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Legal Issues in Neurology – Observations on American Medical Jurisprudence

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Legal and Forensic Medicine

Abstract

This chapter provides an overview of the common legal issues affecting neurologists in the United States of America (USA). It focuses on tort law, with particular attention to the current malpractice trends. Illustrative management strategies are provided for several recurring claims involving selected neurological conditions. Non-malpractice liability topics are briefly mentioned in the context of overall neurological liability. A discussion of forensic liability centers on the unique risks engendered by the expert witness.

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References

  1. Johnston JC. Tort reform system: medical negligence in New Zealand. In: Sanbar S, editor. The medical malpractice survival handbook. Philadelphia: Mosby Elsevier; 2007. p. 287–96 (providing an overview of the New Zealand scheme).

    Chapter  Google Scholar 

  2. Hunter J, Cassell-Stiga G, Doroshow J. True risk: Medical liability, malpractice insurance and health care. Americans for Insurance Reform (a project of the Center for Justice and Democracy). www.insurance-reform.org (2009). Accessed 22 Jan 2011)

  3. Baker T. The medical malpractice myth. Chicago: University of Chicago Press; 2005.

    Book  Google Scholar 

  4. Physicians Insurers Association of America. Risk management review (Neurology). Rockville: PIAA; 2010.

    Google Scholar 

  5. Physicians Insurers Association of America. Risk management review (Neurology). Rockville: PIAA; 2009.

    Google Scholar 

  6. Evans R, editor. Secondary headache disorders. Neurol Clin. 2004;22:1–260.

    Google Scholar 

  7. Greer D. Management of subarachnoid hemorrhage, unruptured cerebral aneurysms, and arteriovenous malformations. In: Fisher M, editor. Stroke III: investigation and management (Handbook of clinical neurology, vol 94, series 3). Amsterdam: Elsevier; 2009, p. 1239–49.

    Chapter  Google Scholar 

  8. van Gijn J, Kerr RS, Rinkel GJ. Subarachnoid hemorrhage. Lancet. 2007;369(9558):306–18.

    Article  PubMed  Google Scholar 

  9. Rothrock J. Headaches due to vascular disorders. Neurol Clin. 2004;22:21–37.

    Article  PubMed  Google Scholar 

  10. Mayer PL, Awad IA, Todor R, et al. Misdiagnosis of symptomatic cerebral aneurysm. Prevalence and correlation with outcome at four institutions. Stroke. 1996;27:1558–63.

    Article  PubMed  CAS  Google Scholar 

  11. Weir B. Headache from aneurysms. Cephalalgia. 1994;14(2):79–87.

    Article  PubMed  CAS  Google Scholar 

  12. Linn FHH, Rinkel GJE, Algra A, van Gijn J. Headache characteristics in subarachnoid hemorrhage and benign thunderclap headache. J Neuro Neurosurg Psychiatry. 1998;65:791–793.

    Article  CAS  Google Scholar 

  13. van Gijn J, Rinkel GJE. Subarachnoid hemorrhage: diagnosis, causes and management. Brain. 2001;124(2):249–278.

    Article  PubMed  Google Scholar 

  14. Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. NEJM. 2006;354(4):387–396.

    Article  PubMed  CAS  Google Scholar 

  15. Brisman JL, Song JK, Newell DW. Cerebral aneurysms. NEJM. 2006;355(9):928–939.

    Article  PubMed  CAS  Google Scholar 

  16. van Gijn J, van Dongen KJ. The time course of aneurysmal hemorrhage on computed tomograms. Neuroradiol. 1982;23(3):153–6.

    Google Scholar 

  17. Mohamed M, Heasly DC, Yagmurla DM. Fluid associated inversion recovery MR imaging and subarachnoid hemorrhage: not a panacea. Am J Neuroradiol. 2004;25:545–50.

    PubMed  Google Scholar 

  18. Kelly ME, Dodd R, Steinberg GK. Subarachnoid hemorrhage. In: Fisher M, editor. Stroke part II: Clinical manifestations and pathogenesis (Handbook of clinical neurology, vol 93, series 3). Amsterdam: Elsevier; 2009, p. 791–808.

    Chapter  Google Scholar 

  19. Evans RW. Diagnostic testing for the evaluation of headaches. Neurol Clin. 1996;14(1):1–26.

    Article  PubMed  CAS  Google Scholar 

  20. Dupont SA, Wijdicks EFM, Manno EM, Rabinstein AA. CSF analysis valuable for detection of ruptured cerebral aneurysm. Mayo Clin Proc. 2008;83(12):1326–31.

    Article  PubMed  Google Scholar 

  21. Bederson JB, Connolly ES, Batjer H, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group for the Stroke Council, American Heart Association: The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke. 2009;40(3):994–1025.

    Article  PubMed  Google Scholar 

  22. Wijdicks EFM, Kerkhoff H, van Gijn J. Long term follow up of 71 patients with thunderclap headache mimicking subarachnoid hemorrhage. Lancet. 1988;2(8602):68–9.

    Article  PubMed  CAS  Google Scholar 

  23. Harling DW, Peatfield RC, van Hille PT, Abbot RJ. Thunderclap headache: is it migraine? Cephalalgia. 1989;9(2):87–90.

    PubMed  CAS  Google Scholar 

  24. Markus HS. A prospective study of thunderclap headache mimicking subarachnoid hemorrhage. J Neurol Neurosurg Psychiatry. 1991;54:1117–25.

    Article  PubMed  CAS  Google Scholar 

  25. Linn FH, Wijdicks EF, van deer Graf Y, et al. Prospective study of sentinel headache in aneurysmal subarachnoid hemorrhage. Lancet. 1994;344:590–3.

    Article  PubMed  CAS  Google Scholar 

  26. Landtblom AM, Fridriksson S, Boivie J, et al. Sudden onset headache: a prospective study of features, incidence and causes. Cephalalgia. 2002;22:354–60.

    Article  PubMed  Google Scholar 

  27. Purdy RA, Kirby S. Headaches and brain tumors. Neurol Clin N Am. 2004;22(1):39–53.

    Article  Google Scholar 

  28. Forsyth PA, Posner JB. Headaches in patients with brain tumors. Neurology. 1993;43:1678–83.

    Article  PubMed  CAS  Google Scholar 

  29. Schankin C, Ferrari U, Reinish V, et al. Characteristics of brain tumor associated headache. Cephalalgia. 2007;27(8):904–911.

    Article  PubMed  CAS  Google Scholar 

  30. Levy MJ, Matharu MS, Meeran K, et al. The clinical characteristics of headache in patients with pituitary tumors. Brain. 2005;128(8):1921–1930.

    Article  PubMed  CAS  Google Scholar 

  31. Favier I, van Vliet JA, Roon KI, et al. Trigeminal autonomic cephalgias due to structural lesions. Arch Neurol. 2007;64(1):25–31.

    Article  PubMed  Google Scholar 

  32. Chen PK, Fuh JL, Wang SJ. Cough headache: A study of 83 consecutive patients. Cephalalgia. 2009;29(10):1079–1085.

    Article  PubMed  Google Scholar 

  33. Pascaul J, Iglesias F, Oterino A, et al. Cough, exertional and sexual headaches. Neurology. 1996;46(6):1520–1524.

    Article  Google Scholar 

  34. Headache Classification Subcommittee of the International Headache Society. The international classification of headache disorders, 2nd ed. Cephalgia. 2004;24(Supp 1):1–160.

    Google Scholar 

  35. Frishberg B, Rosenberg J, Matchar D, et al. Evidence-based guidelines in the primary care setting: neuroimaging in patients with nonacute headache. United States Headache Consortium. www.aan.com/professionals/practice/pdfs/g10088.pdf. Accessed 21 Jan 2011.

  36. Evans R, Johnston JC. Migraine and medical malpractice. Headache. 2011;51(3):434–40.

    Article  PubMed  Google Scholar 

  37. Sandrini G, Friberg L, Coppola G, et al. Neurophysiological tests and neuroimaging procedures in nonacute headache (2nd edition). Eur J Neurol. 2010. doi: 10.1111/j.1468-1331.2010.03212.x.

    Google Scholar 

  38. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333:1581–7.

    Article  Google Scholar 

  39. Hacke W, Kaste M, Fieschi C, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke: the European Cooperative Acute Stroke Study (ECASS). JAMA. 1995;274:1017–25.

    Article  PubMed  CAS  Google Scholar 

  40. Hacke W, Kaste M, Fieschi C, et al. Randomized double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischemic stroke (ECASS II). Lancet. 1998;352:1245–51.

    Article  PubMed  CAS  Google Scholar 

  41. Marler JR, Tilley BC, Lu M, et al. Early stroke treatment associated with better outcome: the NINDS rt-PA Stroke Study. Neurology. 2000;55:1649–55.

    Article  PubMed  CAS  Google Scholar 

  42. Clark WM, Wissman S, Albers GW, et al. Recombinant tissue-type plasminogen activator (alteplase) for ischemic stroke 3 to 5 hours after symptom onset – the ATLANTIS study: a randomized controlled trial. JAMA. 1999;282:2019–26.

    Article  PubMed  CAS  Google Scholar 

  43. Hacke W, Donnan G, Fieschi C, et al. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet. 2004;363:768–74.

    Article  PubMed  Google Scholar 

  44. Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359:1317–29.

    Article  PubMed  CAS  Google Scholar 

  45. del Zoppo GJ, Saver JL, Jauch EC, et al., on behalf of the American Heart Association Stroke Council. Expansion of the time window for treatment of acute ischemic stroke with intravenous tissue plasminogen activator: A Science Advisory from the American Heart Association/American Stroke Association. Stroke. 2009;40:2945–8.

    Article  PubMed  Google Scholar 

  46. American Academy of Neurology. Report of the Quality Standards Subcommittee: Practice advisory: thrombolytic therapy for acute ischemic stroke (summary statement); 1996, reaffirmed 18 Feb 2003.

    Google Scholar 

  47. Adams HP, del Zoppo GJ, Alberts MJ, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an education tool for neurologists. Stroke. 2007; 38:1655–1711. [Erratum: Stroke 2007;38(6):e38, 2007; 38(9):e96].

    Article  PubMed  Google Scholar 

  48. Adams HP, Brott T, et al. Guidelines for the early management of patients with ischemic stroke: a scientific statement from the Stroke Council of the American Stroke Association. Stroke. 2003;34:1056–83.

    Article  PubMed  Google Scholar 

  49. Schellinger P, Kohrmann M, Hacke W. Thrombolytic therapy for acute stroke. In: Fisher M, editor. Stroke III: Investigation and management (Handbook of clinical neurology, vol 94, series 3). Amsterdam: Elsevier; 2009, p. 1155–93.

    Chapter  Google Scholar 

  50. Coull BM, Williams LS, Goldstein LB, et al. Anticoagulants and antiplatelet agents in acute ischemic stroke: report of the joint stroke guideline development committee of the American Academy of Neurology and the American Stroke Association (a Division of the American Heart Association). Neurology. 2002;59:13–22 (Reaffirmed 2 August 2008).

    Article  PubMed  CAS  Google Scholar 

  51. Schwartz NE, Diener H, Albers GW. Antithrombotic agents for stroke prevention. In: Fisher M, editor. Stroke III: Investigation and management (Handbook of clinical neurology, vol 94, series 3). Amsterdam: Elsevier; 2009, p. 1277–94.

    Chapter  Google Scholar 

  52. English J, Smith W. Cardio-embolic stroke. In: Fisher M, editor. Stroke II: Clinical manifestations and pathogenesis (Handbook of clinical neurology, vol 93, series 3). Amsterdam: Elsevier; 2009, p. 719–49.

    Chapter  Google Scholar 

  53. Freeman WD, Aguilar MI. Stroke prevention in atrial fibrillation and other major cardiac sources of embolism. Neurol Clin. 2008;26:1129–60.

    Article  PubMed  Google Scholar 

  54. American Academy of Neurology. Report of the Quality Standards Subcommittee: practice parameter: stroke prevention in patients with nonvalvular atrial fibrillation. Neurology. 1998;51:671–3.

    Article  Google Scholar 

  55. American Academy of Neurology 61st annual meeting. Neurology update I: Stroke, 3FC.002, 27 Apr 2009 (access via Marathon Multimedia Syllabi2view).

    Google Scholar 

  56. Sacco RL, Diener HC, Yusuf S, PRoFESS Study Group, et al. Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke. NEJM. 2008;359:1238–1251.

    Article  PubMed  CAS  Google Scholar 

  57. Rothwell P. Carotid endarterectomy, stenting, and other prophylactic interventions. In: Fischer M, editor. Stroke III: Investigation and management (Handbook of clinical neurology, vol 94, series 3). Amsterdam: Elsevier; 2009, p. 1295–325.

    Chapter  Google Scholar 

  58. Chaturvedi S, Bruno A, Feasby T, et al. Carotid endarterectomy – an evidence based review: report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology. Neurology. 2005;65:794–801 (Reaffirmed 9 Feb 2008).

    Article  PubMed  CAS  Google Scholar 

  59. Easton D, Saver J, Albers G, et al. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; council on cardiovascular surgery and anesthesia; council on cardiovascular radiology and intervention; council on cardiovascular nursing; and the interdisciplinary council on peripheral vascular disease: the American academy of neurology affirms the value of this statement as an educational tool for neurologists. Stroke. 2009;40:2276–93.

    Article  PubMed  Google Scholar 

  60. Fairhead J, Mehta Z, Rothwell P. Population-based study of delays in carotid imaging and surgery and the risk of recurrent stroke. Neurology. 2005;65(3):371–5.

    Article  PubMed  CAS  Google Scholar 

  61. American Academy of Neurology 61st annual meeting. Update on endovascular treatment of cerebrovascular diseases, 7 AC.005, 2009 (access via Marathon Multimedia Syllabi2view).

    Google Scholar 

  62. Browne R, Holmes G. Epilepsy. N Engl J Med. 2001;344:1145–51.

    Article  PubMed  CAS  Google Scholar 

  63. Engel J, Pedley T, editors. Epilepsy: a comprehensive textbook. 2nd ed. Philadelphia: Lippincott-Raven; 2008.

    Google Scholar 

  64. Bortz J. Neuropsychiatric and memory issues in epilepsy. Mayo Clin Proc. 2003;78:781–7.

    Article  PubMed  Google Scholar 

  65. Krumholz A, Wiebe S, Gronseth G, et al. Practice parameter: evaluating an apparent unprovoked first seizure in adults (an evidence based review): report of the quality standards subcommittee of the american academy of neurology and the American epilepsy society. Neurology. 2007;69:1996–2007.

    Article  PubMed  CAS  Google Scholar 

  66. Hirtz D, Thurman D, Gwinn-Hardy K, et al. How common are the “common” neurological disorders? Neurology. 2007;68:326–37.

    Article  PubMed  CAS  Google Scholar 

  67. Morrow J, Russell A, Guthrie E, et al. Malformations risks of antiepileptic drugs in pregnancy: a prospective study from the UK epilepsy and pregnancy register. J Neurol Neurosurg Psychiatry. 2006;77:193–8.

    Article  PubMed  CAS  Google Scholar 

  68. Holmes L, Harvey E, Coull B, et al. The teratogenicity of anticonvulsant drugs. N Engl J Med. 2001;344(15):1132–8.

    Article  PubMed  CAS  Google Scholar 

  69. American Academy of Neurology. Practice parameter update: management issues for women with epilepsy – focus on pregnancy (an evidence based review): teratogenesis and perinatal outcomes. Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology. 2009;73:133–41.

    Article  Google Scholar 

  70. Wyszynski D, Nambisan M, Survet T, et al. Increased rate of major malformations in offspring exposed to valproate during pregnancy. Neurology. 2005;64:961–965.

    Article  PubMed  CAS  Google Scholar 

  71. Meador KJ, Baker GA, Browning N, et al. Cognitive function at 3 years of age after fetal exposure to antiepileptic drugs. NEJM. 2009;360:1597–1605.

    Article  PubMed  CAS  Google Scholar 

  72. Holmes LB, Baldwin EJ, Smith CR, et al. Increased frequency of isolated cleft palate in infants exposed to lamotrigine during pregnancy. Neurology. 2008;70:2152–8.

    Article  PubMed  CAS  Google Scholar 

  73. American Academy of Neurology. Practice parameter update: management issues for women with epilepsy – focus on pregnancy (an evidence based review): obstetrical complications and change in seizure frequency. Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology. 2009;73:126–32.

    Article  Google Scholar 

  74. American Academy of Neurology. Practice parameter update: management issues for women with epilepsy – focus on pregnancy (an evidence based review): vitamin K, folic acid, blood levels, and breastfeeding. Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology. 2009;73:142–49.

    Article  Google Scholar 

  75. Joy TR, Hegele RA. Narrative review: statin-related myopathy. Ann Intern Med. 2009;150:858–68.

    Article  PubMed  Google Scholar 

  76. Bigal ME, Kurth T, Hu H, et al. Migraine and cardiovascular disease: possible mechanisms of interaction. Neurology. 2009;72:1864–71.

    Article  PubMed  CAS  Google Scholar 

  77. Scher AI, Gudmundsson LS, Sigurdsson S, et al. Migraine headache in middle age and late-life brain infarcts. JAMA. 2009;301:2563–2570.

    Article  PubMed  CAS  Google Scholar 

  78. Keller DM. Repeated migraine attacks raise risk of ischemic brain lesions (quoting the International Headache Society Special Lecture, The cerebral abnormalities in migraine, an epidemiological risk analysis – CAMERA II study 1999–2008). www.medscape.com/viewarticle/708900. Accessed 24 Jan 2011.

  79. Safran A, Skydell B, Ropper S. Expert witness testimony in neurology: Massachusetts experience 1980–1990. Neurol Chronicle. 1992;44:2477–84.

    Google Scholar 

  80. Holtz S. The neurologist as an expert witness. AAN Education Program Syllabus 7DS.003 (2002).

    Google Scholar 

  81. Hutchins JC, Sagsveen MG, Larriviere D. Upholding professionalism – the disciplinary process of the American Academy of Neurology. Neurology. 2010;75:2198–203.

    Article  PubMed  Google Scholar 

  82. American Board of Psychiatry and Neurology: General information and board policies, §B.4. revocation of certificates, 2009.

    Google Scholar 

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Acknowledgments

Portions of this text are reprinted from James C. Johnston, Neurological malpractice and non-malpractice liability, Neurol Clin 2010; 28(2):441–458, with permission from Elsevier.

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Correspondence to James C. Johnston M.D., J.D., FCLM, FACLM .

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Johnston, J.C. (2013). Legal Issues in Neurology – Observations on American Medical Jurisprudence. In: Beran, R. (eds) Legal and Forensic Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-32338-6_42

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