Is the Medicolegal Issue Avoidable in Neurosurgery? A Retrospective Survey of a Series of 115 Medicolegal Cases from Public Hospitals

Abstract

Since the mid-1950s, neurosurgery has benefited from the remarkable progress due to tremendous advances in neuroimaging techniques, neuroanesthesia, neurostimulation, and brain-computer interfaces, as well as breakthroughs in operating microscopes and surgical instruments. Yet, this specialty has to do with delicate human structures and is hence considered as highly risky by insurance companies. In France, although neurosurgery's casualty rate (6%) is lower than in other specialties, the number of legal prosecutions has increased since 2002 because of easier access to medicolegal procedures. In order to avoid patients' resorting to the law courts, it becomes necessary to clearly identify the risk factors. From the data bank of the insurer Société Hospitalière d'Assurances Mutuelles (SHAM, main insurance company for public hospitals in France), we retrospectively analyzed 115 files (34 cranial and 81 spinal surgeries) covering the period 1997-2007 for the reasons for complaints against French neurosurgeons working in public hospitals. Five main causes were identified: surgical site infection (37%), technical error (22%), lack of information (14%), delayed diagnosis (11%), and lack of supervision (9%). Some causes are definitely avoidable at no cost to the hospital. Besides basic preventive safety procedures, we reiterate the mandatory steps for a good defense when being prosecuted. The evolution of patients' attitudes toward medical institutions observed in most countries has forced surgeons to adapt their practice. In this context, a common action certified by learned societies on sustainable health care quality, patient safety, and respect of good practices appears as the golden path to maintain a favorable legal, insurance, and financial environment.