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Effective Incident Reporting

Discuss about the Malpractice Liability of Radiology Reports.

The reporting in radiology calls for medical and legal responsibilities in areas such as communication, observation, interpretation, analysis, and giving appropriate advice and recommendations to the patient and the relevant medical personnel. It is important that radiologists maintain a high level of medical and legal commitment when carrying out imaging procedures and making the reports to avoid medical and legal implications. The duty of care in radiology reporting refers to the legal obligation imposed on radiologists that require them to adhere to the standards of reasonable medical care when carrying out imaging and reporting. When a plaintiff is filing a legal complaint, the duty of care is the first element to be established, indicating that the radiologist who is the defendant has breached it through negligence (Booth, Jackson, Wardlaw, Taylor & Waldman, 2014).The essay will focus on the responsibilities and the consequences of negligence in radiology.

To begin with, effective incident reporting should be adhered to by all personnel involved in radiology to enhance communication among radiologists, technicians, colleagues, nurses and patients and any referrers involved. Among the health personnel, interpretation and reporting of radiologic reports and results for the purpose of interventional procedures should be transmitted in time after being carefully proofread to reduce typographical errors, conflicting or confusing statements, accidentally omitted words, and appropriate use of abbreviations. With the patient, the radiologists’ reports should be communicated in confidence and in a manner that the patient fully understands so that they can have the right information to make appropriate medical decisions (Berlin, Murphy & Singh, 2014). Failure to adhere to proper incident reporting guidelines would result in a potential misdiagnosis and this would call for a malpractice lawsuit. In 2013, there was a communication error in the University of Maryland Medical Centre whereby following the death of a 77-year old woman, her daughter filed a wrongful death lawsuit against the radiologist for failing to report the staph infection that led to her death and failure to advise that the woman needed to minimize body movement. The radiologist was found guilty and had to award the daughter $ 1,341,000. Therefore, adequate communication should be maintained between radiologists, technicians, colleagues, nurses, and patients to avoid any confusion that might arise in the process.

Moreover, to produce x-rays that are of a diagnostic quality, it is a legal requirement that the medical personnel has appropriate skills and training to provide standard care for the patients. They ought to be in a position to evaluate the quality and suitability of the images and link them to a possible diagnosis. Radiologists should be able to identify incomplete or suboptimal images with incidences such as inadequate sequences to facilitate an MRI study. They must have the technical knowledge of determining to what extent such cases would affect the accuracy of a diagnosis and whether the patient needs to be summoned for another imaging. Lack of such knowledge would greatly put the patient at the risk of a misdiagnosis; the consequences could be fatal since the patient is susceptible to deterioration and even death (Weiss, Kim, Branstetter & Prevedello, 2014). The medical personnel involved risks facing a lawsuit because of their negligence. In June 2011, a radiologist failed to notice a malignant nodular density in a man’s lung and when the man came back a year later complaining of chest pains it was then discovered that he had cancer all along but cancer had already metastasized and he died four months later. The man’s estate brought a malpractice lawsuit against the radiologists and the jury ruled in favor of the plaintiffs and awarded them $691,565 (Baker, 2014). Therefore, medical personnel requires necessary skills that will help in identifying and responding to the needs of the patients to avoid lawsuits like the one discussed above.

Appropriate Skills and Training

In addition, the initial assessment of a patient’s identification report should be keenly cross checked to determine and confirm the type of examination required. Radiologists as trained observers are required by the law to use passive and active observation techniques and accurately distinguish between normal findings and variants, abnormal findings that are either unanticipated or anticipated. Failure to keenly observe and take note of important details in patients’ identification reports and radiologists’ reports could result in a false interpretation of a patient’s condition and an accurate diagnosis of the patient would not be made (Babu &Brooks, 2015). A misdiagnosis would result in administering the wrong kind of treatment or even failure to carry out any treatment and this would be harmful to the patient and could even worsen their health condition. Subsequently, the radiologists and medical personnel involved would face legal repercussions and a possible lawsuit against them (Levine&Kressel, 2016).

Furthermore, upon conducting radiology, the findings are evaluated to establish the imaging features such as the shape, enhancement pattern, density, contour, echogenicity and signal intensity to formulate an expert opinion about the condition of the patient. If at all the findings indicate an active pathological process the imaging features are further analyzed to narrow down on the diagnosis (Halpin, 2014). The results are then related to other medical factors to establish their relevance to the patient under review. It is a legal requirement that extensive medical knowledge is applied to come to a specific diagnosis that will facilitate consequent clinical decisions. The basis of the knowledge could be in areas such as the possible disease the patient could be suffering from and linking it to their demographic characteristics, clinical manifestations and their radiological, laboratory, pathological and clinical tests. In addition, the law requires that previous imaging findings should be reviewed and any supplementary information that may be substantial in making a radiology opinion. This should come from the referring clinician specifically or through laboratory findings and histology reports (Bossuyt et al. 2015). Failure to follow this radiology analysis and medical interpretation guidelines will deter the establishment of an appropriate medical opinion. In May 2011, a man underwent a chest x-ray after the physician had ordered it and the radiologist reported that he had a minor condition and was discharged. One year later, it was discovered that the radiologist failed to sufficiently analyze and interpret his findings and missed a lung cancer diagnosis. After a court trial, the jury found the radiologist guilty and the plaintiff was awarded $2,600,000 (Cronin & Rawson, 2016).

Keen Cross-Checking of Patient Identification Reports

Lastly, the radiologists need to advise the referring physicians and patients accordingly. If a definite diagnosis is established, it should be considered appropriate for the patient’s treatment. If there is any level of uncertainty or doubt about the quality of imaging, accuracy, and applicability of the technique used, it should be clearly outlined in the report. Recommendations for further investigation should be made where the radiology report does not provide for sufficient diagnosis. In addition, where a patient is not comfortable during imaging the radiologists should advise and suggest other measures be taken for the investigation. Failure to give proper advice and recommendations would result in physicians failing to assess the patient’s condition effectively (Grieve, Plumb & Khan, 2014). In October 2011, radiologists failed to discover an arteriovenous malformation on the spine of a 14-year old girl due to the young girl’s discomfort in the MRI machine. Later on, the malformation bled out and caused damaged to her spinal cord, rendering her paralyzed from the waist downwards. Had the radiologists advised the physician to have the patient sedated during the MRI, she would have been stable enough for the detection of the malformation. The girl’s parent sued the entire medical center for medical negligence and was awarded $6,400,000 (Baker, Patel, Yang, Lelkes&Castro,2013).

In conclusion, the essay has discussed on the responsibilities and the consequences of negligence in radiology. In this case, all medical personnel involved with radiology should be responsible when it comes to delivering reports and should avoid negligence. They should provide imaging reports that allow for a specialist interpretation of the findings of the images so as to diagnose a patient accordingly or provide for an understanding of their clinical condition.

References

https://www.millerandzois.com/university-maryland-hospital-malpractice.html

Baker, S. R., Patel, R. H., Yang, L., Lelkes, V. M., & Castro III, A. (2013). Malpractice suits in chest radiology: an evaluation of the histories of 8265 radiologists. Journal of thoracic imaging, 28(6), 388-391.

Baker, S. R. (2014). Malpractice Suits against Radiologists. In Notes of a Radiology Watcher (pp. 181-183). Springer International Publishing.

Berlin, L., Murphy, D. R., & Singh, H. (2014). Breakdowns in communication of radiological findings: an ethical and medico-legal conundrum. Diagnosis, 1(4), 263-268.

Booth, T. C., Jackson, A., Wardlaw, J. M., Taylor, S. A., & Waldman, A. D. (2014). Incidental findings found in “healthy” volunteers during imaging performed for research: current legal and ethical implications. The British journal of radiology.

Bossuyt, P. M., Reitsma, J. B., Bruns, D. E., Gatsonis, C. A.,Glasziou, P. P., Irwig, L.,&Kressel, H. Y. (2015). STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. Radiology, 277(3), 826-832.

Cronin, P., & Rawson, J. V. (2016). Review of research reporting guidelines for radiology researchers. Academic radiology, 23(5), 537-558.

Grieve, F. M., Plumb, A. A., & Khan, S. H. (2014). Radiology reporting: a general practitioner's perspective. The Australian journal of radiology.

Halpin, S. F. S. (2014). Medico-legal claims against English radiologists: 1995–2006. The Australian journal of radiology.

Levine, D., &Kressel, H. Y. (2016). 2016: Reviewing for Radiology—Reporting Guidelines and Why We Use Them.

SrinivasaBabu, A., & Brooks, M. L. (2015). The malpractice liability of radiology reports: minimizing the risk. Radiographics, 35(2), 547-554.

Weiss, D. L., Kim, W., Branstetter, B. F., &Prevedello, L. M. (2014). Radiology reporting: a closed-loop cycle from order entry to results communication. Journal of the American College of Radiology, 11(12), 1226-1237.

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