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A Black Box or Pandora's Box? IVC Filter Malpractice Litigation in Context
Kenny Oh, JD1, Anil Hingorani, MD2.
1Temple University School of Medicine, Philadelphia, PA, USA, 2NYU Langone Hospital - Brooklyn, Brooklyn, NY, USA.

OBJECTIVES- Placement of inferior vena cava (IVC) filters is a controversial focus of medical malpractice. Clinicians currently have little information to guide them regarding key issues and outcomes in litigation. In this retrospective legal case review, we analyzed the factors associated with malpractice actions involving IVC filters. METHODS- The legal databases LexisNexis and Westlaw were searched from 1967 to 2016 for all published legal cases in the United States involving placement of IVC filters. Keywords included "IVC", "inferior vena cava", "filter", and "malpractice". Social Security Disability claims, product liability actions, and hospital employment disputes were excluded. RESULTS- 310 search results were eligible for initial review. Cases involving Social Security Disability, insurance disputes, tax revenue, and hospital employment contracts were excluded. 29 cases involving medical malpractice were included in final analysis. Overall, private practitioners were most often sued (11/29, 37.9%), while 24.1% of defendants were academic hospitals (7/29), 20.7% were prisons (6/29), and 17.2% were community hospitals (5/29). The most common indications for IVC filter placement were hypercoagulable state (8/29, 29.6%), recurrent pulmonary embolism (PE) (6/29, 22.2%), and trauma (5/29, 18.5%). The most common underlying allegations involved failure to insert IVC filter when indicated (14/29, 48.3%), intra-procedural negligence (5/29, 17.2%), and failure to timely remove device (5/29, 17.2%). Common complications included failure to prevent occurrence of PE (14/29, 48.3%), device migration (4/29, 13.8%), and perforation of organs/vasculature (3/29, 10.3%). Death of patient occurred in 41.4% of total cases (12/29). In cases where the patient died, the most common indications for filter placement were trauma (4/12, 33.3%) and DVT (3/12, 25.0%), and the most common complication was failure to prevent occurrence of PE (9/12, 75.0%). Available verdicts favored defendants (13/14, 92.9%). In cases with defense verdicts, the most common indications for filter placement similarly were trauma (4/13, 30.8%) and DVT (3/13, 23.1%), and the most common complication was failure to prevent PE (9/14, 64.3%). CONCLUSIONS- Analysis of malpractice cases involving IVC filters revealed key factors associated with litigation. Overall, verdicts favored defendants. Private practitioners were most commonly sued, and the most common reasons for bringing suit were failure to insert filter, intra-procedural complications, and failure to remove filter. Deeper awareness of issues related to malpractice litigation can inform clinical practice and improve patient care and safety. 

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