Medical malpractice in heart transplantation from 1994 to 2019

Abstract

Background Heart transplantation is a unique clinical intervention because it involves two separate parties, the donor and the recipient. This increases the potential for the legal liability of heart teams involved with heart transplantation, but there is no research that exists to date that analyzes the etiology of medical malpractice litigations relating to heart transplantation. Methods The Westlaw legal database was queried for all medical malpractice litigations concerning heart transplantation from 1994 to 2019 in the United States. Individual litigations were reviewed for inclusion, resulting in 41 included cases, and then analyzed for legal and clinical data. Statistical analyses were performed with the Fisher exact test and Mann–Whitney U tests. Results The mean age of patients involved in these litigations was 38.88 years, with female patients being younger on average. Female patients received a significantly larger average award than male counterparts (p = .03). Alleged failure to diagnose was significantly associated with settlements (p = .047). An alleged failure to obtain informed consent as presented by the plaintiff was significantly associated with defendant verdicts (p = .03). Incidence of stroke and infection were each significantly associated with nondefendant verdicts (p = .02 and p = .02). Conclusions There should be an emphasis on documenting informed consent from all involved parties in heart transplantation to limit litigations filed against clinicians. As technologies and growing donor pools increase the prevalence of heart transplantation, clinicians would be well‐served to be aware of legally tenable practices that will allow them to adopt a higher transplant volume without simultaneously adopting added legal exposure.

Commentary: Malpractice in heart transplantation

“…In a recent issue of the Journal of Cardiac Surgery, Palaniappan and colleagues reviewed malpractice claims in heart transplantation from 1994 to 2019 using the Westlaw legal database. 1 They found that factors significantly associated with settlements and non-defendant verdicts were failure to diagnose as well as postoperative stroke and infection. Alleged failure to obtain consent was associated with defendant verdicts.…”

“…Alleged failure to obtain consent was associated with defendant verdicts. 1 We read this study with interest as it provides relevant information for cardiac surgeons regarding the etiology and outcome of medical malpractice claims in heart transplantation.…”

“…In the current work, failure to diagnose, delay in treatment, failure to monitor, failure to test, and failure to refer were all listed as causes of litigation. 1 Seamless communication between provider teams may be one strategy to limit these occurrences. Doing so would both improve patient outcome and minimize physician legal exposure.…”

“…Another commonly identified basis for litigation was procedural error. 1 It would be interesting to know whether this correlated with surgeon experience, and If so, perhaps a strategy for limiting risk would be to encourage continued operative mentorship by senior cardiac surgeons. While these tangible efforts may limit litigation risk, the impact of less tangible characteristics, such as emotional intelligence cannot be overstated.…”

“…Critical evaluation of various claims is essential for all parties to understand and improve processes in the hopes of optimizing patient outcomes. In a recent issue of the Journal of Cardiac Surgery , Palaniappan and colleagues reviewed malpractice claims in heart transplantation from 1994 to 2019 using the Westlaw legal database 1 . They found that factors significantly associated with settlements and non‐defendant verdicts were failure to diagnose as well as postoperative stroke and infection.…”