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What Causes Medical Errors in Cardiology?

Written by Berkowitz

gavel with a stethoscope right next to it

The primary causes of medical errors in cardiology include diagnostic errors, a substandard performance of treatment, surgical errors, medication errors, inadequate record-keeping, and staff communication breakdowns. In 2020, you can probably add fatigue to that list, because healthcare providers are becoming burnt out due to the demands of the COVID-19 crisis.

What Cardiologists Do

Cardiologists diagnose, treat, and prevent heart disease, cardiovascular disease, and other health conditions relating to the heart and blood vessels. Unlike some medical specialties where surgery is prominent, cardiologists spend most of their time in diagnosis and testing.

A cardiologist’s patients generally come as referrals from primary care doctors or specialists in other fields. A patient may be referred to a cardiologist due to symptoms such as chest pain, shortness of breath, elevated heart rate, high blood pressure, or other telltale symptoms. Cardiologists also treat victims of heart attack or other heart conditions such as:

  • Congenital heart disease;
  • Heart arrhythmia;
  • Hypertension (high blood pressure);
  • Atrial fibrillation; and
  • Atherosclerosis.

Diagnostic testing includes EKG, ECG, and echocardiograms, among others. Some cardiologists, known as interventional cardiologists, also perform certain types of surgery such as angioplasty, valvuloplasty, stenting, and thrombectomies.

How cardiologists are organized

Cardiologists typically work in solo practice or with small groups of other cardiologists. They are almost always affiliated with a hospital. It has become a recent trend, however, for hospitals to purchase small cardiology practices and integrate them into the hospital’s own medical systems.

Regardless of their form of organization, cardiologists are usually closely affiliated with particular hospitals, and a great percentage of their patients have been admitted to the hospital as inpatients. Whether through acquisition or otherwise, most cardiologists have a standing affiliation with a hospital and a large part of their practice involves in-patient care.

Malpractice Claims against Cardiologists

Some types of doctors get sued for malpractice more than others, and cardiologists are among the most frequently sued doctors. In fact, nearly two-thirds of all cardiologists report having been named in a malpractice lawsuit at some point in their careers. One study found that from 2006 to 2015, cardiology malpractice claims have nearly doubled throughout the country. Most other medical specialties have not experienced the same increase.

Causes of Medical Errors in Cardiology

The number of medical errors that can harm a cardiology patient is too large to specify. Nevertheless, these errors do tend to cluster within a small number of categories as described below.

Diagnostic Errors

Diagnostic errors account for about 25% of all cardiology-related malpractice claims. Some of the more specific claims include:

  • Failure to order diagnostic tests when needed;
  • Failure to respond to abnormal test results;
  • Failure to use all available information to formulate a diagnosis;
  • Misdiagnosis of one condition as another – diagnosing myocardial infarction as aortic dissection, for example; or
  • Failure to diagnose a condition such as myocardial infarction because of recent normal results of an ischemic heart disease work-up (not always serious enough to justify a malpractice claim).

Keep in mind that mere failure to diagnose does not establish medical negligence if another reasonably competent doctor would have missed the diagnosis as well. Doctors are not expected to be perfect. Likewise, the occurrence of an adverse event such as a heart attack relatively soon after normal testing results does not by itself prove malpractice, because the condition could have developed after testing had already been completed.

Example of how a diagnostic error can lead to a wrongful death claim

A patient sees a cardiologist due to shortness of breath and other symptoms. The cardiologist performs basic testing, the results of which do not indicate a problem. Consequently, the cardiologist sends the patient home with instructions to contact him if his symptoms get any worse. Two weeks later, the patient dies of a heart attack that could have been diagnosed and treated with more extensive testing.

Substandard performance of treatment

Healthcare providers (not limited to doctors) have a professional obligation to comply with generally accepted professional standards of care when planning and executing the treatment. Some of the treatment issues that most commonly trigger malpractice lawsuits include:

  • Resorting to surgery or other risky and invasive procedures before first ruling out or attempting safer and less invasive approaches;
  • Failing to inform the patient of the risks of a particular medical procedure, or failure to present the patient with realistic treatment options; and
  • Failing to provide proper follow-up care.

Surgical Errors

The topic of surgical errors is a frightening one. Such errors, however, are all too common. This is especially true in cardiac surgery, because cardiac surgery is particularly complex and because the consequences of even a small error can be particularly far-reaching. Nevertheless, it is the very need for almost superhuman skill and endurance on the part of the surgeon that sometimes renders it difficult to win a malpractice claim over a surgical error.

Nevertheless, surgical errors are common enough that they are thought to represent the second leading cause of lawsuits against cardiologists. Some of these errors are mere human errors that do not rise to the level of malpractice, while others represent actionable medical negligence. Some of the most serious surgical errors include:

  • Performing the wrong procedure on the patient;
  • Operating at the wrong site;
  • Leaving a medical instrument inside the patient’s body after sewing him up; and
  • Administering an overdose of general anesthesia.

Medication Errors

Medication errors are one of the most common triggers for malpractice lawsuits against cardiologists. An inherent difficulty in this state of affairs is that some medications must be prescribed to cardiology patients. In fact, it would normally be malpractice to fail to prescribe them under many circumstances, yet these very medications carry inherent dangers that can, themselves, result in harm to the patient. Examples of dangerous medications include:

  • Anticoagulants such as warfarin, which inhibit blood coagulation. Not only does this guard against the formation of life-threatening blood clots, but it also renders the patient more vulnerable to excessive bleeding that could be life-threatening for a completely different reason.
  • Amiodarone, an antiarrhythmic that has triggered lawsuits over harmful side effects such as pulmonary fibrosis, the symptoms of which often do not manifest themselves until years after the commencement of treatment.

Inadequate Record Keeping

Unfortunately, there is no organized global (or even nationwide) medical records platform that can be absolutely trusted. Since most patients see multiple service providers over the course of their lifetime, it is up to the healthcare provider to provide accurate and complete medical records and to put these records onto the right platform so that the next healthcare provider can access them.

Failure to do so is a recipe for disaster. Imagine, for example, that a healthcare provider fails to properly document a patient’s allergy to a particular medication. A doctor can be sued for malpractice many years after the fact in cases where the malpractice is based on failure to properly update medical records.

Staff communication breakdowns

Cardiology is one of the branches of medicine that is most susceptible to the negative effects of a communication breakdown. A communications breakdown can occur between a healthcare provider and a patient, or between or among healthcare providers (between a doctor and a nurse, for example). Possible communication breakdowns include:

  • Miscommunication of a patient’s condition;
  • Incomplete, misleading, or illegible documentation;
  • Lack of informed consent from the patient;
  • Failure to appreciate the true gravity of a patient’s complaint (leading to failure to adequately respond);
  • Miscommunication concerning the dosage of medicine to administer (which can be deadly);
  • Wrong testing results are given to the patient (resulting in a false sense of security);
  • Inadequate follow-up instructions; and
  • Language barriers.

What You Have to Prove to Win a Malpractice Lawsuit against a Cardiologist

To win a malpractice lawsuit against a cardiologist, regardless of whether you are the victim or you represent someone who died as a result of medical treatment, you must prove each of the legal elements of a malpractice claim on a “more likely than not” (51%) basis.

  • A professional duty was owed to the patient by the healthcare provider (a doctor-patient relationship, for example). Such a relationship might not be present if, for example, the doctor was off-duty and rendered first aid on a heart attack victim in a shopping mall
  • Breach of duty (failure to treat the patient with the required standard of care). Normally,  an expert medical witness will be retained to testify as to exactly what the cardiologist’s duty was and whether the cardiologist breached that duty.
  • An injury caused by the breach. The causation factor might be absent if, for example, the cardiologist failed to diagnose a condition that was incurable and untreatable anyway. Even if such a condition killed the patient, the defendant could argue that the patient would have died even if no failure to diagnose occurred.
  • Resulting damages. Damages might include medical bills, pain and suffering, lost earnings, lost quality of life, and other tangible and intangible losses. All of these damages must be proven.

Berkowitz Hanna Stands Ready to Assist You

You might think you can’t afford a top-tier injury law firm like Berkowitz Hanna. The reality is quite different, however. Do you know how much it will cost you to retain us? Not a dime. You will not receive a bill from us until and unless we win your case and you actually receive the money. Essentially, it is the defendant who pays us, not you. If we don’t win, you don’t pay us anything – ever.

Malpractice cases are not easy to win, of course – many doctors will fight to the end to defend against what they see as an attack on their reputation. If you do win, however (and the vast majority of our clients do), you could be entitled to a lot more money than you think. Call Berkowitz Hanna directly, or simply contact us online to get the process started.