Inferior Vena Cava Filter Malpractice Litigation

Damned if You Do, Damned if You Don't

John Phair, John Denesopolis, Evan C. Lipsitz, Larry A. Scher

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: The aim of this study was to analyze malpractice litigation trends and to better understand the causes and outcomes of suits involving inferior vena cava filters (IVCF) to prevent future litigation and improve physician education. Methods: Jury verdict reviews from the Westlaw database from January 1, 2000, to December 31, 2015, were reviewed. The search term “inferior vena cava filter” was used to compile data on the demographics of the defendant, plaintiff, allegation, complication, and verdict. Results: A total of 156 cases were identified. Duplicates and cases in which the IVCF was incidentally included were excluded from the analysis. Forty-nine cases involving either failure to place or a complication of IVCF placement were identified. Throughout the last 15 years, there has been increased number of jury verdicts toward IVCF. The most frequent defendants were internal medicine physicians (38%), vascular surgeons (19%), and cardiothoracic surgeons (12%). The most frequent claims were denied treatment or delay in treatment (in 35% of cases), negligent surgery (in 24% of cases), and failure to diagnose and treat complications (in 24% of cases). Of these, the most frequent specific claims were failure to place IVC filter (41%), implantation failure such as misplacement and/or misaligned implant (24%), erosion of IVC/retroperitoneal bleed (6%), and discontinuation of anticoagulation prematurely (6%). Seventeen cases (35%) were found for the plaintiff, with median awards worth of $1,092,500. In the 21 cases where pulmonary embolism (PE) was involved (43% of cases), 19 were fatal (90%). Of the fatal PE cases, 8 cases ended with verdicts in favor of the plaintiff (42%). Both nonfatal PE cases were won by the defense. Conclusions: IVCF placement with subsequent PE and death results in verdicts that favor the plaintiffs. This study emphasizes that adequate and transparent communication regarding preoperative planning, decision for IVCF placement, and informed consent may reduce the frequency of litigation. Public awareness of complications related to the placement of IVCF is increasing largely and spurned by aggressive advertising and marketing by plaintiff attorneys. Conditions for which IVCF placement is contemplated carry significant risk of malpractice litigation.

Original languageEnglish (US)
JournalAnnals of Vascular Surgery
DOIs
StateAccepted/In press - Jan 1 2018

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Vena Cava Filters
Malpractice
Jurisprudence
Pulmonary Embolism
Physicians
Lawyers
Internal Medicine
Marketing
Informed Consent
Blood Vessels
Communication
Demography
Databases
Education

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Inferior Vena Cava Filter Malpractice Litigation : Damned if You Do, Damned if You Don't. / Phair, John; Denesopolis, John; Lipsitz, Evan C.; Scher, Larry A.

In: Annals of Vascular Surgery, 01.01.2018.

Research output: Contribution to journalArticle

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title = "Inferior Vena Cava Filter Malpractice Litigation: Damned if You Do, Damned if You Don't",
abstract = "Background: The aim of this study was to analyze malpractice litigation trends and to better understand the causes and outcomes of suits involving inferior vena cava filters (IVCF) to prevent future litigation and improve physician education. Methods: Jury verdict reviews from the Westlaw database from January 1, 2000, to December 31, 2015, were reviewed. The search term “inferior vena cava filter” was used to compile data on the demographics of the defendant, plaintiff, allegation, complication, and verdict. Results: A total of 156 cases were identified. Duplicates and cases in which the IVCF was incidentally included were excluded from the analysis. Forty-nine cases involving either failure to place or a complication of IVCF placement were identified. Throughout the last 15 years, there has been increased number of jury verdicts toward IVCF. The most frequent defendants were internal medicine physicians (38{\%}), vascular surgeons (19{\%}), and cardiothoracic surgeons (12{\%}). The most frequent claims were denied treatment or delay in treatment (in 35{\%} of cases), negligent surgery (in 24{\%} of cases), and failure to diagnose and treat complications (in 24{\%} of cases). Of these, the most frequent specific claims were failure to place IVC filter (41{\%}), implantation failure such as misplacement and/or misaligned implant (24{\%}), erosion of IVC/retroperitoneal bleed (6{\%}), and discontinuation of anticoagulation prematurely (6{\%}). Seventeen cases (35{\%}) were found for the plaintiff, with median awards worth of $1,092,500. In the 21 cases where pulmonary embolism (PE) was involved (43{\%} of cases), 19 were fatal (90{\%}). Of the fatal PE cases, 8 cases ended with verdicts in favor of the plaintiff (42{\%}). Both nonfatal PE cases were won by the defense. Conclusions: IVCF placement with subsequent PE and death results in verdicts that favor the plaintiffs. This study emphasizes that adequate and transparent communication regarding preoperative planning, decision for IVCF placement, and informed consent may reduce the frequency of litigation. Public awareness of complications related to the placement of IVCF is increasing largely and spurned by aggressive advertising and marketing by plaintiff attorneys. Conditions for which IVCF placement is contemplated carry significant risk of malpractice litigation.",
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