Common Reasons for Malpractice Lawsuits Involving Pulmonary Embolism and Deep Vein Thrombosis

• Published in: The Journal of surgical research 2020-01, Vol.245, p.212-216
• Main Authors: Wilson, Eelin, Phair, John, Carnevale, Matthew, Koleilat, Issam
• Format: Article
• Language: English
• Subjects: Anticoagulants - therapeutic use; Databases, Factual - statistics & numerical data; Delayed Diagnosis - economics; Delayed Diagnosis - legislation & jurisprudence; Delayed Diagnosis - statistics & numerical data; DVT; Failure to Rescue, Health Care - economics; Failure to Rescue, Health Care - legislation & jurisprudence; Failure to Rescue, Health Care - statistics & numerical data; Humans; Informed Consent - legislation & jurisprudence; Informed Consent - statistics & numerical data; Lawsuits; Litigation; Malpractice; Malpractice - economics; Malpractice - statistics & numerical data; Physicians - economics; Physicians - legislation & jurisprudence; Physicians - statistics & numerical data; Pulmonary Embolism - diagnosis; Pulmonary Embolism - etiology; Pulmonary Embolism - mortality; Pulmonary Embolism - therapy; United States - epidemiology; Venous Thrombosis - diagnosis; Venous Thrombosis - etiology; Venous Thrombosis - mortality; Venous Thrombosis - therapy; VTE
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2019.07.079

Pulmonary embolism and deep vein thrombosis are common clinical entities, and the related malpractice suits affect all medical subspecialties. Claims from malpractice litigation were analyzed to understand the demographics of these lawsuits and the common reasons for pursuing litigation. Cases entered into the Westlaw database from March 5, 1987, to May 31, 2018, were reviewed. Search terms included “pulmonary embolism” and “deep vein thrombosis.” A total of 277 cases were identified. The most frequently identified defendant was an internist (including family practitioner; 33%), followed by an emergency physician (18%), an orthopedic surgeon (16%), and an obstetrician/gynecologist (9%). The most common etiology for pulmonary embolism was prior surgery (41%). The most common allegation was “failure to diagnose and treat” in 62%. Other negligence included the failure to administer prophylactic anticoagulation while in the hospital (18%), failure to prescribe anticoagulation on discharge (8%), failure to administer anticoagulation after diagnosis (8%), and premature discontinuation of anticoagulation (2%). The most frequently claimed injury was death in 222 cases (80%). Verdicts were found for the defendant in 57% of cases and for the plaintiff in 27% and settled in 16%. The most frequently cited negligent act was the failure to give prophylactic anticoagulation, even after discharge. The trends noted in this study may potentially be addressed and therefore prevented by systems-based practice changes. The most common allegation, “failure to diagnose and treat,” suggests that first-contact doctors such as emergency physicians and primary care practitioners must maintain a high index of suspicion for deep vein thrombosis/pulmonary embolism.