Jury verdicts and outcomes of malpractice cases involving arteriovenous hemodialysis access

Abstract

Objective: To analyze malpractice cases involving hemodialysis access to prevent future litigation and improve physician education. Methods: Jury verdict reviews from the WESTLAW database from 1 January 2005 to 1 January 2015 were reviewed. The search terms “hemodialysis,” “dialysis,” “graft,” “fistula,” “AVG,” “AVF,” “arteriovenous,” “catheter,” “permacatheter,” and “shiley” were used to compile data on the demographics of the defendant, plaintiff, allegation, complication, and verdict. Results: Sixty-six cases involving the litigation pertaining to hemodialysis catheter, arteriovenous fistula (AVF) or arteriovenous grafts (AVGs) were obtained. Of these, 55% involved catheter-based hemodialysis access, 18% involved AVF, and 27% involved AVG. The most frequent physician defendants were vascular surgeons (36%), internists (14%), nephrologists (14%), general surgeons (9%), and interventional radiologists (6%). Of the patients, 38% involved were male and the average patient age was 56.3 (standard deviation (SD) = 20.1) years. Region of injury was 50% in the neck or chest, 42% in the arm, and 8% in the groin. Injury was listed as death in 79% of cases. Of the deaths, 95% involved bleeding at some point in the chain of events. The most common claims related to the cases were failure to perform the surgery or procedure safely (44%), failure to diagnose and treat in a timely manner (30%), and negligent hemodialysis treatment (11%). The most common complications cited were hemorrhage (62%), loss of function of limb (15%), and ischemia due to steal syndrome (11%). A total of 26 cases (39%) were found for the plaintiff or settled. The median award was US$463,000 with a mean of US$985,299 (SD = US$1,314,557). Conclusion: While popular opinion may indicate that steal syndrome is a commonly litigated complication, our data reveal that the most common injury litigated is death which may frequently be the result of a hemorrhagic episode. In addition to hemorrhage, the remaining most common complications included steal syndrome and loss of limb function. Therefore, steps to better prevent, diagnose and treat bleeding, nerve injury, and steal syndrome in a timely manner are critical to preventing hemodialysis-access-associated litigation.

Medical malpractice related to dialysis and vascular access: An analysis of lawsuit judgements in South Korea

“…In addition, the rate of litigations related to complications occurring during CVC insertion (25.0%) was greater than those due to complications related to AV access cannulation (6.3%) and formation (21.9%). Similar results were obtained in a study of malpractice suits brought on behalf of patients undergoing hemodialysis in the United States, in which the rate of CVC-associated cases (36%) was higher than those of cases associated with other types of vascular access (AVF formation, 18%; AV grafting, 12%) [ 13 ].…”

“…In the current study, the most common cause of disputes was vascular access management–related complications. In a recent study of medical dispute cases tried between 2005 and 2014 in the United States and recorded in the WESTLAW database [ 13 ], 66 cases involved complications arising from vascular access establishment or management (e.g., double-lumen CVC insertion or AVF creation/graft placement). Considering the annual incidence of hemodialysis treatment in Korea [ 20 ], which is about one-tenth that in the United States, the rate at which such legal disputes have been tried in Korea (12 cases over 19 years) is similar to that in the United States.…”

“…In particular, many complications are associated with procedures undertaken to prepare for hemodialysis, such as central venous catheter (CVC) placement and surgery performed to obtain vascular access [ 10 – 12 ]. Although the uremic milieu confers vulnerability in many cases in which accidents occur, medical team negligence triggers and exacerbates many hemodialysis -related complications [ 13 , 14 ] and should be prevented.…”

Determining the incidence of needle-related complications in hemodialysis access: We need a better system

“…Inadvertent NRI such as back-wall puncture can result in contained hematoma, but side-wall laceration can result in severe hematoma or hemorrhage, which, in turn, can lead to impingement of the conduit and thrombosis, or in severe cases, uncontrollable hemorrhage can result in exsanguination and death. [15][16][17][18][19] There are several potential causes for HDA infection outside of cannulation such as contamination during implant, infected seroma/lymphocele at the surgical site, or seeding of the conduit from concurrent bacteremia (e.g. central venous catheter and heart valve vegetation).…”

Accessory veins related hand ischemia: A case series

“…Furthermore, a complete reversal of most of the signs was seen in all six cases following surgical ligation of the accessory vein. Nonetheless, not detecting these complications related to AVF and lack of timely intervention to salvage the limb would be considered as negligence and a cause of litigation and compensation [ 16 ].…”