Addendum to MRI Report Not Communicated to Providers

In September 2006, a 42-year-old woman was transported to a medical center in New York City with symptoms of a manic bipolar episode. She was admitted and stabilized, and she remained in the hospital for 11 days.

During her hospitalization, an MRI of the brain was performed. The radiologist initially noted no significant findings. However, several hours later, he prepared an addendum to his report, indicating the presence of a mass suggestive of a meningioma. The addendum was never transmitted to the patient’s attending physician, and she was discharged.

In December 2007, the patient had a seizure and was transported to the same medical center. The physician who reviewed the patient’s records discovered the addendum to the MRI report. It was determined that the seizure was caused by the meningioma.

The tumor was surgically removed but recurred, necessitating a second procedure. The patient continues to experience periodic seizures. She claimed that the defendants failed to timely treat her meningioma.

The matter ultimately proceeded against only the radiologist and the hospital. The plaintiff specifically claimed that the radiologist should have ensured that the addendum was transmitted to her physicians.

The defendant claimed that any failure to immediately address the meningioma did not change the patient’s outcome and that the treatment at that time would have entailed monitoring the tumor for signs of growth.

Outcome

According to a published account, a $4 million settlement was reached.

Comment

This case is frustrating: Frustrating because the radiologist made the correct interpretation, but that information never made it to the patient’s primary provider. He made the right diagnostic call—how can he be on the hook for a hospital-related “systems error”?  

A frustrated patient injured by a systems error will attempt to blame everyone, including the clinician. Will the jury be persuaded to blame the clinician too? It depends on the interrelationship between the clinician’s practice and the system that failed.

For example, if an ambulatory patient in a large HMO complex slips and falls on a recently mopped bathroom floor, there will be no case against a clinician because the arguable negligence was the failure to notify the patient that the floor was wet. The system that failed and the clinician’s services are distinct.

By contrast, if an unsteady ambulatory patient is examined by a clinician and then sent to walk down the hallway for x-rays, and the patient slips and falls, there is likely a case against the clinician. The clinician discovered that the patient was unsteady during the examination, and it was a foreseeable risk that an unsteady patient could fall and suffer injury. The plaintiff will claim that a reasonably prudent clinician, recognizing the risk, would arrange for wheelchair transport. 

In the present case, the radiologist and hospital settled for $4 million. We can rationally infer that the plaintiff’s legal team was able to produce an expert to testify (during deposition) that the standard of care required that the radiologist not just interpret the MRI correctly, but also ensure that the test’s findings were communicated to the patient’s attending physician.

Would a jury agree and fault the radiologist for the “systems error”? We don’t know. We do know the plaintiff’s attorney felt this argument was strong enough to keep the radiologist in the case and force a settlement against him—which usually results in an adverse National Practitioner Data Bank recording.  

What risks exist in your practice? Once a clinician-patient relationship is established, risks that seem out of your control could land you with liability if a jury believes that the elimination of that risk was in your control—and therefore your responsibility.

Once a clinician-patient relationship is established, take reasonable steps to protect patients. Between the extremes of omniscience at one end of the spectrum and willful blindness on the other, we are left with the clinician’s duty to avert reasonably foreseeable harms.

Here, if the radiologist had any reason to believe that the addendum may not have been forwarded, he had an obligation to take affirmative steps to ensure it was communicated. Yet, if his system had functioned previously without flaw, faulting him would be unfair. Apparently, the plaintiff’s attorney had some evidence suggesting that the radiologist had knowledge that the existing system was flawed—and under those circumstances, simply entering an addendum with the hope that it would be communicated was risky.

In sum, if you see potential harm looming for a patient, take action before “mere risk” materializes into actual harm. —DML

In September 2006, a 42-year-old woman was transported to a medical center in New York City with symptoms of a manic bipolar episode. She was admitted and stabilized, and she remained in the hospital for 11 days.

During her hospitalization, an MRI of the brain was performed. The radiologist initially noted no significant findings. However, several hours later, he prepared an addendum to his report, indicating the presence of a mass suggestive of a meningioma. The addendum was never transmitted to the patient’s attending physician, and she was discharged.

In December 2007, the patient had a seizure and was transported to the same medical center. The physician who reviewed the patient’s records discovered the addendum to the MRI report. It was determined that the seizure was caused by the meningioma.

The tumor was surgically removed but recurred, necessitating a second procedure. The patient continues to experience periodic seizures. She claimed that the defendants failed to timely treat her meningioma.

The matter ultimately proceeded against only the radiologist and the hospital. The plaintiff specifically claimed that the radiologist should have ensured that the addendum was transmitted to her physicians.

The defendant claimed that any failure to immediately address the meningioma did not change the patient’s outcome and that the treatment at that time would have entailed monitoring the tumor for signs of growth.

Outcome

According to a published account, a $4 million settlement was reached.

Comment

This case is frustrating: Frustrating because the radiologist made the correct interpretation, but that information never made it to the patient’s primary provider. He made the right diagnostic call—how can he be on the hook for a hospital-related “systems error”?  

A frustrated patient injured by a systems error will attempt to blame everyone, including the clinician. Will the jury be persuaded to blame the clinician too? It depends on the interrelationship between the clinician’s practice and the system that failed.

For example, if an ambulatory patient in a large HMO complex slips and falls on a recently mopped bathroom floor, there will be no case against a clinician because the arguable negligence was the failure to notify the patient that the floor was wet. The system that failed and the clinician’s services are distinct.

By contrast, if an unsteady ambulatory patient is examined by a clinician and then sent to walk down the hallway for x-rays, and the patient slips and falls, there is likely a case against the clinician. The clinician discovered that the patient was unsteady during the examination, and it was a foreseeable risk that an unsteady patient could fall and suffer injury. The plaintiff will claim that a reasonably prudent clinician, recognizing the risk, would arrange for wheelchair transport. 

In the present case, the radiologist and hospital settled for $4 million. We can rationally infer that the plaintiff’s legal team was able to produce an expert to testify (during deposition) that the standard of care required that the radiologist not just interpret the MRI correctly, but also ensure that the test’s findings were communicated to the patient’s attending physician.

Would a jury agree and fault the radiologist for the “systems error”? We don’t know. We do know the plaintiff’s attorney felt this argument was strong enough to keep the radiologist in the case and force a settlement against him—which usually results in an adverse National Practitioner Data Bank recording.  

What risks exist in your practice? Once a clinician-patient relationship is established, risks that seem out of your control could land you with liability if a jury believes that the elimination of that risk was in your control—and therefore your responsibility.

Once a clinician-patient relationship is established, take reasonable steps to protect patients. Between the extremes of omniscience at one end of the spectrum and willful blindness on the other, we are left with the clinician’s duty to avert reasonably foreseeable harms.

Here, if the radiologist had any reason to believe that the addendum may not have been forwarded, he had an obligation to take affirmative steps to ensure it was communicated. Yet, if his system had functioned previously without flaw, faulting him would be unfair. Apparently, the plaintiff’s attorney had some evidence suggesting that the radiologist had knowledge that the existing system was flawed—and under those circumstances, simply entering an addendum with the hope that it would be communicated was risky.

In sum, if you see potential harm looming for a patient, take action before “mere risk” materializes into actual harm. —DML

In September 2006, a 42-year-old woman was transported to a medical center in New York City with symptoms of a manic bipolar episode. She was admitted and stabilized, and she remained in the hospital for 11 days.

During her hospitalization, an MRI of the brain was performed. The radiologist initially noted no significant findings. However, several hours later, he prepared an addendum to his report, indicating the presence of a mass suggestive of a meningioma. The addendum was never transmitted to the patient’s attending physician, and she was discharged.

In December 2007, the patient had a seizure and was transported to the same medical center. The physician who reviewed the patient’s records discovered the addendum to the MRI report. It was determined that the seizure was caused by the meningioma.

The tumor was surgically removed but recurred, necessitating a second procedure. The patient continues to experience periodic seizures. She claimed that the defendants failed to timely treat her meningioma.

The matter ultimately proceeded against only the radiologist and the hospital. The plaintiff specifically claimed that the radiologist should have ensured that the addendum was transmitted to her physicians.

The defendant claimed that any failure to immediately address the meningioma did not change the patient’s outcome and that the treatment at that time would have entailed monitoring the tumor for signs of growth.

Outcome

According to a published account, a $4 million settlement was reached.

Comment

This case is frustrating: Frustrating because the radiologist made the correct interpretation, but that information never made it to the patient’s primary provider. He made the right diagnostic call—how can he be on the hook for a hospital-related “systems error”?  

A frustrated patient injured by a systems error will attempt to blame everyone, including the clinician. Will the jury be persuaded to blame the clinician too? It depends on the interrelationship between the clinician’s practice and the system that failed.

For example, if an ambulatory patient in a large HMO complex slips and falls on a recently mopped bathroom floor, there will be no case against a clinician because the arguable negligence was the failure to notify the patient that the floor was wet. The system that failed and the clinician’s services are distinct.

By contrast, if an unsteady ambulatory patient is examined by a clinician and then sent to walk down the hallway for x-rays, and the patient slips and falls, there is likely a case against the clinician. The clinician discovered that the patient was unsteady during the examination, and it was a foreseeable risk that an unsteady patient could fall and suffer injury. The plaintiff will claim that a reasonably prudent clinician, recognizing the risk, would arrange for wheelchair transport. 

In the present case, the radiologist and hospital settled for $4 million. We can rationally infer that the plaintiff’s legal team was able to produce an expert to testify (during deposition) that the standard of care required that the radiologist not just interpret the MRI correctly, but also ensure that the test’s findings were communicated to the patient’s attending physician.

Would a jury agree and fault the radiologist for the “systems error”? We don’t know. We do know the plaintiff’s attorney felt this argument was strong enough to keep the radiologist in the case and force a settlement against him—which usually results in an adverse National Practitioner Data Bank recording.  

What risks exist in your practice? Once a clinician-patient relationship is established, risks that seem out of your control could land you with liability if a jury believes that the elimination of that risk was in your control—and therefore your responsibility.

Once a clinician-patient relationship is established, take reasonable steps to protect patients. Between the extremes of omniscience at one end of the spectrum and willful blindness on the other, we are left with the clinician’s duty to avert reasonably foreseeable harms.

Here, if the radiologist had any reason to believe that the addendum may not have been forwarded, he had an obligation to take affirmative steps to ensure it was communicated. Yet, if his system had functioned previously without flaw, faulting him would be unfair. Apparently, the plaintiff’s attorney had some evidence suggesting that the radiologist had knowledge that the existing system was flawed—and under those circumstances, simply entering an addendum with the hope that it would be communicated was risky.

In sum, if you see potential harm looming for a patient, take action before “mere risk” materializes into actual harm. —DML