (99%) would have experienced a claim of malpractice. In light of this heightened exposure, the November 2020 issue of Neurosurgical Focus is dedicated to raising awareness of this risk and educating the physicians in this specialty regarding the medical and legal issues that impact their exposure to claims of malpractice. The articles in this publication focus on a variety of topics including:

  • exploring current medical legal reforms in the United States and its’ impact on physicians’ tendency to practice proactively or defensively
  • identifying the pros and cons of utilizing practice guidelines
  • understanding the current medicolegal environment and its impact on neurosurgical practice  
  • examining the use of expert witnesses in the defense of neurosurgical malpractice litigation

It has been well established that malpractice claims in neurosurgery result in some of the largest medical malpractice payments. As demonstrated in the 2018 CRICO Benchmark Report, “Medical Malpractice in America”, neurosurgery, along with obstetrics, “incur significantly disproportionate financial losses” when considering the severe nature of the patient injuries. At MLMIC, we remain committed to providing education to our insured physicians regarding the medical legal issues associated with their specialty.  These resources will help neurosurgeons to gain a better understanding of the impact of the risks identified in the included articles.

Physicians who will participate in our MLMIC Proactive Risk Management Follow-Up IX: Diagnostic Error, Near Misses, and High Exposure Cases will have access to Medical Interactive’s educational module: “Clinical Practice Guidelines and the Standard of Care,” to be released in the Spring of 2021.

Reference list:


2. The importance of understanding the medicolegal climate in neurosurgery
Bharat Guthikonda, MD, MBA,1 Catherine A. Mazzola, MD,2 Michael P. Steinmetz, MD,3 Joseph S. Cheng, MD,4 Jason D. Stacy, MD,5 Asdrubal Falavigna, MD, PhD,6 and Richard N. W. Wohns, MD, JD, MBA7

3. Status of current medicolegal reform in the United States: a neurosurgical perspective
Devon LeFever, MD,1 Audrey Demand, MS,1 Sandeep Kandregula, MBBS,1 Alexis Vega, MS,1, Breydon Hobley,1 Soleil Paterson, BS, RN,1 Krystle Trosclair, PhD,1 Richard Menger, MD, MPA,2, Jennifer Kosty, MD,1 and Bharat Guthikonda, MD, MBA1

4. The ethical and legal status of neurosurgical guidelines: the neurosurgeon’s golden fleece or Achilles’ heel?
Ishaan Ashwini Tewarie, BSc,1–3 Alexander F. C. Hulsbergen, BSc,1–3 Victor Volovici, MD, PhD,4,5 and Marike L. D. Broekman, MD, PhD, LLM1–3

5. Experiences of neurological surgeons with malpractice lawsuits
Pravesh S. Gadjradj, MD,1 Julian B. Ghobrial, BSc,1 and Biswadjiet S. Harhangi, MD, PhD, MSc2

6. Overview of medical malpractice in neurosurgery
Collin J. Larkin, MSc,1 Anastasios G. Roumeliotis, BS,1 Constantine L. Karras, MD,1 Nikhil K. Murthy, MD,1 Maria Fay Karras, JD,2 Huy Minh Tran, MD,3 Ketan Yerneni, BA,1 and Matthew B. Potts, MD1

7. Litigation risks despite guideline adherence for acute spinal cord injury: time is spine
Daniel Rafter, MD,1 Ranveer Vasdev, BS,1 Duncan Hurrelbrink, BA,1 Mark Gormley III, BS,1Tabitha Chettupally, BS,1 Francis X. Shen, JD, PhD,2,3 and Usman Samadani, MD, PhD1,4