There are few assessments of patterns of medicolegal cases involving cardiac catheterizations. This descriptive study reviews the patterns of liability and medical outcomes involving cardiac catheterization litigation from the LexisNexis Academic database and the Physician Insurers Association of America registry. From 1985 to 2009, the Physician Insurers Association of America registry documented 1,361 closed coronary angiography claims. The cardiovascular disease specialty was involved in 699 with other specialties involved in the remaining cases. Of the 1,361 closed claims, 301 (22%) resulted in payments to the plaintiff (average indemnity of $230,987). The most common alleged error was for improper performance (35.4%; average indemnity of $255,542). The alleged error with the highest average indemnity of $270,916 was errors in diagnosis. Not performing an indicated procedure had the highest ratio of paid to closed claims (41%) with an average indemnity of $246,988. In regard to the severity of injury, death was the most common outcome (44%). The highest ratio of paid to total closed claims (43%) was for grave injuries (highest average indemnity of $555,625). Of the 116 LexisNexis cases, litigation against physicians occurred in 90.5% of cases with judgments in favor of the patients in 29.5%. When death was the outcome (31% of cases), physicians were highly likely to be sued (97%) and the judgment was more likely in the plaintiffs’ favor (44%). In conclusion, in litigation related to cardiac catheterizations, most cases are due to medical malpractice and physicians are sued in a high percentage of cases. Cardiologists should recognize these patterns of litigation as these may impact and improve processes of care.
The widespread use of cardiac catheterization makes it an important aspect of cardiovascular (CV) litigation to investigate as the number of medical professional liability (MPL) claims seems to be correlated to the frequency with which procedures are performed. According to the American College of Cardiology/American Heart Association, cardiac catheterizations were the second most frequent in-hospital operative procedure performed in the United States in 1993. In 2010, diagnostic cardiac catheterization remained as the second most common procedure among hospitalized patients aged 45 to 64 years and was the third most common procedure in adults aged 65 to 84 years. Another study states that percutaneous coronary intervention (PCI) is now the most common procedure for patients with coronary heart disease. Medical malpractice litigation cases have been studied in other procedure-based specialties, such as radiology, to recognize medicolegal risks and develop risk management processes to minimize malpractice and improve patient care. Similarly, this descriptive study focuses on MPL claims involving cardiac catheterization to identify common trends, which may be useful in developing standards to help minimize the risks of litigation and improving patient care.
Methods
The LexisNexis Academic database (LexisNexis is division of Reed Elsevier, Dayton, Ohio), a publically available and searchable archive, was searched for published legal case opinions involving the keyword “cardiac catheterization”. Data were obtained from 1,441 cases; of which, 116 cases involved patients who were litigating partially or fully related to the cardiac catheterization from 1976 to 2010. Each legal case opinion was reviewed for the following data: the date the case was decided, plaintiff, defendant, patient outcome, and trial outcome.
Data were additionally obtained from the Physician Insurers Association of America (PIAA)—a registry that collects data on MPL closed claims that have been resolved either, with or without payment to the claimant, through private agreement between the parties or by court action. The PIAA is a trade association of >50 liability insurance companies that covers >60% of private practice physicians. Diagnostic information and procedures are submitted to the PIAA using the International Classification of Diseases, Ninth Revision coding system. The PIAA then classifies data within broad categories. A search was submitted for cases involving coronary angiography from 1985 to 2009 and information was gathered on medical specialties, claimant and physician demographics, severity of outcome, alleged error, diagnosis, and trial outcome. Despite its limitations, the PIAA database appears to be the best source of information regarding MPL claims.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
