This month we are introducing a new feature in Vascular Specialist – a column on medicolegal matters. After all there are few issues that we face as vascular surgeons that can so negatively affect our lives. For a malpractice suit can cause great financial loss even if the verdict is in our favor. Attending various depositions, trials, and meetings with attorneys is nonproductive. Not to mention the emotional toll of self-doubt, embarrassment from negative press, or resentment of a frivolous suit.
Vascular surgeons pay some of the highest insurance premiums because we deal with critical issues which may have the potential for catastrophic outcomes. Lawsuits can occur when we perform a CEA and the patient suffers a stroke or a nerve injury, or after we save a ruptured aneurysm but the patient wakes up paralyzed. We can be sued for doing too much or too little. Do a bypass for critical limb ischemic that fails or attempt a thrombectomy and ultimately perform an amputation, and we are sued for not doing a primary amputation.
Decide that a limb is beyond salvage and perform a primary amputation, and we are sued for not attempting a bypass. Further, we are often called to the operating room to save a patient who suffered an inadvertent vascular injury during a procedure by another specialist. When the lawsuit arrives, we are the ones named. In some states, lawsuits are so common and juries so biased that insurance premiums have become unaffordable. Many vascular surgeons have gone without, risking their livelihood.I believe that much can be learned from prior malpractice suits and so I have turned to Dr. O. William Brown to help develop a column dealing with lessons learned from these claims. Bill has been a President of the Society for Clinical Vascular Surgery and is an accomplished physician and educator. He is also a lawyer with a huge experience in medicolegal issues. Together we have written the first column, dealing with the issue of retroperitoneal bleeds after femoral access for endovascular procedures.
By evaluating the cases that will be presented, you will notice that there are many traps that could lead a vascular surgeon to be involved in a suit especially if the patient suffers a lethal or life-altering complication. Importantly, for newer surgeons and those in training, these cases may also be informative as to how to best manage these situations. It is possible that textbooks might not be as instructive! The cases will obviously be modified to preserve confidentiality but this information is freely available for review in the legal literature. However, since some aspects may be fictional and since there are always extenuating circumstances that these scenarios may not reflect, trial lawyers should not expect that the cases are meant to define standard of care.
A further issue with malpractice litigation is the role of the “expert witness.” Since the legal system in the United States mostly requires a trial by jury and since these so-called peers do not have our knowledge or expertise, someone must take on the responsibility of educating jurors as to the merits or demerits of the case. This is a responsibility that must not be taken lightly. The honesty and integrity of the expert needs be paramount and so we support respected authorities performing legal reviews. This requires a great deal of time and so their time should be compensated. However, all too often the expert becomes a hired gun for the attorney supporting a specious plaintiff or defense argument simply for financial gain. Such “experts” should be shunned. When their testimony becomes egregious, they should be reported to the SVS Professional Conduct committee for investigation and possible sanction. Guidelines for experts have been published by the SVS (http://www.vascularweb.org/about/policies/Pages/expert-witness-guideline…).While Dr. Brown and I hope to be able to write these columns every other month, we invite any member to contribute. You could write the column or provide us with details of a suit, or a disease process or procedure that results in complications that could land a surgeon in trouble. We would be happy to research this and, if needed, write the column for you. You may also comment on a prior column by submitting a letter to the editor. Your contribution could save a colleague from a lawsuit. More importantly it could help prevent a complication occurring in one of your patients.
Dr. Samson is the medical editor of Vascular Specialist.