In this chapter we address medico-legal issues that impact practicing neonatologists. While clinicians often mistrust the legal system in general, it is important for them to have basic knowledge of legal concepts. General legal principles are explained, including an overview of the United States Government and the role of both Federal and State Governments. The chapter then discusses medical malpractice, including the requirement that a plaintiff patient prove, by a preponderance of the evidence, that the defendant physician: 1. Owed a duty of care to the patient 2. Breached that duty by failing to meet the standard of care 3. Caused injury through that breach of duty 4. Which then led to compensable damages. There is concern that a difficult malpractice environment for physicians leads to decreased access to care as well as the practice of defensive medicine. Various States have attempted malpractice reforms in a number of ways, including placing caps on non-economic damages. These measures, however, have less impact on neonatologists, due to the fact that injured neonates often have very high lifetime costs of care which are not covered by the caps. It is important for neonatologists to work to improve patient safety by encouraging a ‘culture of safety’ where the focus is on working together to unmask, study, and fix safety problems that can potentially harm patients.