119 Acute Stroke, Thrombolytics and Litigation: Reasons Physicians Get Sued

Abstract

To investigate the reasons for litigation surrounding the use of alteplase in the setting of acute ischemic stroke. The authors examined cases from a legal online database, Westlaw, that took place from 1993 to 2020 regarding alleged complaints for whether or not thrombolytic treatment was given for acute stroke. The query terms that were used for this paper were “tissue plasminogen activator,” “tPA,” “alteplase,” “thrombolytic therapy,” and “acute stroke.” From the initial search, cases that did not include acute ischemic stroke or the use of alteplase were excluded, as were suits that had to do with other issues surrounding the stroke care but not involving the issue of thrombolysis specifically. Setting: online legal database. Type of participants: publicly available cases (study cleared by institutional IRB). The initial search yielded 1364 cases. In the final dataset, 33% involved the hospital as defendants, 19% involved the emergency physicians as defendants, 11% involved internal medicine physicians as defendants, (6%) involved nurses as defendants, (3%) involved a neurologist as the defendant, (3%) involved a radiologist as the defendant, and (3%) involved a gynecologist as the defendant. Six percent of the cases did not clearly specify each defendant involved and were thus classified as “various physicians” in Table 1. Thirty-six percent involved non-healthcare providers as the principal defendants but also often saw subsidiary physicians or hospital staff being sued. There was no clear trend in the number of cases over time. In over sixty percent of cases, the plaintiff claimed that the physician failed to offer or treat the patient with tPA, and of those cases, more than 25% were a result of a failure to timely diagnose the stroke, and 14% were a result of the hospital or physician violating the Emergency Medical Treatment and Labor Act (EMTALA). The plaintiff claimed in 31% of the cases that the physician delayed in administering tPA to the patient as a consequence of various reasons. In all cases, the plaintiffs sued for issues stemming from either failure to give tPA or a delay in giving tPA. Out of the cases that had a definitive outcome, the plaintiff won in 1/3 cases. It is more common for patients to sue physicians for not administering tPA in a timely fashion or at any point. Thus, tPA should not be withheld or delayed in patients who meet criteria, and physicians should not fear litigation in these situations.