Malpractice litigation is a risk that’s inherent to acute stroke care, Mount Sinai researchers reported in Stroke this month—and while just over half of cases get resolved, the remainder can cost medical centers millions in payouts.
For their review, published Aug. 19, Jack J. Haslett, BSc, and colleagues at the Icahn School of Medicine at Mount Sinai in New York scrutinized three large legal databases in the U.S., searching for jury verdicts and settlements in cases related to acute stroke care. Medical malpractice lawsuits are a concern for any doctor, Haslett and co-authors wrote, but it’s been estimated that up to 99% of physicians in high-risk specialties—including neurosurgery, cardiovascular and thoracic surgery and general surgery—will face a malpractice claim by the time they’re 65.
For neurosurgeons in particular, that risk was hiked in 2015 alongside the acceptance of thrombectomy as a standard therapy to treat emergent large vessel occlusion (ELVO).
“This sudden change in the standard of care requires reorganization in the way these patients are triaged and managed acutely, which may lag behind the new treatment guidelines,” Haslett and colleagues wrote, noting thrombectomy requires expertise “beyond that available at many hospitals” and changes in care patterns are likely to be reflected in future litigation.
Using “stroke” and “medical malpractice” as search terms, Haslett et al. identified 246 malpractice cases related to the acute management of ischemic stroke and 26 related to intracranial hemorrhage. Seventy-one cases specifically alleged a failure to treat with tissue-type plasminogen activator (tPA), while another seven cases alleged a failure to treat, or timely treat, with thrombectomy.
The authors said the majority of cases (56%) ended with no payout, but the remainder cost some centers dearly. Twenty-seven percent of cases were settled out of court, averaging payouts of $1,802,693, and 17% went to court and resulted in a verdict. The mean payout in plaintiff verdicts was a colossal $9,705,099.
According to the study, half of cases included both a doctor and hospital as defendants; 30% and 20%, respectively, involved only a doctor or a hospital as the defendant. Emergency department physicians were most likely to be sued (33%), followed by primary care physicians or family doctors (27%), neurologists (17%), neurosurgeons (9%) and radiologists (4%).
“Even doctors not routinely involved with acute stroke patients can have patients suffering strokes present to them and can be found negligent for their subsequent care,” Haslett and co-authors wrote.
The team said physicians can help protect themselves against litigation by ensuring timely patient referral to a neurologist or other appropriate specialist, as well as administering tPA in a timely manner.
“Failure to administer tPA is a prevalent allegation in stroke medical malpractice,” Haslett et al. said. “Allegations of a failure to timely transfer a patient and a failure to timely perform thrombectomy were also seen in this analysis, and it is anticipated that cases with these allegations will increase in frequency in the coming years.”