Radiology – Leader in Allied Health Negligence

Radiology as an applied health field is an essential part of the diagnoses to many health care professionals. The areas where negligence can occur are many within this field and thus the rate of occurrences are higher than other comparable fields. Negligence can be as simple as a misinterpretation of films to as complex as miscommunications between the physician and the radiologist. Many instances have occurred where there is a breakdown in communication between the readings to the actual “receipt of information” by the physician in charge of the patient. Everyone is considered liable or responsible for their actions (Fremgen, 2009), which is why the responsibility of the Radiologist to the patient falls equally, in addition the that same responsibility of the physician.
“Approximately 4% of radiologic interpretations rendered by radiologists in their daily practice contain errors. Fortunately, most of these errors are of such minor degree, or if serious are found and corrected with sufficient promptness, that they do not cause injury to patients.” (Berlin, L., 2007) Despite these errors, the actual harm to the patient is limited in the radiologic field, and yet the occurrence for medical malpractice lawsuits is still relatively high. In many cases a judge can rule that the diagnostic error was committed by a radiologist thus was the result of negligence and therefore the radiologist will be held.
The medical practice of x-ray was developed by Wilhelm Rontgen about a hundred years ago, and at the time it was proclaimed as a great breakthrough in medicine that would help eliminate misdiagnosis. As the practice developed it became a means of looking inside a patient's body and the use for diagnostic evidence has increased through other forms of radiology such as CT Scans, Sonograms and Ultrasounds which are considered common practice today.
The range of available radiologic techniques are varying as they include imaging machines including Ultrasound, Computed Tomography (CT), Nuclear Medicine, Positron Emission Tomography (PET) and Magnetic Resonance Imaging (MRI) available in most hospitals around the world. “With the increasing sophistication of these diagnostic techniques, they offer huge benefits to patients in terms of reducing the need for exploratory operations or other painful, and less reliable, methods of ascertaining the causes of a medical problem and as a precursor to effective treatment.”(Pinto, A. & Brunese, L., 2010) As with the increased complexity of these techniques the job of a radiologist has developed into a more difficult task with the function of interpreting the images and then making a diagnosis which is then referred to a doctor.
Most patients expect radiology to be 100% accurate, 100% of the time but where there is human judgment as well as skill, this gives room for error as well as the possibility of a medical negligence case if a misdiagnosis or failure of a reporting system is involved. A case where an oncology patient can be victim to this discrepancy is the delay in identifying a potentially cancerous entity that could or does pilot the spread of the cancer. Administrative mistakes also prove to be proponents for failure in the care of the patients as they can be a failure to recall and/or record patients which is also ground for negligence. Radiologists have the responsibility to correspond with the treating physician clearly as well as efficiently to their colleagues and the patients, both by writing and in person, should any abnormality be found through in scans, thus needing an urge of speed in action, especially if there is any likelihood of the seen condition determining to be life-threatening.
Failed communications in health care lawsuits unfortunately are not rare. One of the singularly most common causes of medical malpractice litigation regarding in the United States is “failure to diagnose,” but data from medical malpractice insurance companies show that the second most common cause is failure to communicate results of radiologic examinations. (Pinto, A. & Brunese, L., 2010) The fact of the matter is the data shows that communication problems are at least a causative factor in up to 80% of medical malpractice cases, according to Pinto and Brunese. Despite this statistic, it is relatively common knowledge. Additionally, another study found that physicians failed to acknowledge 36% of abnormal radiologic results; 4% of these, many of which made reference to a possible cancer, were lost to follow-up. (Pinto, A. & Brunese, L., 2010)
With the increases in today’s available manners of communication, the manner by which medical information is transmitted today can be relatively conducive to communication breakdown between the referring physicians and radiologists. With the increase in regulations regarding HIPPA and other health care record communications security, the awareness of this can both liberate and inhibit the communications between practicing professionals. “The typical primary-care physician receives 800 chemistry reports, 40 radiology reports and 12 pathology reports a week. In the hospital environment, a recent study found that direct communication between hospital-based physicians and primary care physicians occurs only infrequently (3% to 20% of the time).” (Pinto, A. & Brunese, L., 2010)
With the increasing prevalence of communication lawsuits in Radiology, the American College of Radiology (ACR) surveyed that almost 25% of respondents acknowledged being involved in at least 1 malpractice lawsuit involving failure of communication, with indemnification to the plaintiff averaging $2 million.(Jaffe, Nelson, DeLong, & Paulson, 2004) The quantity of negligence lawsuits involving that of failed communication, and with the naming of a radiologist as either a defendant or a codefendant, is on the rise as well as the amount of the settlements which have grown significantly in relation to the same increase.
Some may ask what really is the obligation of the radiologist in regards to that communication being sought out? The legal duties as enunciated by a myriad of state and supreme courts seem rather clear-cut regarding these duties. One of the first court decisions regarding radiologists’ communications and the malpractice that results from it, dates back to a case in 1971. This case is where a federal court in Indiana ruled on a case involving a radiologist who on Christmas day dictated a radiography report that raised suspicion of a skull fracture. Although the radiologist knew the report would be delayed several days because of the holiday, he made no effort to telephone the findings to the referring physician. The patient sustained irreversible neurologic damage as a result, and a medical malpractice lawsuit was filed.” (Pinto, A. & Brunese, L., 2010) The court stated the radiologist was indeed negligent, because he knew that there would be a delay in the transcription of his report. Because the radiologist noted the likelihood of the serious injury, “he” then should have taken due care that would require that he telephone his report to the attending physician.
Another case in 1989 where the Arkansas Supreme Court decision involving a radiologist’s failure to communicate in timely fashion concurred that; when a patient is in peril of his life, it does him little good if the examining doctor has discovered his condition unless the physician takes measures and informs the patient, of that fact. (Pinto, A. & Brunese, L., 2010)
Other subsequent court decisions since these early cases have begun to focus not only on the radiologist’s duty to communicate with referring physicians, but also to patients themselves. A United States federal appeals court even held a radiologist liable because he failed to communicate findings of a routine chest radiograph to a patient who then later died of Hodgkin’s disease, despite an earlier finding of which had been noted by the radiologist. (Pinto, A. & Brunese, L., 2010)
Diagnostic errors are imperative in all branches of medicine because they are an indication of poor patient care. Beginning as early as the 1970s, physicians have been subjected to an increasing number of medical malpractice claims. Radiology has been one of the specialties held most liable to claims of medical negligence because of their importance in diagnostic care. The singular most common complaint by a plaintiff’s against a Radiologist is the failure to diagnose. These errors can fall into numerous categories. Errors can arise from deficient techniques, failures in simple observations, a general lack of knowledge and misinterpretations. The work of diagnostic radiology consists of the complete detection of any and all abnormalities in an imaging examination as well as their accurate diagnosis. The spectrum of diagnostic errors in radiology that can occur with stresses on the malpractice issues in Mammography, Chest Radiology and Obstetric Sonography can be complex and varying in their degrees. Sometimes the simplicity of missed fractures in emergency situation and even communication issues between radiologists and physicians can be plaintive as well. (Berlin, 2010)
The importance in communications is imperative in diagnostic medicine as well as general medicine. The idea that the breakdown in communication between the health professionals and the patients can mean the difference between a speedy recovery and complicated treatment plan which could eventually lead to death. When a patient is able to receive accurate and timely results of a diagnostic scan, they can plan and prepare for a treatment regime that will assist in a recovery that is both beneficial for the patient as well as the practitioner. After all, any health professional is ultimately aiming for a patient that is healthy and happy, which is the Hippocratic Oath for the physicians and the Nightingale Pledge of the nurses.

References Berlin, L. (2007). International Journal of Business and Management. Radiologic Errors and Malpractice: A Blurry Distinction. American Journal of Roentgenology, 189:517-522 Berlin, L. (January, 2010). Failure of radiologic communication: An increasing cause of malpractice litigation and harm to patients. Applied Radiology. 39 (1-2): 17-22. Fremgen, B. (2009). Medical Law and Ethics (3rd ed.). Upper Saddle River, NJ: Prentice Hall.

Jaffe, T., Nelson, R., DeLong, D., & Paulson, E. (December, 2004). Practice Patterns in Percutaneous Image-guided Intraabdominal Abscess Drainage: Survey of Academic and Private Practice Centers. Radiology. 233, (750-756).

Pinto, A. & Brunese, L. (October 28, 2010). Spectrum of diagnostic errors in radiology. World Journal of Radiology. 2(10): 377-383.