Getting to the Heart of Why Cardiologists Get Sued
Updated: Mar 5, 2019
As American Heart Month draws to a close, what a better opportunity to look at the primary reasons underlying medical malpractice suits against cardiologists, who face a slightly higher than average rate of malpractice claims than other types of physicians.
Heart disease is the leading cause of death for men and women in the United States, and, according to the American Heart Association, 1 in 4 deaths is caused by heart disease. Genetic factors often do play a part in cardiovascular disease incidence, but it can often be prevented. In November 2018, the American Heart Association and the American College of Cardiology released revised cholesterol guidelines. High cholesterol leads to hardened arteries that in turn can cause a heart attack or stroke. The last iteration of these guidelines five years ago began moving away from using solely cholesterol numbers to determine who needs treatment and towards a formula that considers age, high blood pressure and other factors to more broadly estimate risk, but were not clear and often led to more treatment confusion than clarity. The new guidelines instead provide for more personalized patient care and set clear treatment targets based on individual circumstances and include other medical conditions, family history of heart disease, as well as traditional factors of age and high blood pressure.
A 2014 study analyzing claims during the period of 1991 - 2005 found that the cost to defend a cardiologist in a medical malpractice claim totaled around $83,593; in comparison, the cost for defending an ophthalmology claim, the least expensive specialty to defend, clocked in around $20,000. The litigation cost discrepancy is likely due in large part to the fact that Cardiologists are unique in the medical malpractice arena because of the diverse type of patient interactions in which they engage and wide scope of treatments and procedures they perform.
A study of 429 closed cardiology malpractice claims between 2007 and 2013 by The Doctors Company, the nation’s largest physician-owned medical malpractice insurer, revealed the most common patient allegations in these claims and the most common factors that contribute to patient injury. According to the study, diagnostic-related issues are the main reason cardiologists are sued and the top cause of patient injury.
The most frequent type of malpractice claim in The Doctors Company study was alleged failure to diagnose, delay in diagnosis or wrong diagnosis, comprising 25% of all malpractice claims. The other top allegations included improper management of treatment, improper performance of treatment/procedure/surgery, and improper medication management. A more recent 2017 Medscape Cardiology Malpractice Report reveals similarly that complications from treatment/surgery (36%), wrongful death (25%), and failure to treat/diagnose (41%) are the most common reasons for malpractice claims.
New data shows that while myocardial infarctions are sometimes misdiagnosed by cardiologists (and more frequently by physicians without cardiac training), cardiologists are more likely to misdiagnose non-cardiac diagnoses with symptomatologies that present similarly to cardiac ailments, such as pulmonary embolism or cancer.
With respect to patient injuries, The Doctors Company study indicated that the top factors contributing to patient injury were:
issues with patient assessment, including failure to establish a differential diagnosis (25%);
technical performance, including injuries that were known complications (21%);
patient factors, including patient non-adherence with the treatment plan (20%);
selection and management of therapy, including inappropriate surgical procedure (18%);
communication among providers, including failure to review the medical record (15%); and
communication between patient/family and provider, including inadequate patient education on the risks of medications (14%).
Eliminating all risk of lawsuits is impossible, but there are strategies that providers can take to minimize these risks:
With respect to improper management of treatment, for example, one way physicians can seek to minimize their risk of these types of claims would be to set standardized processes of care in their practices, such as:
adopting standardized hand-off forms for patient care transfers among physicians,
implementing protocols for following up on test results to ensure results are timely reviewed and acted upon if warranted, and
ensuring all providers are capturing all information into electronic medical records.
Of course, discussing all known and potential risks of any treatment procedures is necessary prior to performance of the procedure/surgery, but it is equally important to consider any related complications that occur; the handling of the complication, rather than the occurrence of the complication itself, is more often what leads a patient to file a claim. Practitioners would be wise to:
not hesitate to involve other specialists to consult for issues or complications that arise,
document all suspicions and treatments, and
have open lines of communication with the patient, the patient's family and any other treatment providers also involved as complications, proposed solutions, and treatment occurs.
Practitioners must be well versed in the potential and common complications of the procedures they perform, and be aware that failure to quickly act when a known complication does arise, e.g., failure to order a CT scan to evaluate a possible retroperitoneal bleed, may have the effect of turning a routine and common complication into a lawsuit.
For cardiologists especially, there needs to be careful attention paid to potential complications arising from prescription medications. Medication-based claims are almost exclusively related to bleeding complications often arising from the use of anticoagulants. Additionally, the potentially significant lung- and liver- side effects from amiodarone cannot be ignored; similarly, the use of Warfarin, which has a narrow therapeutic window, yet is effective at decreasing a patient's stroke risk, and can also cause severe bleeding, can create liability problems for cardiologists.
Interestingly, cardiologists who were involved in litigation most often reported after going through the litigation process that their 'take aways' from the process was to take steps to (1) improve their chart documentation and (2) spend more time with the patient and his/her family in an effort to avoid the occurrence of the lawsuit at all.
Please contact Christina Mott Hesse at 208.336.9777 or firstname.lastname@example.org if you would like any additional information about this topic.