News: A patient underwent a routine screening mammogram. The radiologist who reviewed the mammogram did not find any suspicious results, and recommended another screening in a year. The patient reported pain and a lump, but never spoke with the radiologist. A year later, the patient was diagnosed with breast cancer.

The patient filed a lawsuit against the radiologist, the radiology practice group, and others. The radiologist and the practice group sought dismissal from the case based on their adherence to their limited duty to read and interpret the images, which they did. A trial court denied that motion, but an appellate court reversed the determination, finding the radiologist and practice group only had a limited duty to the patient.

Background: In April 2010, a female patient’s physician referred her for a mammogram. The referral was faxed the same day to a radiology practice group. The referral did not specify whether it was for screening or diagnostic purposes, and did not indicate any particular patient complaint.

When the patient underwent the mammogram the following day, she reported to an employee at the imaging company that she felt a lump in her breast. She was informed her physician schedule the mammogram as routine. The patient’s paperwork, signed by the patient herself, confirmed the reason for the mammogram was routine, but also noted she experienced pain and/or soreness in her left breast. It did not mention a lump.

A radiologist read and interpreted the patient’s mammogram. The radiologist’s report noted the purpose was a routine screening and stated there were no suspicious mammographic findings. The radiologist recommended another routine screening in one year. Despite a mistake in the report, the radiologist and radiology group claimed that given the lack of suspicious findings, the recommendation would not have changed. The radiologist never spoke with the patient, and never spoke with the patient’s prescribing physician.

In May 2011, the patient was diagnosed with cancer in her left breast. The patient sought treatment, but died in August 2014. Before her death, the patient filed a medical malpractice action against the radiologist and radiology practice group, among other individuals and entities. The patient alleged the radiologist and the practice group ignored her complaints of breast pain and feeling a lump, which constituted negligence. After the patient died, the administrator of her estate amended the lawsuit to seek additional damages for wrongful death.

While the defendants generally denied liability, the radiologist and radiology group specifically challenged their liability by bringing a motion for their dismissal from the case. The defendants alleged their duty was only to read the mammography images and to document findings, and that as a matter of law and fact, they abided by this duty. The trial court denied the radiologist and the group’s motion. The defendants appealed.

Upon review, the appellate court disagreed with the trial court. The court recognized that while physicians owe a general duty of care to patients, the scope of that duty may be limited to the specific medical functions undertaken by the physician and relied on by the patient. The court confirmed the defendants discharged their duty in accordance with accepted practices for radiologists, a finding that was supported by the defendants’ expert.

Furthermore, the appellate court found a formulaic closing sentence in the radiology report, thanking the referring physician “for the opportunity to participate in the care of this patient,” did not change the applicable standard of care for a limited-scope physician. The court expressly stated “politeness alone will not give rise to a heightened duty of care.” Because of the defendants’ adherence to accepted radiology practices, the court ruled the trial court should have granted the defendants’ motion and dismissed them from the case.

What this means to you: This case demonstrates both procedural and substantive defenses for physicians and care providers. For the procedural side, the reversal by the appellate court reveals defendants in malpractice cases need not always wait for a jury to determine the care provider did not act negligently. During litigation, there are various mechanisms defendants can use to seek adjudication before trial, including the mechanism used in this case: a motion for summary judgment. When the relevant material issues of fact are not disputed, and when those facts reveal the defendant is not liable, then a motion for summary judgment is proper. There is no need to wait for a jury, as courts rule on these motions on their own.

Such early affirmative efforts can be invaluable to physicians and care providers, as these may result in early dismissals and prevent further attorneys’ fees and costs associated with trials, which are significant. While courts apply high standards for granting such motions, it is worth consulting with counsel to determine if such a motion is appropriate given the particular circumstances, as an early victory may be worth the time and effort.

In this case, the malpractice litigation was brought against multiple physicians and care providers, but this appellate decision was focused on the radiologist and radiology practice group. These care providers’ involvement in the patient’s evaluation and treatment was limited, as they were only required to undertake the function of reading the mammography images and documenting those findings. Thus, if the interpretation was consistent with accepted radiology practices and relayed to the proper physician, the radiologist and radiology practice group could not be liable as a matter of law, regardless of how the treating physician acted with the results from the report.

According to the appellate court, this is precisely what occurred. That finding was supported by the defendants’ expert, who opined the interpretation of the mammogram conformed with accepted practices. This decision, like the underlying motion, was limited to the radiologist and radiology practice group. This reveals another important lesson: Multiple physicians and care providers all may be lumped together in a medical malpractice action as defendants, as patients seek to place blame on anyone and everyone involved in treatment (which may be many different individuals or groups), but each individual and entity is distinct.

An appropriate defensive mechanism for one individual or entity might not be appropriate for a different party. Here, the defendants were not involved much with the patient’s medical care, and thus held a narrower duty to the patient. Additionally, the defendants never directly interacted with the patient, or even with the patient’s prescribing physician about the patient. This was not a circumstance where a group of treating physicians collaborated on the course of treatment. Instead, the defendants performed a narrow function of interpreting images and relaying those findings to others who were then responsible for taking the necessary measures. Physicians and care providers should evaluate the scope of their care with an eye toward the associated duties owed to the patient, as those duties may be limited. When a duty is limited, it might be easier for a physician or care provider to demonstrate there was no departure from the duty, or that any departure did not cause any harm to the patient.

On the substance of the defense, the court agreed the defendants did not deviate from the applicable standard of care for radiologists. For this, the importance of experts is yet again confirmed: The appellate court relied on the testimony of the defendants’ expert. The court recognized the defendants satisfied their duty of care to the patient, and the patient presented no evidence to the contrary. The court was not persuaded by the patient’s argument that her statement in her paperwork about breast pain gave rise to a heightened duty; the defendants were only interpreting the mammography images and reporting those findings. Beyond that, the defendants bore no duty to the patient.

It is worth noting one appellate judge disagreed with this result, arguing the defendants’ regular practice was to provide recommendations of further clinical care and diagnostic testing depending on the patient’s symptoms at the time of a mammogram, as well as the result of the mammogram itself. According to the dissenting judge, the radiologist’s erroneous notation the patient was “asymptomatic” revealed the physician assumed a more expansive duty of care to the patient, and the patient’s other medical records should have revealed further testing or care was necessary. While the majority of the court rejected that opinion, a different court could reach a different conclusion and determine a radiologist’s interpretation alone was insufficient to satisfy the standard of care when the radiologist knows the patient suffered from pain or reported a lump.

If the referring physician knew of the patient’s symptoms, that should have been written on the requisition for the mammogram. In addition, there is an opportunity for the radiology technician to ask the patient if she is experiencing any symptoms. A negative mammogram is not the diagnosis if the clinical picture does not fit. Further studies, such as ultrasound evaluation, should have been considered. A call to the radiologist from the physician, describing the patient’s symptoms, might have been key in this case. This failure to communicate critical information is too common a risk in healthcare settings. Efforts should be made by all involved in patient care to be aware of this. Electronic medical records are designed to reduce this risk if access is made available to all involved practitioners.

REFERENCE

  1. Decided June 23, 2021, in the Supreme Court of the State of New York Appellate Division, Second Judicial Department, New York, Case Number 2018-031614.