Malpractice data challenge value of defensive radiology

Medical procedures performed to protect a radiologist against the threat of future litigation make little practical sense, according to an evaluation of the malpractice claims experience of nearly 5500 radiologists across the nation.

The analysis by New Jersey Medical School radiology chair Dr. Stephen Baker found that radiologists are rarely sued for failing to perform an imaging procedure. The failure to perform an additional test was relevant in only 21 of 3000 claims filed against the radiologists in Baker's study. He reported his findings Wednesday at the RSNA conference.

The conclusions were drawn from the malpractice histories of 5497 radiologists affiliated with One-Call Medical, a specialty PPO network for workers' compensation-related MR and CT imaging. The PPO serves 40 states and contracts with about 15% of practicing U.S. radiologists, Baker said. Information for the study was extracted from credentialing forms and the Center for Medicare and Medicaid Services' National Medical Practitioners data bank.

Baker found that malpractice claims have been filed against about four of every 10 radiologists in his study. The odds of a lawsuit are highest in Pennsylvania, Utah, and Oregon. At least half of the radiologists in those states have been named in at least one medical malpractice lawsuit.

States where 41% to 50% of radiologist have been sued at least once are New York, Michigan, New Jersey, Louisiana, Mississippi, Alabama, and Illinois.

Florida, a state infamous for the size of monetary settlements for medical malpractice, ranks near the national average for malpractice claims risk. Between 30% to 40% of Florida's radiologists have been involved in a malpractice claim, Baker said.

Failure to diagnose was the most common cause of malpractice claims filed between 1999 and 2003, according to Baker. It was named in 45% of the cases, and in 11% of the cases, the radiologist was peripheral to the central claims. About 9% of cases related to allegations of complications from therapeutic interventions involving imaging and usually applied to an interventional radiologist. About 7% were tied to alleged failures to communicate, and less than 1% involved an adverse reaction to contrast media or negligence.

The results contradict the conventional wisdom about liability risks associated with communication failures and missed opportunity to diagnose disease because additional tests were not performed, he said. Radiologists worry about failure to communicate, but they are not a major cause of malpractice suits.

The rationale for performing defensive radiology also took a beating.

"Part of the thing that is driving excessive utilization is the fear of being sued for not doing a test because someone may bring a claim later on, but that does bear out in reality," Baker said.

The number of claims filed against radiologists annually has been stable since 1999. Claims involving lung cancer and failure to diagnose in all conditions increased, but mammography-related claims fell, despite a large increase in breast imaging volume.

Female radiologists were involved in about 15% of all cases but do not seem more likely to be sued than men, Baker said.