Mutual Matters

Lessons Learned on Neurological Injuries

Posted by Bill Kanich, MD on Feb 2, 2017 1:05:00 PM

Neurological LessonsBecause of the rise in the number of claims involving neurologic injury, we formed a task force looking at these claims. We examined 22 cases that were closed during the years of 2006 to 2013 to develop some claims lessons. The average total incurred costs per claim were 3.33 times higher than the average amount of all other claims over the same time period.

Lesson Learned

The cases examined were complex and we asked the task force to focus on common principles to improve care. Neurologic examinations, whether performed or documented, were often times inadequate to identify many of the lesions and conditions in which serious adverse outcomes eventually occurred. While we cannot differentiate what was done versus what was documented, we can observe the following:

  1. Plaintiff attorneys preferentially litigate these cases due to their high damages. Defense counsel repeatedly are faced with the mantra of “did you think about and diagnose or rule out the most dangerous or life threatening condition?” Our liability exposure is greatly determined by what cases are brought and potential damages.
  2. Neurologic examinations were focused on only a small portion of the functional areas of the brain, predominantly on the anterior circulation. Typical documentation included the motor, sensory, and reflex examinations, posterior circulation findings were either not examined or not documented. These include detailed visual fields, cerebellar examination, coordinated movements, ataxia, nystagmus, gait, proprioception, and subtle behavioral symptoms.  We can defend a well-documented examination that describes the entirety of the brain and spinal cord, and a detailed description of the medical decision making. By and large we are not missing anterior distribution cerebrovascular accidents (CVAs) and transient ischemic attacks (TIAs).

Discover more of the patient safety lessons learned in regards to neurological injuries by clicking below. 

More Lessons

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