A Review of Lawsuits Related to Point-of-care Emergency Ultrasound Applications

Lori Stolz, MD; Kathleen M. O'Brien, MD; Marc L. Miller, JD; Nicole D. Winters-Brown, JD; Michael Blaivas, MD; Srikar Adhikari, MD

Disclosures

Western J Emerg Med. 2015;16(1):1-4. 

In This Article

Abstract and Introduction

Abstract

Introduction New medical technology brings the potential of lawsuits related to the usage of that new technology. In recent years the use of point-of-care (POC) ultrasound has increased rapidly in the emergency department (ED). POC ultrasound creates potential legal risk to an emergency physician (EP) either using or not using this tool. The aim of this study was to quantify and characterize reported decisions in lawsuits related to EPs performing POC ultrasound.

Methods We conducted a retrospective review of all United States reported state and federal cases in the Westlaw database. We assessed the full text of reported cases between January 2008 and December 2012. EPs with emergency ultrasound fellowship training reviewed the full text of each case. Cases were included if an EP was named, the patient encounter was in the emergency department, the interpretation or failure to perform an ultrasound was a central issue and the application was within the American College of Emergency Physician (ACEP) ultrasound core applications. In order to assess deferred risk, cases that involved ultrasound examinations that could have been performed by an EP but were deferred to radiology were included.

Results We identified five cases. All reported decisions alleged a failure to perform an ultrasound study or a failure to perform it in a timely manner. All studies were within the scope of emergency medicine and were ACEP emergency ultrasound core applications. A majority of cases (n=4) resulted in a patient death. There were no reported cases of failure to interpret or misdiagnoses.

Conclusion In a five-year period from January 2008 through December 2012, five malpractice cases involving EPs and ultrasound examinations that are ACEP core emergency ultrasound applications were documented in the Westlaw database. All cases were related to failure to perform an ultrasound study or failure to perform a study in a timely manner and none involved failure to interpret or misdiagnosis when using of POC ultrasound.

Introduction

The use of point-of-care (POC) ultrasound in the emergency department (ED) has dramatically expanded in recent years. Performing and interpreting ultrasound examinations at the patient's bedside without the aid of a radiologist or sonographer has become commonplace for emergency physicians (EP) and is now fully integrated into residency training.[1,2] Improved patient safety and decreased time to definitive care are drivers of this dramatic expansion in use of POC ultrasound.[3–5]

With any change in medical practice, the opportunity arises for lawsuits related to the usage or failure to use this new practice, such as with the use of tissue plasminogen activator in thrombotic stroke.[6] Malpractice claims are a costly reality in the healthcare system, with emergency medicine (EM) considered to be one of the higher-risk specialties. The risk of a lawsuit for an EP is approximately 7.5% each year with the projected risk of claim over a typical career being between 75% and 99%.[7] This is an issue that affects every EP who works clinically.

With the increasing use of POC ultrasound in the ED, there is potential additional legal risk to a practicing EP. Malpractice risk to an EP may stem from failure to perform an adequate ultrasound study, failure to interpret ultrasound findings accurately, and misdiagnosis.[8] Some EPs may choose to forgo POC ultrasound to decrease this perceived risk or to shift potential risk onto consulting services. However, POC ultrasound has become so widely integrated into the practice of EM, the failure to integrate ultrasound into practice may lead to increased legal risk for clinicians.

A previous study on this topic by Blavais et al.[9] analyzed 659 available records for lawsuits related to POC ultrasound over a 20-year period from 1987–2007. They identified no cases related to performance or interpretation of POC ultrasound and one case related to alleged failure to perform POC ultrasound. The aim of this study was to continue this previous work to quantify and characterize lawsuits related to EPs performing POC ultrasound. We hypothesized that given the increased use and scope of practice of POC ultrasound in EM since the previous study, the current legal risk of not using POC ultrasound when it may be indicated may be significant for EPs and departments.

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