Table 1 here
132 cases relating to trigeminal neuralgia and medical malpractice occurring from 1985 to 2019 were obtained from the primary search. Of those, 83 cases were excluded from the study due to litigation focused on a motor vehicle accident, insufficient information about the case, or the presence of duplicate cases. After screening, there were a total of 49 cases eligible for inclusion in this analysis.
Demographics
Of the total 49 cases, 13 (26.5%) were male, 35 (71.4%) were female, and 1 (2.0%) was of unknown sex (Table 1). The average age of those who filed a claim was 48.1 years (range 22 to 78 years old).
Geographic Distribution
Cases involving trigeminal neuralgia were declared across 17 states in the United States. Notably, New York (n=11; 22.4%) had the greatest number of cases, with California and Pennsylvania following with 7 (14.3%) cases each (Table 1).
Reasons for Litigation
Occurrence of a surgical complication (n=21; 42.9%) was cited as the most common alleged reason for filing a malpractice claim. The second most common reason was failure to diagnose (n=16; 32.7%). Other cases cited failure of informed consent (n=6; 12.2%), failure to treat (n=5; 10.2%), and imaging complications (n=1, 2.0%) (Table 1).
Plaintiff Complaints or Outcomes involved in Claim
For pre-operative symptoms, including symptoms reported by patients who never underwent a procedure, cranial nerve deficits (n=10; 20.4%) and financial loss (n=2; 4.1%) were the most frequent complaints (Table 1 and Figure 1). Other complaints included loss of consortium, facial paralysis, speech impairment, quadriplegia, and headache or chronic headache each represented in 1 (2%) case.
Post-operative grievances included cranial nerve deficits (n=17; 34.7%), loss of consortium (n=6; 12.2%), financial loss (n=4; 8.2%), death (n=4; 8.2%), and emotional distress (n=3; 6.1%) (see Table 1 and Figure 1). New post-operative symptoms afflicting patients in the presented cases most commonly included vision impairment or loss (n=3; 6.1%), facial paralysis (n=3; 6.1%), and deafness and motor weakness both with 2 (4.1%) cases each. Less common symptoms included hemorrhage, ischemic stroke, disequilibrium, and memory loss each with 1 (2.0%) case.
Plaintiff pre-operative and post-operative complaints for trigeminal-neuralgia related cases from 1985 to 2019
Figure 1 here
Figure 1: The most frequent pre-operative plaintiff complaints were cranial nerve injury (n=10; 20.4%) and financial loss (n=2; 4.1%). The most frequent post-operative plaintiff complaints were cranial nerve injury (n=17; 34.7%), loss of consortium (n=6; 12.2%), and financial loss and death, both reported for 4 (8.2%) cases. Additional post-operative symptoms included vision impairment or loss (n=3; 6.1%) and facial paralysis (n=3; 6.1%), followed by deafness (n=2; 4.1%) and motor weakness (n=2; 4.1%).
Specialties of Defendants
Of the 49 cases included, the most frequently implicated defendant specialties were Dentistry (n=31; 63.3%) and Neurosurgery (n=10; 20.4%) (Table 1). A hospital, medical center, or healthcare system was involved in 9 (18.4%) cases. Anesthesiology, Family Medicine, Internal Medicine, Otolaryngology, and Radiology each were involved in 1 (2%) case.
Legal Jurisdiction, Verdict, and Payments
Information on case outcome was available for 46 of the cases included in this study. A verdict was reached at the state level for all of these cases. Verdicts ruled in favor of the defendant in 30 (61.2%) of cases, and for the plaintiff in 13 (26.5%). A settlement was reached in 3 (6.1%) cases. The payout range for all verdicts ranged from $55,000 – 7,978,185. The mean payout for verdicts in favor of the plaintiff was $1,982,428.46, which was greater than the $660,724.67 mean for settlements. When considering payouts based on specialty, the largest amount was in a single case involving Anesthesiology, where the payout was $7,978,185 (Table 2). The next highest average payout was $1,030,898 over 9 cases against a hospital, medical center, or healthcare system group. Dental specialists were included in the most cases, 31 (63.3%), and the average payout was $415,908. Neurosurgical specialists were involved in 10 (20.4%) cases which were found to have an average payout of $618,775.
Table 2: Average payout based on medical specialty of the defendant
Specialties of Defendants
|
Average Payout
|
Anesthesiology
|
$7,978,185
|
Dentistry
|
$415,908
|
Family Practice
|
$-
|
Hospital, Medical Center, or Healthcare System
|
$1,030,898
|
Internal Medicine
|
$-
|
Neurosurgery
|
$618,775
|
Oral and Maxillofacial Surgery
|
$-
|
Otolaryngology
|
$-
|
Radiology
|
$-
|
We also compared characteristics between cases which had a verdict in favor of the defendant (n=30) and those in favor of plaintiff (n=13). Cases where the verdict was in favor of the plaintiff were more likely to be older (55.6 ± 12.9 vs 42.9 ± 12.5, p=0.03). Other factors found to be different but not approaching statistical significance included defendant’s position where cases in favor of the plaintiff were more likely to involve physicians (53.8%, n=7 vs 30%, n=9, p=0.137); type of lawsuit where cases in favor of plaintiff were more likely to be malpractice lawsuits (66.7%, n=8 vs 36.7%, n=11, p=0.078). Finally, cases with verdict in favor of plaintiff, compared to those with verdict in favor of defendant, were more likely to involve a litigation of failure to treat and informed consent failure (failure to treat: 23.1%, n=3 vs 6.7%, n=6; informed consent failure: 23.1%, n=3 vs 3.3%, n=1; overall p=0.093).
Table 3 here