A 2012 analysis of lawsuits involving ultrasound in the ED found just one malpractice case — for failure to perform an ultrasound.1 A group of researchers decided to see if the legal landscape had changed for emergency physicians (EPs).
“With a dramatic increase in point-of-care ultrasound use by physicians since the prior study, an update was in order. We were curious if we would find far more cases,” says Lori Stolz, MD, RDMS, director of emergency ultrasound at Banner University Medical Center Phoenix (AZ).
The researchers conducted a retrospective review of all reported state and federal cases between January 2008 and December 2012 in the Westlaw database.2
“We were surprised to find no cases in which EPs were involved in lawsuits involving ultrasounds that were performed,” Stolz says.
Cases were included if an EP was named, the patient encounter was in the ED, the interpretation or failure to perform an ultrasound was a central issue, and the application was within the American College of Emergency Physicians’ (ACEP) ultrasound core applications.3 Five such cases were identified.
“Failure to perform an ultrasound study or failure to perform it in a timely manner was involved in all the identified cases,” Stolz says. Four cases resulted in patient death.
In one case, the patient was discharged from the ED with a follow-up right upper quadrant ultrasound scheduled for the next day. She was found to have acute cholecystitis and suffered several complications from it, which she alleged was secondary to the delay in diagnosis.
“This is an exam type that could have been performed at the time of the visit by the ED physician, had they had the training, as it is an ACEP core application,” Stolz says.
Another case involved an adolescent male involved in a motor vehicle accident. He presented to an ED, where no abdominal imaging was performed, and was discharged.
“The young man died later that night in his sleep, found to have hemoperitoneum with a liver laceration,” Stolz says. “In this case, a FAST [Focused Assessment with Sonography for Trauma] exam could have been performed at the time of the visit.”
All malpractice cases that were identified were within the ACEP core emergency ultrasound applications, and could have been performed by the EP but were not.
“This is new technology. Physicians who trained before ultrasound and were heavily taught in residency may feel inadequately prepared to perform and interpret ultrasound,” Stolz says.
EPs may lack equipment, continuing education, quality assurance, image archiving, or hospital policies that support the use of point-of-service ultrasound.
“Each of these elements are needed for ED physicians to use ultrasound routinely in their practice,” Stolz says.
Because point-of-care ultrasound is relatively new to the field, legal risks remain unclear, Stolz says.
“Radiology is traditionally a high-risk specialty, so one could foresee potential for increased risk for EPs performing an imaging procedure,” she says.
Based on the study’s findings, however, learning and using ultrasound doesn’t seem to put EPs at risk for legal liability, Stolz says; instead, “failure to use the skill may confer more risk.”
Point-of-care ultrasound can potentially decrease risk by aiding EPs in making faster diagnoses.
“There is potential for malpractice lawsuits when EPs fail to perform point-of-care ultrasound in situations where they could,” Stolz says.
REFERENCES
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Blaivas M, Pawl R. Analysis of lawsuits filed against emergency physicians for point-of-care emergency ultrasound examination performance and interpretation over a 20-year period. Am J Emerg Med 2012;30:338-341.
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Stolz L, et al. A review of lawsuits related to point-of-care emergency ultrasound applications. West J Emerg Med 2015;16:1-4.
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American College of Emergency Physicians. Emergency ultrasound guidelines. Ann Emerg Med 2009;53:550-570.
SOURCE
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Lori Stolz, MD, RDMS, Assistant Professor/Ultrasound Director, Banner University Medical Center Phoenix (AZ). Phone: (520) 626-1443. Fax: (520) 626-2480. E-mail: [email protected].
