Breast Cancer at the Center of Radiology Lawsuits

Roxanne Nelson

January 31, 2013

Most claims against radiologists result from errors in diagnosis, not procedural complications or failure to communicate or recommend additional studies.

The most frequently missed diagnosis is breast cancer. Procedural complications as a cause of malpractice lawsuits rank a distant second.

In a study published in the February issue of Radiology, researchers report data on 8401 radiologists in 47 states participating One-Call Medical, a provider organization offering diagnostic imaging services for the workers' compensation, group health, and auto insurance industries.

A key responsibility of radiologists is to interpret and communicate results of imaging studies to the referring clinician, explain Stephen R. Baker, MD, chair of the Department of Radiology at the University of Medicine and Dentistry of New Jersey–New Jersey Medical School in Newark, and colleagues. Dr. Baker is also medical director of credentialing for One-Call Medical.

"The idea of communication being a common cause of suits in radiology is an extrapolation of it being a common cause of many lawsuits in nonradiologists," Dr. Baker noted. When we talk about a communication error, radiologists aren't usually thought of as any different. That's why our data may be surprising to people."

However, with the exception of mammography, radiologists rarely deal directly with patients, he noted.

"It may be a subsidiary allegation, but not the primary one," explained Dr. Baker. In fact, failure to communicate and to recommend additional testing were found to be uncommon reasons for a lawsuit.

In mammography, most of the suits result from the lack of detection or recommendation for biopsy of a lesion that turns out to be cancer, he added. "But the problem is that mammography is not the best tool for finding consequential lesions in dense breasts or in women in their 40s," he explained.

Another common cause of lawsuits is missing a fracture in the foot, he continued. "Many of the things that we think would be major causes of suits aren't, such as missing a bleed in the head. That is hardly ever the cause of a malpractice suit."

Study Details

Malpractice lawsuits are a continuing concern for radiologists; they are not rare in this specialty and are not declining in frequency. Even though only 3.6% of all American physicians are radiologists, among all specialists they were sixth in the number of closed claims against them from 1985 to 2002, according to the Physicians Insurers Association of America.

Dr. Baker and colleagues analyzed 4793 claims filed against 2680 radiologists; an alleged cause could be derived from the narrative for 4043 (84%) claims.

Among radiologists who had been the subject of at least 1 claim, the most common claims were for failure to diagnose (39.07 per 1000 person-years; 95% confidence interval [CI], 37.62 - 40.58). The second most common claims were for procedural complications (4.64 per 1000 person-years; 95% CI, 4.14 - 5.20).

Among all radiologists, there were 14.83 claims per 1000 person-years for errors in diagnosis (95% CI, 14.19 - 15.51). Procedural complications ranked a distant second, with a rate of 1.76 per 1000 person-years (95% CI, 1.58 - 1.96). For radiologists who had only a peripheral role, the rate was 0.92 per 1000 person-years; for failure of communication with another provider, the rate was 0.71; for failure to recommend more testing, the rate was 0.41; and for inadequate communication with the patient or the patient's family, the rate was 0.40.

Breast cancer was the most common generic error subject to an initial malpractice suit for failure of diagnosis, with a rate of claims 3.57 claims per 1000 person-years (95% CI, 3.26 - 3.91). This was followed by musculoskeletal disease; for injuries of all nonvertebral bones, the rate of claims was 2.49 per 1000 person-years (95% CI, 2.28 - 2.72), and for injuries of the vertebrae, it was 1.32 (95% CI, 1.16 - 1.49].

Also common were claims for pulmonary diseases, such as missed lung nodules (1.26 per 1000 person-years; 95% CI, 1.11 - 1.42) and gastrointestinal disease (1.25; 95% CI, 1.10 - 1.41), which included bowel perforation, bowel obstruction, colon cancer, gastric cancer, and esophageal cancer.

The authors have disclosed no relevant financial relationships.

Radiology. 2013; 266:548-554. Abstract