Rads have coin-flip odds of being sued, but risk of adverse judgment low

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Nearly half of all radiologists have been sued at least once, with women’s imaging and lung imaging cases among the most common liability claims, according to an article published in the October issue of the Journal of the American College of Radiology.

Despite the high odds of a radiologist being involved in a medical liability suit, the risk of adverse judgment or settlement is relatively low, explained authors Norman B. Thomson III, MD, of Georgia Health Sciences University, and Mohini Patel, JD, of Dickason Law Group, both in Augusta, Ga.

The authors cited a survey from 2008 which showed that 47 percent of radiologists had been sued. This is slightly higher than the average of 42 percent for all physicians surveyed, but well below physicians working in obstetrics and gynecology or general surgery, specialties where over 69 percent of physicians have been involved in claims.

Half of radiology claims were due to errors in diagnosis, according to Thomson and Patel. Breast cancer, lung cancer and non-displaced spinal fractures were the most common conditions associated with “failure to diagnose” claims.

“These conditions are associated with dire consequences for patients if not diagnosed and treated early, are more likely to result in large judgments or settlements, and therefore are more likely to be pursued and brought to suit by the plaintiff's bar,” wrote the authors, who advised radiologists to pay special attention to breast, lung and spinal imaging studies.

Another major component of adverse claims against radiologists are communication failures, which were implicated in 30 percent of adverse claims involving radiologists in another study cited by Thomson and Patel. Despite widespread distribution of American College of Radiology communication guidelines, they noted that claims data from MAG Mutual Insurance Company, a medical liability insurer, indicate that suits related to communication failure are becoming more frequent.

Overall, the vast majority of medical liability suits are resolved without an adverse judgment against the defendant, according to the authors. Data from the Physician Insurers Association of America showed 65 percent of medical liability suits are dropped, dismissed or withdrawn, 25.7 percent are settled, 4.5 percent go to alternative dispute resolution and 5 percent go to trial. Of the cases that are tried, 90 percent are won by the defendant.

While this might seem to ease the concerns of physicians, Thomson and Patel argued that the fear of litigation still encourages the overutilization of diagnostic testing and causes radiologists to hedge their reports in many cases. They also claimed the current tort system fails to meet its goal of encouraging appropriate care.

“Compensation is capriciously awarded and distributed. The majority of medical errors do not result in claims or compensation. Often, large awards are given to undeserving patients who have experienced significant complications, without negligent care.”

Efforts to reform the tort system, such as placing caps on damages to limit the amount of recovery the harmed party may receive, have encountered political and practical challenges, wrote the authors, though less traditional reform options have had some positive results in limited trials. “Disclosure-and-offer” programs, in which patients and families are quickly notified of adverse events and offered an explanation, an apology and compensation, if necessary, are one example of such an alternative reform.

“At the University of Michigan Health System, the disclosure program has reduced claims, lawsuits, and liability costs,” wrote Thomson and Patel. “The Agency for Healthcare Research and Quality demonstration projects will evaluate several variations of the disclosure model in different health care systems and states. These and similar programs may provide opportunities to improve patient and provider communication, reduce liability costs, and provide meaningful processes to improve health care quality and outcomes.”