Legal Liability Associated With rtPA Administration and Surrogate Decision Makers

Abstract

Stroke is one of the most common conditions neurologists treat in emergency situations. This article examines the issues of surrogate decision makers and the physician’s potential legal liability in the context of the administration or nonadministration of recombinant tissue plasminogen activator (rtPA) in a common emergency department scenario.

Tissue plasminogen activator and patients with acute ischemic stroke: The litigation landscape

“…The median age was 53 years, with an interquartile range of 44-68 years and a range of 26-102 years. Cases took place in 23 states, with New York State having the highest number ( 14), followed by California (9) and Florida (6) [Figure 2].…”

“…A number of factors can help the plaintiff or defendant prevail. 9 Factors favoring the defendant include documentation of contraindications (such as patient arrival outside time window); documentation of discussion with patient and/or family; existence of an acute stroke protocol in the hospital; documentation of reasons for delay, if applicable; lack of tPA in the hospital; and timely transfer to another hospital if appropriate. Factors favoring the plaintiff include delay in being seen by a physician; failure to diagnose stroke; failure to give tPA (if eligible); delay in giving tPA, and/or obtaining necessary studies such as computed tomography (CT) or bloodwork; and delay in transferring a tPA eligible patient to an appropriate center if tPA not available.…”

“…A number of factors can help the plaintiff or defendant prevail. 9 Not giving tPA for eligible patients is most often due to not recognizing that the patient is having a stroke, rather than the physician not offering it at all. Prehospital stroke recognition aids in expediting tPA administration, and rapid prehospital stroke triage is being explored across the country.…”