Radiology holds the line against malpractice actions

Radiologists who fret about getting sued for malpractice should continue patting themselves on the back for not going into surgery, medicine, Ob/Gyn, anesthesiology, emergency or dentistry/oral surgery.

A study posted Oct. 9 in JACR shows those specialties still shouldering the biggest claims burdens from 2008 to 2012, with only psychiatry, pathology and pediatrics/neonatal proving less risky than radiology—although the payouts were larger in radiology than in any of those and much larger than in oral surgery/dentistry.

H. Benjamin Harvey, MD, JD, of Massachusetts General Hospital, and colleagues noted that these specialty lineups are closely similar to those uncovered by two previous analyses of claims data, one examining claims filed from 1985 to 2002 and the other from 1991 to 2002.

The researchers queried more than 300,000 malpractice cases stored in the Comparative Benchmarking System database in the five-year period they reviewed.

When radiology was the primary responsible service, they evaluated case abstracts to determine injury severity, claimant type by setting, claim allegation, process of care involved, case disposition, modality involved and body section.

Assessing a total of 879 radiology claims, the authors found the aggregate paid loss for these was $180,739,205 (range, $0 to $6,691,762), with a median total paid loss of $30,091 per case (mean, $205,619 ± $508,883).

Other findings of note for radiology:

• Most radiology claims involved diagnosis-related allegations (57.3 percent [504 of 879]), including failure to diagnose or delayed diagnosis, in the clinical setting of cancer and fractures.
• More than three-fifths (62.3 percent [548 of 879]) of radiology claims were closed without indemnity payments.
• Radiology claims were most commonly associated with outpatient settings, at 66.3 percent, and most of the actions, 93.3 percent, claimed injuries of high and medium severity.
• Only 1.3 percent of claims involved communication failures as the primary allegation, but these claims were associated with a statistically higher ratio of paid claims.

The authors found that diagnosis-related breast cancer remains the most common cause of radiology litigation, as it has been since the early 1990s, when it replaced missed lung cancer on chest radiography.

“This is not unexpected given the relatively high volume of mammography in the country secondary to the widespread use of mammographic screening,” they write.

Over the years, failure to communicate has fallen as a source of malpractice suits. Still, “standardization of the content and language of recommendations and integrated IT solutions to ensure that recommended imaging follow-up is obtained may improve referrer adherence with recommendations,” the authors write, “potentially translating into improved patient outcomes and further reducing liability risks for radiologists.”