By Stacey Kusterbeck
Malpractice claims involving intravenous thrombolytic therapy to treat acute ischemic stroke patients are more likely to allege failure to treat than to allege complications related to therapy.1 A group of researchers wanted to know if the same was true regarding mechanical thrombectomy.
“Mechanical thrombectomy in acute ischemic stroke is a safe and efficacious procedure when performed in the setting of expert stroke systems of care,” says Philip B. Gorelick, MD, MPH, professor of neurology at Northwestern University Feinberg School of Medicine.
Gorelick and colleagues wanted to fill an information gap on the number of malpractice claims associated with mechanical thrombectomy and the root causes of those lawsuits. The researchers analyzed 25 malpractice cases from 2009-2021 involving mechanical thrombectomy.2 Emergency physicians (EPs) were the most frequent specialty named as defendants (64% of cases), followed by neurologists.
“Overall, the main reasons leading to medical malpractice claims with mechanical thrombectomy were very similar to those for intravenous thrombolysis in acute ischemic stroke: failure to treat, or delay in treatment, as opposed to complications of the procedure,” Gorelick notes.
Of the 25 malpractice claims analyzed:
• 16 claims alleged the provider failed to treat with mechanical thrombectomy;
• Eight claims alleged the patient was harmed due to delayed treatment;
• One claim alleged complications resulting from treatment.
“The establishment of a well-organized response for acute stroke care in the ED is important for the avoidance of harm to patients and the potential for generation of medical-legal claims,” Gorelick offers.
The defendant prevailed in eight cases, the plaintiff prevailed in nine cases, and eight cases remained open or the outcome could not be determined. In two claims, the hospital’s stroke center certification status played a role. Both cases involved delayed diagnosis of vertebrobasilar occlusions and alleged failure to treat.
One case alleged the institution had received certification status, but failed to put the appropriate policies into effect and failed to maintain the required expertise.
In a similar case, the plaintiff argued the hospital’s certification status indicated “24/7” availability of neurology, but there was a delay in consultation leading to delayed transfer.
The analysis revealed these other root causes of the malpractice lawsuits:
• Communication breakdowns. Some cases involved emergency care providers requesting that a key diagnostic test for acute stroke be performed emergently, but the test was delayed substantially. The provider did not know about the delay. This caused critical time windows for acute ischemic stroke therapies to expire.
In other similar cases, failure to communicate the time the patient was “last known well” led to clinicians incorrectly presuming the patient was not eligible for treatment.
Other communication-related malpractice cases concerned delays in informing providers of important radiology findings.
• Diagnostic delays. Some cases involved delays moving the patient from the ED to vascular imaging, or delays in neurological consultation. This resulted in delayed diagnosis, which in turn caused a delay in transfer.
• Transportation delays to centers offering mechanical thrombectomy. Ideally, EDs will address these factors to find ways to prevent delays contributing to bad outcomes in stroke patients. “These are areas worth paying special attention to, as they may be key underlying causes of malpractice misadventures,” Gorelick says.
REFERENCES
1. Ganti L, Kwon B, George A, et al. Tissue plasminogen activator and patients with acute ischemic stroke: The litigation landscape. J Am Coll Emerg Physicians Open 2022;3:e12646.
2. Qureshi K, Farooq MU, Gorelick PB. Malpractice lawsuits relating to mechanical thrombectomy for acute ischemic stroke: A systematic review. Neurohospitalist 2023;13:228-235.
Malpractice claims involving intravenous thrombolytic therapy to treat acute ischemic stroke patients are more likely to allege failure to treat than to allege complications related to therapy. A group of researchers wanted to know if the same was true regarding mechanical thrombectomy.
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