Adult: Professional Affairs
Medical malpractice litigations involving aortic dissection

https://doi.org/10.1016/j.jtcvs.2020.10.064Get rights and content

Abstract

Objectives

Medical malpractice litigation arises when a discrepancy exists between a patient's expectation of acceptable medical care and the care the patient receives. Aortic dissection is a frequently misdiagnosed and often-fatal condition. The purpose of this study was to characterize trends of medical malpractice litigations arising from aortic dissection, investigate the etiology, and analyze predictive factors regarding the verdict.

Methods

The Westlaw legal database was used to compile relevant litigations from 1994 to 2019 across the United States. Each litigation was screened individually for inclusion, and after inclusion, descriptive factors were compiled, including patient data, litigation data, verdict data, and clinical outcomes data. The Fisher exact test was used to evaluate the significance of association between parameters and verdict type.

Results

In total, 135 unique litigations met criteria for inclusion, with a defendant verdict in 57% (n = 77), plaintiff verdict in 20% (n = 27), and settlements in 23% (n = 31). Plaintiffs most commonly cited a failure to diagnose as their reason for litigation in 64% (n = 87). Patient mortality was associated with a lower average plaintiff award, $1,892,781 versus $5,944,983, and a lower average settlement, $1,230,923 versus $2,250,000, than their surviving counterparts. California, Illinois, and Pennsylvania had the most cases filed. An alleged failure to test, failure to refer, failure to consult, incidence of a stroke, and incidence of an autopsy diagnosis were significantly associated with defendant verdicts and a failure to diagnose was significantly associated with plaintiff verdicts (P < .05).

Conclusions

Plaintiffs frequently cited a failure to timely diagnose, order diagnostic tests, and interpret diagnostic tests as reasons for litigations. Defendant verdicts were common, suggesting judicially acceptable standards of care are commonly satisfied.

Section snippets

Search Methodology

The online Westlaw legal research service (Thomson Reuters, Eagan, Minn) was used to compile medical malpractice litigations involving aortic dissection. Westlaw consists of more than 40,000 online legal databases, with judicial documents including court rulings, dockets, verdict summaries, appellate court documents, trial court memoranda, appellate decisions, settlement summaries, pretrial statements, and legal commentaries. Both US federal court and state court documents are accessible in the

Search Results

The Westlaw database search with the term “aortic/s dissection” resulted in 184 litigations. Of these litigations, 29 litigations were duplicates, 11 litigations did not involve medical malpractice, and 9 litigations did not involve aortic dissection. Litigations not involving medical malpractice but had the term “aortic/s dissection” were all litigations relating to vehicular accidents. Litigations not involving aortic dissection were medical malpractice cases in which a physician's note,

Discussion

Medical malpractice litigations arise when the patient or their family believes the medical care they received deviated from an acceptable standard of care. In demanding and time-sensitive circumstances, such as the treatment of aortic dissection, the acceptable standard of medical care can be overshadowed by the ultimate outcome to patients and their families. Therefore, an unfavorable outcome sustained by the patient, such as death, can induce a family to file a medical malpractice litigation

Conclusions

Aortic dissection is a potentially fatal condition that is often misdiagnosed and consequently associated with significant amounts of stress and fear for patients, and a poor outcome, even in the presence of excellent care. This can induce patients or their families to file medical malpractice claims despite an absence of acts conducted by defendant physicians who have deviated from an accepted standard of care. Accurate and timely diagnosis and treatment of aortic dissection in a patient with

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