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Julie Lloyd - (202) 728-0610 x3010 |
Washington, DC — Emergency physicians who treat stroke patients are much more likely to be sued for not administering tPA, a controversial clot-busting drug, than for administering it. A study appearing online today in Annals of Emergency Medicine shows that 88 percent of ischemic stroke patients who sued their physicians claimed injury resulted from failure to treat with tPA ("Empirical Characteristics of Litigation Involving Tissue Plasminogen Activator and Ischemic Stroke," Bryan A. Liang, MD, PhD, JD).
"Many emergency physicians hesitate to administer tPA to their ischemic stroke patients because of the risks associated with it and the fear that they will be sued for giving it to the wrong patient," said Dr. Liang of the University of California at San Diego School of Medicine and California Western School of Law. "The risks of this powerful drug are real, but the study shows exactly the opposite about the fear of lawsuits: Overwhelmingly the patients who sue are those who did not receive tPA, not those who did. While defendants prevailed in nearly two-thirds of the cases, of those who lost their case, 83 percent did so because they did not give the patient tPA."
The study authors examined 33 lawsuits that involved tPA and ischemic stroke, 19 of which involved emergency physicians as defendants. Nine of the cases resulted in verdicts favorable to the plaintiff, two resulted in settlement, and one resulted in arbitration favorable to the plaintiff. The settlement payments ranged from $100,000 to $30,000,000.
"If emergency physicians are reticent to use tPA because they believe it may lead to litigation, the findings in this study may dispel some of those concerns," said Dr. Liang. "In fact, it would appear from this study that not giving tPA for eligible patients in the emergency department may be the primary source of litigation associated with this therapy."
Of the 33 cases studied, five occurred during the five years after tPA was approved by the FDA, with the other 28 cases occurring in the subsequent five years. Study authors suggest that these numbers indicate that ischemic stroke patients and their attorneys are becoming more aware of tPA and its use in stroke care, and that increasing litigation may mean they are more likely to hold emergency departments and physicians liable for stroke events in which tPA is not used.
"As the population ages, it’s likely that the number of patients suffering from strokes will increase," said Dr. Liang. "Emergency physicians are facing greater likelihood of being sued for not giving tPA to these patients, rather than for any injury associated with its use."
Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, a national medical society with more than 25,000 members. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information visit www.acep.org.
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