Med/mal claims are alleging failure to prevent or treat DVT
Claims involving deep vein thrombosis typically allege that physicians ordered insufficient prophylaxis or otherwise failed to prevent the condition.
Expert witnesses might disagree over which medication should be used and how long to use it.
Physicians should document reasons for discontinuing blood thinners.
Patients with large blood clots should be referred to an interventional radiology specialist.
Robert J. Conroy, JD, MPH, an attorney at Kern Augustine Conroy & Schoppmann in Bridgewater, NJ, has handled multiple claims alleging that physicians ordered insufficient prophylaxis or otherwise failed to prevent deep vein thrombosis (DVT).
"Many times, the prophylaxis was sufficient but not fully recorded and documented," says Conroy." Also, many times a different course of treatment was considered and ruled out, but with no supporting documentation."
One case involved a young woman with no contributory history who had minor same-day surgery. "She died from a DVT that developed shortly after discharge," says Conroy. "The decision making was not adequately documented, and the case was settled."
Internists and surgeons need to communicate about the patient's condition following surgery and the particulars about DVT prophylaxis, emphasizes Peter Espey, JD, an associate at Sharp & Mahoney in Cedar Knolls, NJ. Espey's firm has defended several physicians named in lawsuits alleging that DVT prophylaxis should have been prescribed after a surgery or that the patient should have been kept on the prophylaxis longer.
The cases involved patients who were put on blood thinner to prevent DVT after surgery. "Either there is a disagreement for clinical reasons about how long to keep the patient on the blood thinner, or there is a mistake and the patient is taken off too soon," says Espey. Other cases have alleged failure to diagnose or suspect DVT after examination. These are typical issues in claims involving DVT:
Whether ultrasonography was ordered for patients when DVT is suspected.
When, what type, and for how long DVT prophylaxis was prescribed.
"There does appear to be differences of opinion between specialists as to which medication should be used and how long to use it," Espey says. This disagreement means the jury has to evaluate whether it was a reasonable exercise of medical judgment for the physician to discontinue the medication at a certain point in time.
"There may have been good reasons to have discontinued the blood thinner," says Espey. "Thorough and clear documentation is helpful."
The idea that a blood thinner should have been used to prevent a blood clot can be appealing from a plaintiff's perspective. "This type of allegation can be easier to present to a jury through expert testimony than other more complex alleged deviations from the standard of care," Espey explains.
The time and method of communication and what was communicated.
Documentation of the communication between physicians in the different specialties can prove crucial, says Espey, as well as communication between the physician and the patient.
"This includes the nurses and people working for the physicians," says Espey. "Without the documentation, it is hard for them to remember what happened, or they may not have been told." (See related stories on practices that increase legal risks, below; and documentation that can help to defend a missed pulmonary embolism claim, p. 91.).