All right, we'll go to the last presentation, which is neurosurgery medical professional liability claims in the United States. Good afternoon, everybody. My name is Alainos Medici. I'm a graduating fourth-year medical student at Duke University and will be continuing my neurosurgery training at Yale next year. Thank you for the opportunity to present in front of you all today. Thank you to the scientific committee as well as my research mentors. So, a medical malpractice claim is a civil claim where a physician has allegedly breached the standard of care resulting in a patient being injured. In the past decade, about 2.4% of healthcare costs have been attributed to medical malpractice claims and defensive medicine equating to $55 billion. As we shift away from the fee-for-service modality to now a bundle payment hospital modality, there has been increasing emphasis on the national front to increase tort reform to reduce these disparaging rates and costs of medical malpractice to also better patient quality of care and making a better environment for physicians and surgeons. Neurosurgery is one of those fields that are one of the most complex surgical subspecialties as well as some of the most sick patients. And with that comes these increasing costs as well as rates of medical malpractice claims being against neurosurgeons. In fact, previous studies have shown about 27% according to 131 months of neurosurgery careers are spent with an open unresolved malpractice claim and had the highest risk for recurrent paid malpractice claims if found guilty the first time. Therefore, as you can see, there's been this slew of medical malpractice neurosurgical studies being published and pursued in efforts to really understand what's causing neurosurgery to be so high and with these high costs. However, a lot of these studies have limitations such as the sample size, the self-reporting reliability, the overall lack of physician data, which includes basically the type of claim, procedure performed, and the overall costs associated with that paid-out claim. So our objective was really to characterize the three aspects of the malpractice risk amongst neurosurgeons, first being the overall landscape of the neurosurgical malpractice claims in a 10-year perspective. Secondly, to trend the physician characteristics with the highest NPL claims. And the third being the overall cost burden of these paid claims in a 10-year time period. Additionally, we wanted to compare, well, if you have the neurosurgical physicians, the characteristics to the 26 other medical and surgical specialty groups. So we used this retrospective national database called the PIAA, which is the Physician Insurance Association of America, which has over 100,000 NPL claims across 27 medical and dental specialties. We queried the NPL closed claim data involving a neurosurgeon as the primary defendant, with the incident date being between the calendar year of 2003 to 2012. And associated with these NPL claims, we assessed the physician demographics, such as age and gender, board certification, presenting medical condition of the claim, the operative procedure performed in the claim, and the chief medical factor ensuing that claim. Additionally, we collected the total number of closed paid in proportion to paid to closed malpractice claims, as well as the total and average cost of the indemnity, which is basically what is paid to the patient in a closed claim, as well as the expenses associated with these claims. And what we found was there was a total of 96,441 closed malpractice claims that were filed in the calendar year between 2003 to 2012, with approximately 2,100 of these closed claims being filed against a neurosurgeon. And when we look at the total number of claims, the costs associated with these paid out claims, you can find that there's been this steady state of the malpractice claims and the average indemnities being paid out to the patients or the person injured in these claims. And really, you can see that there just hasn't been really much of a big change, and we steadily stay very high. And when we look at neurosurgery in relation to all the other surgical and medical specialties, we find that neurosurgery is the ninth highest total indemnities being paid, and the first in terms of the average payout of approximately over $400,000 on average being spent per malpractice claim. And so when we compare these physician characteristics, such as the age, sex, and board certification between the neurosurgeons and the rest of the specialties, you find that there's really not that big of a difference in the type of patients being called into the NPL claims. But you can really see that neurosurgery, because of the long training that we have, that between 35 and 54, that's when it's like the peak time of any NPLs being occurring. And when we look at the chief medical factor being the patient coming in or of the ensuing cause of the claim, we find that the top three are improper performance, no medical misadventure, which is, by the PIAA, described as a claim being brought to a physician who had little or no contact with the patient during the event in question, and then three being errors in diagnosis. You can see with improper performance, that is significantly high with the amount that we are being spent out, which is over $100 million. And if you kind of go through the top 10, you can see that a lot of this is due to surgical malpractice. And when we look at the presenting medical condition of the patients that are being presented in these cases, you can see really the top six of the seven are all spine-related, with the first one being the intervertebral disc disorders, and then number two, back disorders, and number three being spinal stenosis. And if you look at the operative procedure, it's no surprise that the top three operative procedures are spine-related. And with these two charts, you can kind of tell that it's, or kind of ensue that it's because of, it's mostly the spine patients who are being part of these malpractice claims, and the surgeons, and the spine surgeons are the ones being brought into these claims. And then we wanted to also look at what are the, are these the, you know, spine patients are not, you don't go into a spine case thinking the patient will pass away, but what about the medical conditions and the chief medical factors associated with patients that resulted in death? And what we found that, and when we look at the top three, that the number one was displacement of intervertebral disc, which is a spine disorder, but after that, it was really headache, subarachnoid hemorrhage, intracranial hemorrhage, so it really is the NPLs that are ensuing patient death have been, our majority being intracranial processes rather than spine. And we look at the chief medical factors, once again, it was the improper performance being the most, and in a surgical sub-specialty, you would think improper performance would be the highest reasoning for a malpractice claim, but then after that being the no medical misadventure, and then thirdly being failure to supervise or monitor a case, and with neurosurgery being a very high critical surgical operations and so forth, especially with intracranial patients, you can see that if you're not, if an attending is not monitoring a resident or so forth, that failure to supervise can be one of the highest causes. So in conclusion, in this 10-year retrospective study, we found that neurosurgery malpractice claims rank among one of the most costly and prevalent, with the average indemnities paid annually and overall economic burden increasing over time. Therefore, continued medical malpractice reform is essential to really correct and really alleviate these overall, the overall healthcare cost burden associated with malpractice and hopefully improve patient care. Thank you.

neurosurgery

medical professional liability claims

medical malpractice

physician characteristics

cost burden