Legal Liability in Neurology: Navigating Malpractice and Regulatory Compliance

Abstract

This article provides a comprehensive examination of legal liability in neurology, encompassing both malpractice litigation and compliance with federal regulations. The article highlights how legal accountability hinges on adherence to the standard of care, the adequacy of informed consent, and accurate documentation of decision-making capacity. Special attention is given to legal and ethical challenges in treating vulnerable populations, including children, pregnant women, and cognitively impaired individuals, for whom neurologists must navigate consent, reporting mandates, and surrogate decision-making. The article also explores driving restrictions for individuals with epilepsy or dementia, where state-specific laws and evolving tort doctrines influence physician liability. The assessment of decision-making capacity and testamentary competency is addressed, emphasizing the role of the neurologist in legal proceedings and estate planning. Brain death determination is discussed as a particularly contentious area with significant implications for organ donation and family disputes. On the regulatory side, the article reviews key statutes such as HIPAA, the 21st Century Cures Act, the False Claims Act, and the Stark Law, identifying the implications for privacy, billing practices, and physician referral behavior. Risk management strategies are offered to help neurologists navigate legal uncertainty, strengthen patient relationships, and comply with federal mandates. This article aims to serve as both a practical guide and a legal primer for neurologists practicing in an increasingly litigious and regulated environment.

Keywords

medical malpractice - brain death - decision-making capacity

Publikationsverlauf

Artikel online veröffentlicht:
18. Juni 2025

• References

• 1 Johnston JC, Sartwelle TP. Medical malpractice and the neurologist: an introduction. Neurol Clin 2023; 41 (03) 485-491
• 2 Aaron DG, Robertson CT, King LP, Sage WM. A new legal standard for medical malpractice. JAMA 2025;2830847;
• 3 Kass JS, Rose RV. Interprofessional internet consultations: the potential benefits and perils of eConsults. Continuum (Minneap Minn) 2021; 27 (06) 1785-1789
• 4 LeFever D, Demand A, Kandregula S. et al. Status of current medicolegal reform in the United States: a neurosurgical perspective. Neurosurg Focus 2020; 49 (05) E5
• 5 Peters Jr PG. The quiet demise of deference to custom: malpractice law at the Millennium, 57 Wash. & Lee. Law Rev 2000; 57: 163
• 6 American Law Institute. . Restatement of the Law, Third, Torts: Medical Malpractice. ALI; 2024
• 7 Haslett JJ, Genadry L, Zhang X. et al. Systematic review of malpractice litigation in the diagnosis and treatment of acute stroke. Stroke 2019; 50 (10) 2858-2864
• 8 Appelbaum PS, Grisso T. Assessing patients' capacities to consent to treatment. N Engl J Med 1988; 319 (25) 1635-1638 Erratum in: N Engl J Med 1989;320(11):748
• 9 American Medical Association. Opinion 2.1.2, Decisions for adult patients who lack capacity. Code of Medical Ethics. Accessed February 15, 2025 at: www.ama-assn.org/system/files/2019–06/code-of-medical-ethicschapter-2.pdf
• 10 Sattin JA, Chiong W, Bonnie RJ, Kirschen MP, Russell JA. Ethics, Law, and Humanities Committee, a joint committee of the American Academy of Neurology, American Neurological Association, and Child Neurology Society. Consent issues in the management of acute ischemic stroke: AAN position statement. Neurology 2022; 98 (02) 73-79
• 11 Katz AL, Webb SA. Committee on Bioethics. Informed consent in decision-making in pediatric practice. Pediatrics 2016; 138 (02) e20161485
• 12 Raine SP. Legal and ethical issues in the neurology of reproductive health. Neurol Clin 2023; 41 (03) 533-541
• 13 Kass JS, Rose RV. Driving and epilepsy: ethical, legal, and health care policy challenges. Continuum (Minneap Minn) 2019; 25 (02) 537-542
• 14 Tran EM, Lee JE. Reporting requirements, confidentiality, and legal immunity for physicians who report medically impaired drivers. JAMA Netw Open 2024; 7 (01) e2350495
• 15 Tolchin B, Krauss GL, Spanaki MV. et al; Ethics, Law, and Humanities Committee, (a joint committee of the American Academy of Neurology [AAN], American Neurological Association [ANA], and Child Neurology Society [CNS]); and for the American Epilepsy Society and the Epilepsy Foundation of America. Seizures, driver licensure, and medical reporting update: an AAN position statement. Neurology 2025; 104 (07) e213459
• 16 Praesel v Johnson,. 967 S.W.2d 391 (Tex. 1998)
• 17 Tarasoff v. Regents of the University of California,. 17 Cal. 3d 425, 551 P.2d 334, 131 Cal. Rptr. 14 (Cal. 1976)
• 18 Duvall v Goldin, 749 N.W.2d 137 (Mich. 2003)
• 19 Iverson DJ, Gronseth GS, Reger MA, Classen S, Dubinsky RM, Rizzo M. Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter update: evaluation and management of driving risk in dementia: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2010; 74 (16) 1316-1324
• 20 Voskou P, Douzenis A, Economou A, Papageorgiou SG. Testamentary capacity assessment: legal, medical, and neuropsychological issues. J Geriatr Psychiatry Neurol 2018; 31 (01) 3-12
• 21 Shulman KI, Peisah C, Jacoby R, Heinik J, Finkel S. Contemporaneous assessment of testamentary capacity. Int Psychogeriatr 2009; 21 (03) 433-439
• 22 Herrmann N, Whaley KA, Herbert DJ, Shulman KI. Susceptibility to undue influence: the role of the medical expert in estate litigation. Can J Psychiatry 2022; 67 (01) 5-12
• 23 Greer DM, Kirschen MP, Lewis A. et al. Pediatric and adult brain death/death by neurologic criteria consensus guideline. Neurology 2023; 101 (24) 1112-1132 Erratum in: Neurology 2024;102(3):e208108
• 24 President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Defining death: medical, legal and ethical issues in the determination of death,. Washington, DC: 1981
• 25 Greer DM. Determination of brain death. N Engl J Med 2021; 385 (27) 2554-2561
• 26 Lewis A. The uniform determination of death act is being revised. Neurocrit Care 2022; 36 (02) 335-338
• 27 Lewis A. The quest to revise the uniform determination of death act: why we tried, why we failed, and where we go from here. Neurocrit Care 2024; 41 (02) 339-344
• 28 Omelianchuk A, Bernat J, Caplan A. et al. Revise the uniform determination of death act to align the law with practice through neurorespiratory criteria. Neurology 2022; 98 (13) 532-536 Erratum in: Neurology. 2023;100(10):496
• 29 NJ Rev Stat § 26. :6A–5 (2024)
• 30 10 N.Y.C.R.R. §400.16(e)(3) (2008)
• 31 Health Insurance Portability and Accountability Act of 1996,. Pub. L. No. 104–191, 110 Stat. 1936. (1996)
• 32 21st Century Cures Act, Pub. L. No. 114–255, 130 Stat. 1033 (2016).
• 33 Standards for Privacy of Individually Identifiable Health Information,. 45 C.F.R. §§ 160, 164 (2024).
• 34 Gostin LO. National health information privacy: regulations under the Health Insurance Portability and Accountability Act. JAMA 2001; 285 (23) 3015-3021
• 35 Rose RV, Kumar A, Kass JS. Protecting privacy: health insurance portability and accountability act of 1996, twenty-first century cures act, and social media. Neurol Clin 2023; 41 (03) 513-522
• 36 U.S. Department of Health and Human Services. 21st Century Cures Act. Public Law 2016; 114-255
• 37 False Claims Amendments Act of 1986, Pub L No. 99–562,. 100 Stat 3153, codified as amended at 31 USC §§ 3729-3733
• 38 Rose RV, Kass JS. False Claims Act and Anti-Kickback Statute: avoiding legal landmines. Neurol Clin 2023; 41 (03) 523-531
• 39 Medicare and Medicaid Patient and Program Protection Act of 1987,. Pub L No. 100–93, 101 Stat 680, codified at 42 USC § 1320a-7b(b)
• 40 Satiani B. Anti-kickback laws and safe harbor protections: brief review for surgeons. Ann Vasc Surg 2003; 17 (06) 693-696
• 41 42 USC § 1395nn (2024)
• 42 Krause JH. Kickbacks, self-referrals, and false claims: the hazy boundaries of health-care fraud. Chest 2013; 144 (03) 1045-1050
• 43 Satiani B. Exceptions to the Stark law: practical considerations for surgeons. Plast Reconstr Surg 2006; 117 (03) 1012-1022 , discussion 1023