Liability laws and risks of malpractice litigation can sometimes lead spine surgeons to make decisions that increase the total cost of care or affect patient access.
Here is how three surgeons approach the concern.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker’s invites all spine surgeon and specialist responses.
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Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CDT Tuesday, May 13.
Editor’s note: Responses were lightly edited for clarity and length.
Question: How do current liability laws affect your surgical decision-making?
Nitin Bhatia, MD. Orthopedic Surgeon at UCI Health (Orange, Calif.): Current liability laws significantly influence surgical decision-making in spine surgery in several keyways, and unfortunately, usually the influence leads to increased cost for the healthcare system. Spine surgeons often practice defensive medicine to minimize legal exposure. This can lead to surgeons delaying or avoiding high-risk surgeries unless absolutely necessary, ordering extra imaging or tests to fully document a condition and support a decision in case of legal scrutiny.
Surgeons may avoid operating on higher-risk patients. At the UCI Health Spine Center, we frequently receive patients to our academic referral center who our colleagues in the community avoid taking care of due to increased risks and a lack of associated increased reimbursement for the increased medical and legal issues. We are honored to help, but it is unfortunate that patients cannot get care in other settings due to the legal risk that may accompany patients with more medical co-morbidities or more challenging surgical cases.
Overall, current liability laws have a clear impact on surgical decision making and the availability of care, especially for the most challenging cases.
Pierce Nunley, MD. Spine Institute of Louisiana (Shreveport): Malpractice risks drive physicians to practice defensively, increasing care complexity and costs. This leads to ordering unnecessary tests, performing procedures prematurely, or avoiding certain treatments. Ultimately, eliminating defensive medicine would simplify patient care, reduce costs, and improve efficiencies and effectiveness.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): A physician’s responsibility/contract is to provide a ‘reasonable’ level of care, and a breach of that duty occurs when the responsible party fails to fulfill that duty through negligence, recklessness, or intentional misconduct. Delivering that level of reasonable surgical care should follow a standard of training and acceptable federal guideline to obviate injury, mishap or abandonment. Adjunct opinion through radiologic modality is supportive, coupled with comprehensive clinical oversight and patient consent are self-evident and imperative. Surgical decision making is clearly based on evidentiary formalization: signs, symptoms, radiological characterization and patient concurrence. The world we live and practice in, is heavily influenced by ‘reasonable’ oversight, which follows care models and expectations from peers and patients alike.
