Malpractice disputes in spine surgery can involve decisions made before, during and after an operation.
Recent Becker’s coverage of lawsuits, verdicts and surgeon perspectives has included questions around the decision to operate, informed consent, postoperative monitoring and emerging liability concerns around AI.
The cases do not establish that malpractice claims are increasing in any one area. They do, however, illustrate several issues that have surfaced in recent spine litigation and surgeon discussions.
Postoperative complications can become a focus of litigation
A $27 million Florida verdict centered on allegations surrounding the recognition of a postoperative spinal cord complication.
A jury awarded $27 million to a couple who alleged that complications following spinal cord stimulator surgery left the patient partially paralyzed. The patient reported signs of spinal cord compression from a hematoma after surgery, and experts at trial argued nurses failed to properly evaluate him and recognize signs of a potential spinal cord injury. The jury found Melbourne, Fla.-based Holmes Regional Medical Center 75% responsible and the surgical team 25% liable. Health First, the hospital’s parent system, said the care met standards of practice and that it planned to appeal the ruling.
Another jury in August awarded $15 million to the family of a 77-year-old patient who died after complications from spine surgery at Wellstar’s Atlanta Medical Center, part of Marietta, Ga.-based Wellstar Health System. The family alleged a radiologist improperly placed a suprapubic catheter outside the patient’s bladder, draining and worsening a chyle leak, and that the attending physician failed to adequately investigate the cause of continued fluid loss as his condition deteriorated. The spine surgeon who performed the operation was not found liable. Wellstar said an internal investigation found the care team followed appropriate protocols and correctly implemented the prescribed procedures.
The cases involved different facts, but both included allegations related to care after the initial surgical procedure.
Timing of diagnosis was central in another case
Not every malpractice allegation results in physician liability.
In December, a jury cleared three physicians in a $3 million lawsuit alleging a patient’s spinal cord compression should have been diagnosed sooner. The patient alleged an MRI should have been ordered during an emergency department visit. Experts at trial argued his symptoms did not justify an emergency workup at that time.
The case centered on whether the physicians’ actions were appropriate based on the patient’s presentation before a follow-up MRI identified spinal cord compression.
Liability concerns can affect patient selection
Some spine surgeons have told Becker’s that malpractice risk influences which patients and procedures they are willing to take on.
Nitin Bhatia, MD, an orthopedic spine surgeon at UCI Health in Orange, Calif., said liability concerns can lead surgeons to delay or avoid higher-risk procedures and order additional imaging or testing to document their decisions.
He said UCI’s academic spine center receives medically complex patients whom some community surgeons avoid treating because of increased clinical and legal risk without corresponding reimbursement.
Patients sometimes “cannot get care in other settings due to the legal risk,” Dr. Bhatia told Becker’s.
Pierce Nunley, MD, of Spine Institute of Louisiana in Shreveport, similarly told Becker’s that malpractice risk can contribute to defensive medicine, including additional testing, performing procedures earlier or avoiding certain treatments.
Patient selection was also central to a recent conversation with James Mooney, MD, a neurosurgeon at VCU Health in Richmond, Va.
“Who to operate on and when is vastly more important to outcomes than executing a technically perfect surgery,” Dr. Mooney told Becker’s. He said factors including bone health, smoking status, diabetes, weight and patient expectations can alter the risk-benefit calculation surrounding surgery.
Some surgeons are expanding informed consent discussions
Vijay Yanamadala, MD, of Hartford (Conn.) HealthCare, told Becker’s that early in his career, informed consent largely involved reviewing immediate risks such as infection, neural injury and hardware failure.
“It was accurate, and it was inadequate,” he said. Dr. Yanamadala said he now spends more time discussing what he calls the “downstream conversation,” including adjacent-segment disease and what fusion may mean for future imaging, procedures and decisions.
Some patients decide they are not ready for surgery after that discussion, which he described as “informed consent working as it should.” His comments reflect one surgeon’s approach to broadening informed consent beyond immediate perioperative risks.
AI raises an unresolved liability question
Dr. Mooney also pointed to a potential liability issue as AI tools begin incorporating continuous postoperative data. If an algorithm detects that a patient is declining, questions remain about who is responsible for acting on the information, whether physicians would be expected to monitor data continuously and how warnings should be escalated.
“There’s a whole new level of liability that needs to be ironed out,” Dr. Mooney told Becker’s. Dr. Mooney said those questions will become more important as AI shifts from analyzing retrospective datasets toward continuous patient monitoring.
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