Introduction: Medical malpractice lawsuits are a risk for any doctor and this risk is especially high for neurosurgeons. Litigation in patients with carotid artery stenosis (CAS) can arise in relation to performing an endarterectomy (CEA) or in relation to failure to perform a CEA. Here the authors conducted a quantitative analysis of this litigation.
Methods: Two large legal databases were used to search for jury verdicts and settlements in cases related to CAS and CEA.
Results: 65 verdicts were obtained and case factors were analysed for their relationship to verdicts and payouts. Cases resulted in 33 defendant verdicts (51%), 18 settlements (28%) and 14 plaintiff verdicts (21%). The mean for settlements was $1,014,642 which is significantly lower than the mean for plaintiff verdicts was $2,727,049 (p=0.0273). The most common injury suffered was stroke (84%). Payouts in cases alleging failure to timely diagnose and treat CAS, were non-significantly higher than payouts arising from cases alleging negligence in relation to performance of a CEA ($2,184,574.78 vs $1,452,541.67).
Conclusions: Around half of CEA/CAS related medical malpractice cases result in defense verdicts. In cases resulting in a settlement or plaintiff verdict the payouts can be considerable. Failure to diagnose and treat CAS is as prevalent a medicolegal issue as performing a CEA. Litigation related to a failure to diagnose CAS can involve doctors from a variety of specialties and often results in a payout. Alleged procedural error in performance of a CEA is usually defensible in the absence of clear negligence. Perioperative stroke in CEA procedures is a common injury cited in litigation. Doctors and hospitals should have a clear and effective method of diagnosing and treating perioperative stroke and should be prepared to defend any decision made in treating patients suffering this complication.
Patient Care: Medical malpractice litigation can lead to defensive medicine which costs billions of dollars annually in the United States. Understanding medicolegal issues can be of benefit to both doctors and patients.
Learning Objectives: By the conclusion of this session participants should: 1) Understand how litigation can arise in relation to CAS and CEA. 2) Understand factors associated with defense or plaintiff verdicts. 3) Consider methods of reducing medicolegal liability.