In Hospital Arrest and Medical Malpractice

Can improper cardiac resuscitation in a hospital setting support a medical malpractice lawsuit?  A recent study published in the British Medical Journal (BMJ) provides a great example of when an actionable medical malpractice claim exists and when one does not.  The BMJ article reports findings from a large patient registry published as part of the American Heart Association’s Get with the Guidelines Resuscitation initiative.  

The Get with the Guidelines Resuscitation registry reviewed records from several thousand patients. In one analysis, the study showed that roughly half of patients with an in-hospital cardiac arrest and a shockable rhythm received epinephrine too soon after the first defibrillation.  Defibrillation is when an electric shock is administered to the patient in an attempt to convert their cardiac rhythm from potentially fatal arrhythmia to normal rhythm. Defibrillation terminates a malignant rhythm and effectively “resets” the heart.  American Heart Association guidelines recommend deferred epinephrine administration after a first shock. Patients who received epinephrine too soon, compared with those who did not, suffered a 30% reduced chance of survival, of return to spontaneous circulation or of a good functional outcome.

How does this study factor into a legal analysis?  In medical negligence lawsuits, the patient has the burden of proving both that the defendant physicians or residents failed to follow accepted standards of medical care. But they must also prove that harm resulted. The BMJ study shows that both negligent resuscitation efforts occur and it directly results in harm.

The second part of the study published by the British Medical Journal showed that hospitalized patients with a persistent ventricular tachycardia or fibrillation were frequently subjected to a second defibrillation within one to 3 minutes of the first shock. The incidence of a second defibrillation rose from 26% to 57% between 2004 and 2012. The use of a second defibrillation is not associated with an improved survival. Further, a 2005 American Heart Association guidelines supports the strategy of an early second shock.

Analyzing this research in the context of a medical malpractice lawsuit, it is clear that a claim for medical negligence could not be based on this unnecessary practice. First, the practice appears to be supported by existing medical guidelines. Second, though the strategy confers no benefit, it confers no harm other than the actual shock. This would not constitute sufficient damages to support a medical malpractice claim, particularly if the patient has died as a result of the initial ventricular arrhythmia.

Given the complex nature of medical malpractice litigation, it is important to hire an experienced medical negligence lawyer in Cleveland, OH, like from Mishkind Kulwicki Law Co., L.P.A., to determine whether a medical error, medical mistake or act or omission of medical negligence supports a claim for medical negligence. This brief analysis of the results of the British Medical Journal shows two instances where medicine being practiced outside accepted standards result in very different legal assessments.