While reading a patient's MRI, a radiologist observed a flattening of the spinal cord at the C6-C7 level, which was considered a critical finding.
"The physician prepared a preliminary report and instructed his assistant to communicate the findings to the ordering physician, stat," says Stephen Shows, a risk management consultant for ProAssurance Companies in Birmingham, AL.
The assistant did so, but "the problem was that the ordering physician was the primary care physician, who had since referred the patient to a specialist," says Shows. The primary care physician assumed the specialist would communicate the results to the patient, but the specialist never received the results. "There was nothing to notify the radiologist he should send a copy to the specialist," Shows says. "As a result, there was a three-day delay in communicating the results to the patient, who eventually suffered paralysis."
The patient claimed this outcome could have been avoided had his results been better communicated, and the patient sued the radiologist and the specialist. The claim against the radiologist eventually was dismissed.
"He was able to show he met the standard of care by having his office timely communicate the findings to the ordering physician," says Shows.
Charting can prevent claims
In a 2012 study by the Physician Insurers Association of America (PIAA) examining closed claims involving radiologists from 2012, 17 reported cases alleging failure to instruct or communicate with patient. Of those, five cases resulted in some type of indemnity payment.1
To avoid claims with these allegations, Shows says that a radiologist should document when, how, and to whom the results were communicated. "Without good documentation on any of these steps, the radiologist and the staff can only rely on memory. The better the documentation, the stronger the case," he says.
For the ordering physician, documentation demonstrating good tracking can prevent claims, says Shows. "If there is documentation showing the ordering physician called on a particular date to inquire about the results of a study, the patient may be less likely to find fault with the ordering physician," he explains.
James W. Saxton, Esq., an attorney at Stevens & Lee in Lancaster, PA, commonly sees claims with these allegations:
. The ordering physician failed to follow up after receiving test results.
. The physician who received a copy of the test results, but was not the ordering physician, did not follow up with the patient and should have.
For example, primary care physicians who receive a copy of a report about X-rays ordered by a surgeon can find themselves a defendant in a case alleging failure to diagnose related to an incidental finding identified in the report. (See related story on incidental findings, p. 118.) "A strong test-tracking policy can help prevent both of these situations from occurring and can help defend such a case, should it be filed," says Saxton.
The policy should specify the process for documenting receipt and review of results, as well as the process for notifying the patient about recommended follow-up, he says. "Follow-up on 'courtesy copies' of test results can include communication with the ordering physician as well as with the patient," Saxton adds.
Once the test-tracking policy is in place, says Saxton, practices should "make sure that the policy is being followed, and that it is achieving the desired result."
Breakdowns result in claims
Shows says that a practice's tracking system should verify the following:
- The test was performed.
- Results were reported to the physician.
- The physician reviewed the results.
- The results were communicated to the patient.
- The results were acted upon.
A good tracking system alerts practices that patients have not been notified of the results of their studies. "A breakdown in any one of those steps could result in a delayed-diagnosis claim or failure-to-communicate claim," he warns.
Some practices rely on patients keeping their appointments to make sure the results are discussed with the patient. "This is a risky practice. If the patients do not keep the appointment, they do not receive the results," says Shows.
Shows discourages practices from telling their patients "if you don't hear from us, you can assume everything is fine."
"If the practice itself never receives the results, the patient is left assuming everything is fine, even though it may not be," says Shows. "All results, good or bad, should be communicated to the patients."
- Physician Insurers Association of America. PIAA 2013 Risk Management Review - Radiology 2014.
James W. Saxton, Esq., Stevens & Lee, Lancaster, PA. Phone: (717) 399-6639. Fax: (610) 236-4181. E-mail: JWS@
- Stephen Shows, Risk Management Consultant, ProAssurance Companies,Birmingham, AL. Phone: (205) 877-4487. Fax: (205) 868-6407. Email: email@example.com.