Medical malpractice in the endovascular era: Has the standard of care changed?

An Analysis of Malpractice Litigation of Vascular Surgeons in Cases Involving Aortic Pathologies

OBJECTIVE

The aim of this study was to analyze malpractice claims for aortic pathologies and to assess if there has been a change in rate of malpractice lawsuits with evolution of endovascular therapy.

METHODS

Malpractice lawsuits were individually screened and compiled from the Westlaw database from 2000 to 2017 through use of relevant search terms. Data were collected of allegations, diagnoses, and outcomes of each case and compared.

RESULTS

268 unique cases were included in this study, with aneurysms (54%, n = 145) and dissection (35%, n = 94) making up the majority. There was a defendant verdict in 53% (n = 141), plaintiff verdict in 24% (n = 65), and settlements in 23% (n = 62) of lawsuits. Litigation was higher in the Midwest and Northeast. There was a gradual decline in litigation overall, however endovascular case numbers remained constant. There was negligible difference in the primary allegation underlying the litigation for various aortic pathologies, time to litigation and award between open and endovascular procedures.

CONCLUSION

The proportion of litigation for clinical negligence in endovascular cases amongst all vascular surgical lawsuits is increasing. As novel methods of endovascular therapy emerge, it is imperative that physicians remain vigilant to legal considerations to minimize malpractice risk.

Review of Malpractice Lawsuits in the Diagnosis and Management of Aortic Aneurysms and Aortic Dissections

OBJECTIVE

Aortic aneurysms and dissections are prevalent causes of morbidity and mortality. The management of aortic pathologies may be called into question in malpractice suits. Malpractice claims were analyzed to understand common reasons for litigation, medical specialties involved, patient injuries, and outcomes.

METHODS

Litigation cases in the Westlaw database from September 1st, 1987 to October 23 rd, 2019 were analyzed. Search terms included "aortic aneurysm" and "aortic dissection." Data on plaintiff, defendant, litigation claims, patient injuries, misdiagnoses, and case outcomes were collected and compared for aortic aneurysms, aortic dissections, and overall cases.

RESULTS

A total of 346 cases were identified, 196 involving aortic aneurysms and 150 aortic dissections. Physician defendants were emergency medicine (29%), cardiology (20%), internal medicine (14%), radiology (11%), cardiothoracic (10%) and vascular surgery (10%). Litigation claims included "failure to diagnose and treat" (61%), "delayed diagnosis and treatment" (21%), "post-operative complications after open repair" (10%) and "negligent post-operative care" (10%). Patients with aneurysms presented with abdominal (63%) and back pain (37%), while dissections presented with chest pain (78%), abdominal pain (15%), and shortness of breath (14%). Misdiagnoses included gastrointestinal (12%), other cardiovascular (9%), and musculoskeletal conditions (9%), but many were not specified (58%). Overall, 83% of cases were wrongful death suits. Injuries included loss of consortium (23%), emotional distress (19%), and bleeding (17%). In 53% of the cases, the jury ruled in favor of the defendant. 25% of cases ruled for the plaintiff. 22% of cases resulted in a settlement. The mean rewarded for each case was $1,644,590.66 (SD: $5,939,134.58; Range: $17,500-$68,035,462).

CONCLUSION

For aortic pathologies, post-operative complications were not prominent among the reasons why suits were brought forth. This suggests improvements in education across all involved medical specialties may allow for improved diagnostic accuracy and efficient treatment, which could then translate to a decrease in associated litigation cases.

A single-institution experience of hand surgery litigation in a major replantation center

BACKGROUND

Bellevue Hospital Medical Center is a level 1 trauma center in New York and a major referral center for complex hand injuries and amputations. These injuries typically occur at the workplace and are thought to be highly litiginous in nature. This study was conducted to analyze the cases involving hand surgery litigation related to trauma over the last 8 years at this institution.

METHODS

The authors performed a retrospective chart review of all claims filed against Bellevue Hospital Medical Center after treatment for a hand injury during 2001 to 2009. Twenty-three patients in total were identified and reviewed for age, mechanism/type of injury, complications, decision to replant, average time after injury to post claim, and whether settlement was obtained.

RESULTS

One of 23 patients who filed suit against Bellevue Hospital Medical Center received a successful settlement involving an incident surrounding the loss of a nonreplantable part. Of 168 patients in whom 219 replantations/revascularizations were performed, five patients filed claims, all surrounding a failed attempt. In total, there were seven complications: five failed replants, one failed thenar flap, and one patient who needed a revision completion amputation.

CONCLUSIONS

The majority of the patients who filed claims did so because of the decision not to replant. Only 2.98 percent (five of 168) of all attempted revascularization/replantation patients filed claims against the authors' institution; all claims were notably dropped. The legal system appears to support physicians and institutions that treat these complex injuries. Better patient understanding of the decision-making process and complications involving treatment of traumatic hand injuries may decrease the number of future lawsuits.