A Review of Lawsuits Related to Point-of-Care Emergency Ultrasound Applications

Abstract

IntroductionNew medical technology brings the potential of lawsuits related to the usage of that new technology. In recent years the use of point-of-care (POC) ultrasound has increased rapidly in the emergency department (ED). POC ultrasound creates potential legal risk to an emergency physician (EP) either using or not using this tool. The aim of this study was to quantify and characterize reported decisions in lawsuits related to EPs performing POC ultrasound.MethodsWe conducted a retrospective review of all United States reported state and federal cases in the Westlaw database. We assessed the full text of reported cases between January 2008 and December 2012. EPs with emergency ultrasound fellowship training reviewed the full text of each case. Cases were included if an EP was named, the patient encounter was in the emergency department, the interpretation or failure to perform an ultrasound was a central issue and the application was within the American College of Emergency Physician (ACEP) ultrasound core applications. In order to assess deferred risk, cases that involved ultrasound examinations that could have been performed by an EP but were deferred to radiology were included.ResultsWe identified five cases. All reported decisions alleged a failure to perform an ultrasound study or a failure to perform it in a timely manner. All studies were within the scope of emergency medicine and were ACEP emergency ultrasound core applications. A majority of cases (n=4) resulted in a patient death. There were no reported cases of failure to interpret or misdiagnoses.ConclusionIn a five-year period from January 2008 through December 2012, five malpractice cases involving EPs and ultrasound examinations that are ACEP core emergency ultrasound applications were documented in the Westlaw database. All cases were related to failure to perform an ultrasound study or failure to perform a study in a timely manner and none involved failure to interpret or misdiagnosis when using of POC ultrasound.

Focused Cardiac Ultrasonography: Current Applications and Future Directions

“…82 The interesting alternative situation is that lawsuits have been filed for failure to perform point-of-care ultrasonography in cases of diagnostic uncertainty. [83][84][85] A review of all reported US state and federal cases from 2008-2012 found 5 appropriate cases involving emergency physicians and point-of-care ultrasonography. All 5 cases alleged a failure to perform timely ultrasonography within the physician's scope of practice, resulting in morbidity or death.…”

Barriers to point-of-care ultrasound use in rural emergency departments

“…23,24 Interestingly, two studies spanning over 25 years of American legal cases did not report a single case against an emergency physician who failed to interpret or made a misdiagnosis using PoCUS but did report six successful cases against physicians who failed to perform PoCUS when it was within their scope of practice, leading to the delayed diagnoses and patient demise. 25,26 Although it is inevitable that a physician error will eventually occur with the use of ultrasound by inexperienced physicians, it is also clear that the benefits seem to greatly outweigh the purported harm. Physicians are encouraged to use PoCUS with the standards set by CEUS, CAEP, and other local associations to minimize the risk of error.…”

In defence of teaching point-of-care ultrasound in undergraduate medical education

“…To date, all state and federal court litigation cases involving POCUS involved the failure to perform POCUS or failure to perform it in a timely manner. 3 Acknowledged also by the authors of the review, large-scale RCT data are unlikely to be forthcoming. 2 Evidence supports that FAST has a high specificity.…”