Medicolegal Aspects of Neurosurgery in India: A Narrative Review.

Neurosurgery is a surgical specialty that routinely deals with life-threatening pathology that has a narrow therapeutic window and a margin of error. These clinical realities, with most emergencies being medico-legal cases, often expose neurosurgical practice to medico-legal scrutiny. Adequate literature is available on medicolegal aspects of neurosurgery from other countries such as North America, Australia, and Europe. However, literature on medicolegal issues of neurosurgery in India is relatively sparse and fragmented. Here, we attempt to review the medico-legal aspects of neurosurgery in India in the light of existing legal judgments from Indian courts. An online search using the keywords "Medical," "Negligence," "Neurosurgeon," "Neurosurgery in India," and their combination was conducted. We found five journal articles available through PubMed using these keywords. Court judgments were screened using the same keywords on Indian legal websites, including Indian Kanoon, AIROnline, and SCC Online[44-46]. After analyzing all the available medicolegal cases through legal websites, we have included 32 cases in this article for discussion. In our study, we found that the doctor was found guilty of negligence in 13 cases (40.6%), while 19 appeals were dismissed (59.4%). The proportion of established medical negligence among cranial cases was found to be 46.7% (seven out of 15), while it was 35.3% (six out of 17) in spinal cases, having a p-value of 0.55. After analyzing the details of all cases, postoperative complications were found to be the major cause for litigation. Lack of adequate informed consent and communication was another common cause. Neurosurgery is complex and is highly risky; it remains highly vulnerable to medicolegal scrutiny. Strengthening documentation, informed consent, perioperative protocols, and knowledge of medicolegal aspects and their application can save medical professionals from litigation. As per the available literature, this appears to be the first comprehensive review focusing on medicolegal aspects of neurosurgery in India.