Pulmonary embolism and malpractice claims

Background. Deep venous thrombosis (DVT) with pulmonary embolization (PE) o ften occurs as an unexpected event with fatal consequences. This provides a setting for malpractice claims. Methods. We reviewed 160 consecutive malpractice claims submitted by attorn eys for medical expert review during the 11-year period ending in 1997. Sev en cases involved DVT with PE. Results. Alleged failure to anticipate and reduce the chance of PE was the basis for six of the claims. All six patients were at risk for lower extrem ity DVT: and one had a history of DVT 6 months earlier. The PE was manifest ed by sudden death in three cases. The seventh case represented a complicat ion of heparin therapy for PE. Conclusions. We conclude that risk management for PE should focus primarily on DVT. Physicians should perform and document an examination for DVT when ever there is a history of lower extremity stasis or it is likely to occur. They should also consider documenting a concurring second opinion when mak ing anticoagulant-related decisions.