Neurological negligence claims in the NHS from 1995 to 2005

The objective of this study was to review available data on negligence claims for neurological disease treated by National Health Service (NHS) clinicians in England and Wales. The study design was a retrospective review of the NHS Litigation Authority (NHSLA) database, which holds data on negligence claims against NHS clinicians from 1995 to 2005. This database was searched to retrieve abstracts of claims concerning neurological disease treated by clinicians of all specialties. Abstracts were systematically reviewed to extract the following information: specialty of clinician, pathology involved, misadventure, patient injury and value of claim. A complete data set was available for 559 cases. The chi-squared test was used to investigate differences in negligence claims between neurologists/neurosurgeons and non-specialists. The specialty most frequently cited was neurosurgery (241) followed by neurology (172). Non-neurologists and non-neurosurgeons were the defendant in 146 cases, predominantly general physicians (42), orthopaedic surgeons (39) and emergency physicians (33). The most common pathologies were intervertebral disc disease (27%), CNS tumours (21%), CNS infection (11%) and subarachnoid haemorrhage (9%). The most frequent misadventure was diagnostic error (44%). In 47% of cases major permanent injury (e.g. blindness, hemiplegia) resulted from the misadventure. The patient died in 17% of cases. The total cost for all closed claims was 37 million pounds (2% of expenditure on claims for medical and surgical specialites over 1995 to 2005). This is the first systematic study of negligence claims for the treatment of neurological disorders in the UK. The prominence of diagnostic error highlights the need for early assessment by neurologists and prompt use of neuroimaging during the acute phase.