Society For Clinical Vascular Surgery

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Damned if you Do, Damned if you Donít: IVC Filter Malpractice Litigation
John Phair, MD, John Denesopolis, MD, Larry Scher, MD, Evan Lipsitz, MD, MBA.
Montefiore Medical Center, Bronx, NY, USA.

OBJECTIVES: 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 1st 2000 to December 31st 2015 were reviewed. The search term ďinferior vena cava filterĒ 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 non-medical cases were excluded. 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 towards IVCF (Figure 1). The most frequent defendants were internal medicine physicians (38%), vascular surgeons (19 %), and cardiothoracic surgeons (12%). The most frequent claims were denied treatment/delay in treatment (in 35% of cases), negligent surgery (in 24% of cases) and failure to diagnose and treat complications (in 24% of cases) (Figure 2). Of these, the most frequent specific claims were failure to place IVC filter (41%), implantation failure: misplacement and/or misaligned (24 %), erosion of IVC/retroperitoneal bleed (6%), and discontinuation of anticoagulation prematurely (6 %). Seventeen cases (35%) were found for the plaintiff; with median awards $1,092,500. In the 21 cases where 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.
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 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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