Researchers collected jury verdicts, settlements, and court opinions regarding alleged malpractice involving anaphylaxis from May 2011 through May 2016. Of 30 anaphylaxis-related malpractice lawsuits identified by researchers, two named EPs.1

To reduce the likelihood of anaphylaxis-related litigation, researchers recommended additional anaphylaxis education, provision of epinephrine auto injectors or other alternatives to reduce dosing errors, and stronger safeguards to prevent administration of known allergens.

Previous studies have revealed that anaphylaxis is underdiagnosed and undertreated frequently.2 “Therefore, we wanted to characterize legal outcomes of cases in malpractice suits related to the management of patients with anaphylaxis,” says Ronna L. Campbell, MD, PhD, a study co-author.

The most common cause of the lawsuits? Exposure to a known trigger. This is followed by delayed recognition or treatment of anaphylaxis and inappropriate use of IV epinephrine. Cases included both over- and underdosing errors. Seventy-seven percent of cases resulted in death or permanent neurologic or cardiac dysfunction. Healthcare providers named in the lawsuits worked in multiple specialties and settings, including the ED.

“ED providers need to rapidly recognize and appropriately manage anaphylaxis,” Campbell advises. Epinephrine auto injectors can mitigate the risk of inappropriate epinephrine dosing. “It is important to have ED systems in place that prevent exposures to known triggers,” Campbell adds.

One of the ED malpractice lawsuits involved IV contrast. The other concerned nonsteroidal anti-inflammatory drugs (NSAIDs). “Both the ED cases were about exposure to known allergens and bad reactions after those exposures, with subsequent morbidity for both patients,” says Rachel A. Lindor, MD, the study’s lead author.

Another case resulted in a $3.6 million verdict against the EP defendant.3 The plaintiff was a 52-year-old woman who underwent a CT scan with IV contrast at a New Jersey ED. She reportedly suffered life-threatening anaphylactic shock and an allergic reaction. This caused stroke, subarachnoid bleeding, hemorrhaging, and neurologic challenges. The lawsuit against the EP alleged failure to take an appropriate history, appreciate the significance of the clinical exam and laboratory tests (which caused contraindicated tests to be performed), and follow hospital policy.

In the other case, the plaintiff was admitted from the ED with shortness of breath, pain, and chest tightness.4 The plaintiff reported a prior history of NSAID-sensitive asthma, which caused shortness of breath, loss of consciousness, and vomiting. Despite reporting the allergy, the plaintiff received ibuprofen. As a result, he required intubation and mechanical ventilation for acute, hypercapnic respiratory failure. Over the next four days, the plaintiff required cardioversion after extubation for atrial fibrillation. The ED providers were not found negligent, “but this was actually based on a technicality,” Lindor notes.

The courts in Connecticut require that malpractice lawsuits be supported by a “similar healthcare provider” to the person named in the suit. The plaintiff’s expert was a pulmonologist. “The court determined that it was not similar enough to an emergency medicine physician, so the case was thrown out,” Lindor says.

REFERENCES

  1. Lindor RA, McMahon EM, Wood JP, et al. Anaphylaxis-related malpractice lawsuits. West J Emerg Med 2018;19:693-700.
  2. Nowak RM, Macias CG. Anaphylaxis on the other front line: Perspectives from the emergency department. Am J Med 2014;127:S34-S44.
  3. Johnson v. University of Medicine & Dentistry of New Jersey (Essex County Sup. Ct., April 22, 2015).
  4. Lohnes v. Hospital of Saint Raphael (CT App. Ct., Nov. 15, 2011).

SOURCES

  • Ronna L. Campbell, MD, PhD, Associate Professor, Emergency Medicine, Mayo Clinic, Rochester, MN. Phone: (507) 255-7002. Email: campbell.ronna@mayo.edu.
  • Rachel A. Lindor, MD, Mayo Clinic, Rochester, MN. Email: lindor.rachel@mayo.edu.