Medico-Legal Issues in Cardiology

Abbott, Ryan; Cohen, Morris

doi:10.1097/crd.0b013e31828af110

Cited by 12 publications

(7 citation statements)

References 30 publications

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“…Finally, myocardial IRI is a critical issue also for forensic pathologists since sudden death may occur despite timely reperfusion following AMI, that is one of the most frequently litigated areas of cardiology practice [ 26 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

Ischemia/Reperfusion Injury following Acute Myocardial Infarction: A Critical Issue for Clinicians and Forensic Pathologists

Neri

Riezzo

Pascale

et al. 2017

Mediators of Inflammation

303

232

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Acute myocardial infarction (AMI) is a leading cause of morbidity and mortality. Reperfusion strategies are the current standard therapy for AMI. However, they may result in paradoxical cardiomyocyte dysfunction, known as ischemic reperfusion injury (IRI). Different forms of IRI are recognized, of which only the first two are reversible: reperfusion-induced arrhythmias, myocardial stunning, microvascular obstruction, and lethal myocardial reperfusion injury. Sudden death is the most common pattern for ischemia-induced lethal ventricular arrhythmias during AMI. The exact mechanisms of IRI are not fully known. Molecular, cellular, and tissue alterations such as cell death, inflammation, neurohumoral activation, and oxidative stress are considered to be of paramount importance in IRI. However, comprehension of the exact pathophysiological mechanisms remains a challenge for clinicians. Furthermore, myocardial IRI is a critical issue also for forensic pathologists since sudden death may occur despite timely reperfusion following AMI, that is one of the most frequently litigated areas of cardiology practice. In this paper we explore the literature regarding the pathophysiology of myocardial IRI, focusing on the possible role of the calpain system, oxidative-nitrosative stress, and matrix metalloproteinases and aiming to foster knowledge of IRI pathophysiology also in terms of medicolegal understanding of sudden deaths following AMI.

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Section: Introductionmentioning

confidence: 99%

Ischemia/Reperfusion Injury following Acute Myocardial Infarction: A Critical Issue for Clinicians and Forensic Pathologists

Neri

Riezzo

Pascale

et al. 2017

Mediators of Inflammation

303

232

View full text Add to dashboard Cite

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“…Our study is not the first to ascertain that missed diagnoses of myocardial infarction are at the crux of much of cardiology malpractice litigation [19]. A 2017 retrospective analysis of malpractice claims involving myocardial infarction found that misdiagnosis was the most common claim.…”

Section: Discussionmentioning

confidence: 98%

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

Patel

Rynecki

Eidelman

et al. 2019

Cureus

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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.

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“…When a medical malpractice suit is brought to court, the plaintiff has the burden of proving that the defendant breached his or her duty to provide patient care by departing from the current acceptable standards; thus, this study reflects, through case outcomes, the widely perceived and accepted standards of care within cardiothoracic surgery at present. One example lies in the perceived communication expectations between cardiothoracic surgeons and anesthesiologists or perfusionists during cases.…”

Section: Discussionmentioning

confidence: 99%

“…A number of cases related to cardiac surgical malpractice were likely not included, and selection biases may exist in terms of various aspects of case content, such as geographical location, plaintiff characteristics, or practice setting. However, although it could be anticipated that the attorney on the opposing end of the Jury's ruling in a case would be deincentivized to report it to a public database, the attorney on the victorious end would be equally as incentivized to use the verdict as a personal marketing tool, so the selection biases in each direction may ultimately cancel out one another.…”

Section: Discussionmentioning

confidence: 99%

Malpractice litigation in cardiac surgery: Alleged injury mechanisms and outcomes

Eltorai

2019

J Card Surg

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Background and Aim The feared prospect of involvement in malpractice litigation ultimately becomes a reality for many physicians in high‐risk specialties such as cardiothoracic surgery. This study systematically analyzes malpractice claims by procedure type and alleged injury mechanism. Methods An extensive nation‐wide database of medical malpractice claims was searched, and 140 involving cardiac procedures were identified. The primary reason for the lawsuit was classified as a periprocedural injury, postoperative mismanagement, failure to operate in a timely manner or at all, performing an unnecessary procedure, performing a procedure too soon, lack of informed consent, or patient abandonment. Results Cardiac surgeons were defendants in 47.8% of cases and cardiologists in 56.4%. Forty percent of cases involved coronary artery bypass grafting, valvular surgery, or both; 50% of these received defendant verdicts. The most common reason for the lawsuit was periprocedural injury, most frequently due to poor prosthetic valve fit/securement (23.1%) or surgical site infection (15.4%). For congenital cases, most lawsuits alleged periprocedural injury, with perfusion‐related issues (cooling during circulatory arrest, failure to inform surgeon about poor oxygenation) cited in 37.5%. Cardiologists and cardiothoracic or vascular surgeons were codefendants in 14.3% of cases, most commonly coronary artery bypass grafting (40%) or cardiac catheterizations (25%). In all catheterization cases, the allegation against the surgeon was a failure to diagnose/treat the complication in a proper or timely manner. In postoperative mismanagement cases, bleeding/tamponade was the most common allegation category (31.8%). Conclusions A careful review of cardiac surgical malpractice litigation can identify common contributory factors to adverse patient outcomes and catalyze practice improvement.

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Medico-Legal Issues in Cardiology

Cited by 12 publications

References 30 publications

Ischemia/Reperfusion Injury following Acute Myocardial Infarction: A Critical Issue for Clinicians and Forensic Pathologists

Ischemia/Reperfusion Injury following Acute Myocardial Infarction: A Critical Issue for Clinicians and Forensic Pathologists

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

Malpractice litigation in cardiac surgery: Alleged injury mechanisms and outcomes

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