Dive into cardiology liability claims reveals common mistakes

If you want to avoid damaging litigation, concentrate on dialogue and details. Cardiologists who fail to maintain detailed, two-way conversations with patients and thoroughly assess diagnostic data are at risk of negligence lawsuits, a study shows.

The Doctors Company reviewed 429 cardiology liability claims that closed between 2007 and 2013 to paint a portrait of cardiologists’ vulnerabilities—and arm cardiologists with the information needed to potentially avoid lawsuits.

By illustrating where colleagues have had system failures, the report, “Cardiology Closed Claims Study,” can raise awareness of potential problems for cardiologists, one of the authors, Darrell Ranum, JD, told Cardiovascular Business. Ranum is vice president for patient safety at The Doctors Company.

Complaints related to missed or overlooked incidental findings are the most common patient allegations of negligence, Ranum said. Sometimes, cardiologists scan radiologists’ and other specialists’ reports simply for the results they requested. When they get that answer, they stop reading.

But the incidental findings are often buried lower in the report, leading cardiologists to miss a medical concern that should be followed up on either by referral or by letting the patient know about the concern, Ranum said.

"Cardiologists sometimes failed to establish a differential diagnosis or to use clinical information available to them that should have prompted further investigation," Ranum and co-author David Troxel, MD, The Doctors Company’s medical director, wrote in the report.

"It's one of those subtle things that doesn't happen very often, but it does happen," Ranum said.

Cardiologists have to be mindful of reading the whole report, Ranum said, and radiologists are starting to put the most important information at the top of their reports.

Building a good rapport with patients also can help. "It's important patients fully think the cardiologist is looking out for their best interests,” Ranum said. “Patients are hesitant to bring claims against a physician they trust and like."

Cardiologists need to give patients time to ask questions and talk to them thoroughly about potential complications. If there are complications, they need to take the time to fully explain to the patient and family exactly what happened and the care that will be provided to deal with the problem.

If that detailed presurgery discussion has taken place, the cardiologist might need to go back and connect the dots between what happened and what had been said during the informed consent discussion.

"If patients have clearly been informed about what they should expect, they will see that a complication is not a negligence," Ranum said.

Doing a thorough assessment and documenting that process is important. Patient-assessment issues, including failure or delay in ordering diagnostic tests and in establishing a differential diagnosis, was the most common patient allegation in the reviewed cases.

"If the physician can show that they worked their way through a different diagnosis, it's hard to claim negligence," Ranum said.

Over the past 10 to 12 years, lawsuits against physicians have decreased significantly, Ranum said. There's no established reason for the decrease, but Ranum attributes it to improved quality of care and a push to be more open and transparent when a complication does occur. That shift started in about 2000, he said.

Before, too many patients felt they were being abandoned by the hospital when there was a complication, and their response was to hire an attorney. Now, coinciding with improved communication, those numbers had dropped.

However, a January 2012 report from the U.S. Department of Health and Human Services found that in only 14 percent of cases did hospital staff report treatment errors or other mistakes. That was partly because of staff misperceptions about what constitutes patient harm, the report stated.