A Qualitative Analysis of Malpractice Litigation in Cardiology Using Case Summaries Through a National Legal Database Analysis

Abstract

IntroductionPhysicians are increasingly practicing defensive medicine as a response to society’s litigious climate. This study sought to characterize cardiology malpractice claims and elucidate the allegations underlying the use of defensive medicine.MethodsThe WestlawNext™ database was queried to obtain state and federal jury verdicts and settlements related to medical malpractice and cardiology that occurred in the United States between 2010 and 2015. Cardiology cases were identified using the search terms “medical malpractice” and “cardiology” and reviewed by two individuals utilizing available case documents. Duplicate and nonpertinent cases were excluded. Binary logistic regression models were created to predict the likelihood of defendant verdict, plaintiff verdict, and settlement based on the various reasons for litigation cited.ResultsInclusion criteria were met in 166 cases. The plaintiffs were predominantly male (94 cases; 56.6%), and the average patient age was 53.3±17.5 years. More than half of the cases involved a cardiologist as a defendant. The most common reasons for litigation were: failure to treat (129; 77.7%), failure to diagnose (115; 69.3%), failure to refer/order diagnostic tests (107; 64.5%), and patient death (118; 71.1%). Among cases tried for failure to diagnose, the most commonly missed diagnosis was myocardial infarction. Cases most commonly resulted in a defendant verdict (94; 56.6%). However, odds of a plaintiff verdict were significantly higher when failure to diagnose was alleged with an odds ratio (OR) of 7.60 (95% confidence interval 1.14 - 50.87, p = 0.0365).ConclusionsFailure to diagnose remains a commonly alleged base for litigation. In conclusion, our analysis suggests increased training for non-cardiologists in the recognition of the acute coronary syndrome and enhanced awareness of inherent biases among all physicians may facilitate reducing missed diagnoses.

How defensive medicine is defined in European medical literature: a systematic review

“…(6) The study includes data from Europe. *USA,11 12 14 76–145 New Zealand,74 75 146 147 China,148–150 Japan,151 152 Iran,153 Israel,154–160 Sudan,161 Canada,162 163 Australia,164 165 South Africa,166 Singapore,167 India,168 Hong Kong,169 Brazil170 and one study from both USA, Canada and South Africa 73…”

Review of Cardiac Malpractice Cases Involving a Trainee

“…While liability risks within cardiology and cardiac surgery have been well-documented, [3][4][5] little is known about liability involving trainees in these fields. Involvement of trainees has been studied in other specialties, 6 but there remains a dearth of information in cardiology and cardiovascular surgery.…”

“…Within cardiology, failure to diagnose is the most common reason for litigation. 5 Other commonly cited reasons for cardiac malpractice cases also include unnecessary studies and complications following angioplasty, postoperative bleeding, and infection. 3 Further insight to the commonalities, the pit-falls and the high-risk situations in training the future of cardiac care will both improve the care of patients but also the quality of future cardiologists and cardiac surgeons.…”