ABSTRACT
Litigation is a not uncommon occurrence when a patient has suffered harm because ofheparin-induced thrombocytopenia (HIT) due to alleged physician or nursing "malpractice" (more properly termed professional negligence). One reason may be the general increase in medicolegal actions (Mello et aI., 2003) including those involving issues of thrombosis and antithrombotic therapy, especially in the United States (McIntyre, 2001). Regarding HIT in particular, one explanation could be the legal concept of res ipsa loquitur ('the thing speaks for itself'), i.e., the situation of a patient who enters the hospital for elective surgery and leaves with an amputated limb may itself "speak" persuasively to a jury that someone somehowmust have been at fault for such a tragic outcome to have occurred (Kelton, 1998). Further, the patient may
have been unaware of such a potential catastrophic outcome, as physicians usually do not specifically include HIT and its attendant complications when obtaining informed consent. The tendency for a finding ofsubstandard care to occur more frequently when harm is severe ("outcome bias") exists even though outcome per se is a poor index ofblameworthiness (Caplan et aI., 1991; Runciman et aI., 2003).
