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03-10-2011 | Article

Autopsy helps anesthesiologists’ malpractice claims


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MedWire News: Autopsy findings are more likely to be helpful than harmful to anesthesiologists defending a claim of malpractice after a patient death, show US study results.

Anesthesiologists should therefore encourage the use of autopsy, particularly in cases where perioperative death is unexpected or has an apparently ambiguous cause, say the researchers.

"With the increasing sophistication of imaging technology, clinical laboratory testing, and specialized pathologic techniques such as immunohistochemistry, flow cytometry, molecular diagnostics, and cytogenetics, many fatal diseases may be diagnosed before death, resulting in a declining interest in autopsy," they write, in the journal Anesthesiology.

"Nevertheless, diagnostic technologies do not necessarily provide comprehensive substitution for pre-existing methods, and studies continue to show that hospital autopsies are useful in the identification of cause of death or significant pathologic findings that were not diagnosed before death," they add.

Lorri Lee, from the University of Washington in Seattle, and co-workers evaluated data for deaths that occurred from 1990 onwards, detailed in the American Society of Anesthesiologists Closed Claims Project Database that includes malpractice claims and autopsy findings, when undertaken.

Among 980 claims for death during the period studied, 551 (56%) had an autopsy noted, with 288 having available data to review, and 429 claims had no autopsy indicated.

Autopsies provided unequivocal cause of death in 21% of the 288 claims with available data, and pathologic diagnoses but not unequivocal causes of death were identified in 69% of the 288 claims.

Unexpected pathologic information was revealed in 143 of the 288 deaths with reviewable autopsy data, and 61% found a significant nonanesthetic contribution to the deaths. Both unexpected information and nonanesthetic contribution appeared in 38% of cases, the most common in the latter group being cardiac disease, pulmonary emboli, and surgical complications.

Autopsy results were considered helpful to the anesthesiologists' defense in 56% of the 288 claims with available autopsy data, whereas the equivalent information was judged to be harmful in 26% of claims. In 18% of claims, the autopsy played a neutral role.

Lee and colleagues acknowledge that their study was significantly limited by a lack of standardized reporting among claims, in terms of autopsy information, and under-reporting could have occurred when autopsy reviewers "encountered unremarkable results."

More structured and standardized approaches to the investigation of anesthesia-surgical deaths have been proposed, they remark, including anesthesiologist consultants to evaluate anesthesia-specific issues.

"Adoption of more uniform medical and pathologic investigative procedures for [these deaths] would likely improve the quality of the objective pathologic information and the death investigation," the team concludes.

By Sarah Guy