In one malpractice case, a 71-year-old female had an angiogram of her chest in February 2012 to rule out a pulmonary embolism (PE). The PE was ruled out, but an incidental finding of a 3.4 cm left axillary mass was noted on the report.
"The primary care physician documented his review of the report but failed to notify the patient of the mass," says Nancy Meyers, JD, an attorney at Ward Black Law in Greensboro, NC. Six months later, the patient palpated the mass and sought treatment that revealed that she had Stage 4 metastatic breast cancer.
In a similar case involving an 82-year-old man, a CT of the chest revealed an opacity within the anterior right lower lobe with somewhat nodular appearance. Follow-up evaluation was recommended in the report, which was received by the primary care physician. However, no report was made to the patient regarding the nodular opacity and no follow-up evaluations were conducted.
"Almost three years later, the patient developed pulmonary symptoms. A CT of the chest confirmed lung cancer in the right lower lobe. The patient expired later that year," says Meyers.
In both of these cases, the physicians documented that they received the report, signed off on the report as having been reviewed, yet failed to take action as recommended in the report. "This made the cases very difficult to defend," says Meyers.
Systems errors can harm
Often, there is an appropriate read on a study, but a systems error leads to harm of the patient due to delayed treatment or diagnosis, says Jennifer L'Hommedieu Stankus, MD, JD, an attending physician at Group Health Physicians, a Seattle-based multi-specialty group practice and former medical malpractice defense attorney.
"Missed diagnosis on radiologic studies is a common area of liability, and it is one that will continue to be, especially if safeguards are not put in place," she says.
L'Hommedieu Stankus recommends these practices:
- It should be standard operating procedure to get a call back on all radiology studies with a positive finding, including over reads that might be done the following day.
- There should be mechanisms in place for specific diagnoses, such as lung nodules, so that follow-up on the patient is set in motion and so that the patient is made aware of the abnormal finding.
As a standard practice, physicians always should read their own studies, read the radiologist's interpretation, and speak with the radiologist if there are any questions, advises L'Hommedieu Stankus.
"If the radiologist is not available, and you still have concerns or questions about the study, run it by another physician such as a general surgeon or a neurologist, depending upon what it is you are looking for," she says.
Liability for a "missed read" might fall solely on the radiologist or both the radiologist and the physician, depending upon the situation, says L'Hommedieu Stankus.
"The truth is, that even when a radiologist, a specialist in reading studies, misses a diagnosis, the physician caring for the patient will also be named," she says.
Once a radiologist notifies a physician about an abnormal finding, it becomes the responsibility of that physician to get the information to the patient, adds L'Hommedieu Stankus.
"How liability is apportioned will depend, in part, on what state the physician is in," she adds. "State law on liability varies, even on joint and several liability issues."