A significant finding was missed by two radiologists, so why was only one held liable?
One radiologist is being held liable for a patient’s injuries due to a “breach of standard of care” despite another radiologist also missing the same significant finding, Canadian Lawyer reports.
In the case of Levy v. Rubenstein, 2022 ONSC 4547, Nissim Levy’s growing lung cancer was missed by two radiologists on chest radiographs until it had advanced to an incurable stage, eventually leading to the need for neoadjuvant chemotherapy.
Previously, Levy had been diagnosed with kidney cancer, for which he underwent surgery to remove the tumor. He was followed closely by his urologist and sent routinely for chest radiographs to monitor for any signs of recurrence between 2010 and 2013. Radiologists Joel Rubenstein and Anna Zavodni did not report abnormalities in Levy’s imaging during this time, but after an episode of hemoptysis and a subsequent CT scan in October of 2013, a 4.5 cm lung mass was identified.
The tumor was removed but the cancer recurred three years later—this time at an incurable stage that would require chemotherapy. Levy filed a suit against Rubenstein and Zavodni for medical malpractice, claiming that the doctors negligently conducted their reads and that if the tumor had been spotted during routine monitoring it would not have reached such an advanced stage.
Expert Testimony
During the trial, expert radiologists sided with Levy, testifying that the tumor was, in fact, visible on the radiographs at the time of Rubenstein’s reviews in April 2012 and June 2013, and at the time of Zavodni’s interpretation in October 2012. The radiologists noted that the tumor was 2.5 cm in size during Rubenstein’s review in April of 2012 and had grown to 4 cm by the time Zavodni reviewed the radiographs the following October.
The court concluded that a “reasonably prudent and diligent radiologist” would have identified the tumor in April of 2012 during Rubenstein’s review, at which time the tumor could have been removed. Had this happened, the cancer’s odds of recurrence would have been reduced and Levy might have avoided chemotherapy. For this reason, Rubenstein was determined to have breached the standard of care and consequently held liable for Levy’s injuries.
Zavodni—who was also determined to have breached the standard of care—was not held liable for the patient’s injuries because experts determined that the Levy would have required the same treatment regardless of the miss since the tumor was 4 cm by the time that interpretation took place.
For more information on the case, click here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.