Updates in medical professional liability: a primer for electrophysiologists

  • Christopher AustinEmail author
  • Fred Kusumoto


Medical professional liability (MPL), traditionally known as medical malpractice, affects most electrophysiologists some point during their career, either directly through personal experience or indirectly by the experiences of colleagues. Despite this, most physicians struggle to accurately describe MPL in the context of clinical practice. Providers know little about the outcomes of malpractice claims as reporting of settled or litigated MPL cases is sparse in the medical literature. In the USA, individual patients can file a malpractice claim in a tort-based system, whereas in other parts of the world, no-fault malpractice systems are increasingly prevalent. Tort reform remains a topic of much debate as the economic costs of malpractice contribute to the ever-expanding costs of health care in the USA. This review provides a framework to define MPL, describes the tort and no-fault systems of malpractice, and details the economic impacts of MPL on health care and the practice of cardiology in the USA. Current policy trends towards MPL including tort reform are reviewed, and MPL as it relates to the practice of cardiac electrophysiology is detailed.


Medical malpractice Malpractice Medical professional liability MPL Cardiology Electrophysiology Tort 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Thirumalaikolundusubramanian P, Meenakshisundaram R, Senthilkumaran S. Ethics, legality, and education in the practice of cardiology. In: Heart and toxins. New York: Elsevier; 2015. p. 595–623. Scholar
  2. 2.
    Fisher M, Schneider P. Stroke and the law: principles and practice. Stroke. 2014;45:3141–6. Scholar
  3. 3.
    Sanbar S, Warner J. Medical malpractice overview. In: Sanbar S, Firestone M, Fiscina S, LeBlang T, Wecht C, Zaremski M, editors. Legal medicine. 7th ed. Philadelphia: Mosby Elsevier; 2007. p. 253–64.Google Scholar
  4. 4.
    Moffett P, Moore G. The standard of care: legal history and definitions: the bad and good news. West J Emerg Med. 2011;12(1):109–12 Accessed 5 Aug 2018.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Howard M. Physician-patient relationship. In: Sanbar S, Firestone M, Fiscinac S, LeBlang T, Wecht C, Zaremski M, editors. Legal medicine. 7th ed. Philadelphia: Mosby Elsevier; 2007. p. 315–24.Google Scholar
  6. 6.
    Oetgen WJ, Parikh PD, Cacchione JG, et al. Characteristics of medical professional liability claims in patients with cardiovascular diseases. Am J Cardiol. 2010;105(5):745–52. Scholar
  7. 7.
    Bank W. Medical malpractice systems around the globe: examples from the US- tort liability system and the Sweden- no fault system (English). Washington, DC. 2003;World Bank:1–37.
  8. 8.
    Kessler DP. Evaluating the medical malpractice system and options for reform. J Econ Perspect. 2011;25(2):93–110 Accessed 6 Aug 2018.CrossRefGoogle Scholar
  9. 9.
    Gaine WJ. No-fault compensation systems. BMJ. 2003;326(7397):997–8. Scholar
  10. 10.
    Cooper JK. Sweden’s no-fault patient-injury insurance. N Engl J Med. 1976;294(23):1268–70. Scholar
  11. 11.
    Mello MM, Chandra A, Gawande AA, Studdert DM. National costs of the medical liability system. Health Aff (Millwood). 2010;29(9):1569–77. Scholar
  12. 12.
    Seabury S, Chandra A, Lakdawalla D, Jena AB. Defense costs of medical malpractice claims. N Engl J Med. 2012;366(14):1354–6. Scholar
  13. 13.
    Schaffer AC, Jena AB, Seabury SA, Singh H, Chalasani V, Kachalia A. Rates and characteristics of paid malpractice claims among US physicians by specialty, 1992–2014. JAMA Intern Med. 2017;177(5):710–8. Scholar
  14. 14.
    Studdert DM, Mello MM, Gawande AA, Gandhi TK, Kachalia A, Yoon C, et al. Claims, errors, and compensation payments in medical malpractice litigation. N Engl J Med. 2006;354(19):2024–33. Scholar
  15. 15.
    Jena AB, Seabury S, Lakdawalla D, Chandra A. Malpractice risk according to physician specialty. N Engl J Med. 2011;365(7):629–36. Scholar
  16. 16.
    Mangalmurti S, Seabury SA, Chandra A, Lakdawalla D, Oetgen WJ, Jena AB. Medical professional liability risk among US cardiologists. Am Heart J. 2014;167(5):690–6. Scholar
  17. 17.
    Clinton HR, Obama B. Making patient safety the centerpiece of medical liability reform. N Engl J Med. 2006;354(21):2205–8. Scholar
  18. 18.
    S. 1784 — 109th Congress: National MEDiC Act. Published 2005. Accessed 3 Apr 2018.
  19. 19.
    Dove JT, Brush JE, Chazal RA, Oetgen WJ. Medical professional liability and health care system reform. J Am Coll Cardiol. 2010;55(25):2801–3. Scholar
  20. 20.
    Wilson H, Wilson JS, Ryan F. Tort reform and the cardiologist. J Am Coll Cardiol. 2017;70(2):290–2. Scholar
  21. 21.
    Sattia N, Hodge S. Physician apologies. Pract Lawyer. 2011;Fall:35–43.Google Scholar
  22. 22.
    Saitta N, Hodge SD. Efficacy of a physician’s words of empathy: an overview of state apology laws. J Am Osteopath Assoc. 2012;112(5):302–6. Scholar
  23. 23.
    Sattia N, Hodge S. Is it unrealistic to expect a doctor to apologize for an unforeseen medical complication?—a primer on apologies laws. Pennsylvania Bar Assoc Q. 2011;July:93–110.Google Scholar
  24. 24.
    Stewart RM, Love JD, Rocheleau LA, Sirinek KR. Tort reform is associated with more medical board complaints and disciplinary actions. J Am Coll Surg. 2012;214(4):567–71. Scholar
  25. 25.
    McMichael BJ, Van Horn RL, Viscusi WK. Sorry is never enough: the effect of state apology laws on medical malpractice liability risk. SSRN eLibrary. (forthcoming 2018). doi:
  26. 26.
    Mangalmurti S. Avoiding lawsuits: understanding cardiology malpractice claims. CardioSource WorldNews. Published 2015.
  27. 27.
    Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Hear Rhythm. 2017;14(10):e275–444. Scholar
  28. 28.
    Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, et al. Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation. 2005;111(9):1100–5. Scholar
  29. 29.
    Sobolev M, Shiloh AL, Di Biase L, Slovut DP. Ultrasound-guided cannulation of the femoral vein in electrophysiological procedures: a systematic review and meta-analysis. Europace. 2017;19(5):850–5. Scholar
  30. 30.
    Tanaka-Esposito CC, Tchou P. Ultrasound guided vascular access in the electrophysiology lab: should it be a standard of care? J Interv Card Electrophysiol. 2017;49(1):1–2. Scholar
  31. 31.
    Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, et al. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol. 2010;3(1):32–8. Scholar
  32. 32.
    Slotwiner D, Varma N, Akar JG, et al. HRS expert consensus statement on remote interrogation and monitoring for cardiovascular implantable electronic devices. Hear Rhythm. 2015;12(7):e69–95. Scholar
  33. 33.
    Vinck I, De Laet C, Stroobandt S, Van Brabandt H. Legal and organizational aspects of remote cardiac monitoring: the example of implantable cardioverter defibrillators. Europace. 2012;14(9):1230–5. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of CardiologyUniversity of FloridaGainesvilleUSA
  2. 2.Division of Cardiovascular DiseaseMayo Clinic FloridaJacksonvilleUSA

Personalised recommendations