Misdiagnosis spurs most legal actions against Australian rads

If Australia is any barometer of malpractice lawsuit patterns across the Western world, U.S. radiologists best be on guard against misdiagnosing patients due to delays and misses in interpreting images.

A recent study uncovering this area of error as far and away the single largest source of imaging-related legal woes in the Land Down Under shows it accounting for 62 percent of 401 closed medicolegal claims involving radiology. “Misdiagnosis: delay or failure to correctly read imaging exam” was distantly trailed by “problem during a procedure” (11 percent), “prost-procedural complication” (6 percent), “injury during procedure” (4 percent) and “missing radiology report” (3 percent). The study report ran in the June edition of the Journal of the American College of Radiology.

Proceeding from the premise that radiology has not kept pace with other medical specialties in mining closed-claims data to guide quality improvement, Stacy Goergen, MBBS(Hons), of Monash University, and colleagues from the Australian Patient Safety Foundation looked at which modalities and procedures expose imaging to greatest legal risk. Radiography came in as most susceptible in cases involving a single modality, accounting for 33.8 percent of claims, followed by ultrasound (19.9 percent) and CT (10.7 percent).

Meanwhile, mammography proved the most sued procedure type, with breast ultrasound, whole-body MR, whole-body CT and OB-GYN ultrasound also in the running. Holding the safest ground with the fewest actions were cardiac ultrasound, extremity radiography and whole-body radiography.

“This ordering may reflect the likelihood of a claim being successful and yielding payment to the litigant more than it does any inherent procedural ‘risk,’” the authors wrote. “Nevertheless, this information is useful in that radiologists can be aware of procedures that may, for whatever reason, be more likely to result in a claim.”

The authors cited other studies showing that diagnostic errors are the category with the most successful malpractice claims, accounting for 28.6 percent of claims paid out in the U.S. They noted that diagnostics are held responsible for mortality at nearly twice the rate of other kinds of claims, such as surgery and other treatments.

Zeroing in on the high claims incidence involving mammography, the authors commented that “patient and technical factors leading to diagnostic errors … such as breast density and lack of use of tomosynthesis and ultrasound as adjuncts to mammography in these patients, have been widely publicized. However, the problem may additionally relate to fragmentation of care and failure of clear communication between radiologists and referrers, resulting in inadequate correlation of history and examination findings with imaging and subsequent pathology results.”

They suggested as a solution multidisciplinary settings in which the correlation process may be easier and more efficient.