Radiologist’s rec for follow-up CT falls through cracks, leading to patient’s terminal diagnosis 3 years later
An overlooked radiologist recommendation for a follow-up CT to assess an incidental finding eventually led to one South Carolina woman’s stage 4 cancer diagnosis 3 years later, according to a recently filed lawsuit.
Shannon James, 67 at the time, visited her primary care provider, affiliated with the Roper St. Francis Hospital, Charleston, in June 2022 for her annual physical. Due to her family history of heart disease, she underwent a CT cardiac scoring study and carotid screening ultrasound, according to the complaint, filed Sept. 8.
Radiologist Brian C. Gardner, MD—not a defendant in the case—spotted an 8 mm lobular nodule in the left lower lobe, recommending another CT within the next 6 to 12 months. However, this never occurred, with the follow-up falling through the cracks. James’ cancer wasn’t discovered until May 2025, when it had grown to a 3.1 cm tumor mass in the left lung.
“Shannon James has suffered profound and life-altering harm as a direct and proximate result of the defendants' failures,” the complaint, filed in the Court of Common Pleas for the 9th Judicial Circuit, charges. “A non-smoker with an 8 mm lung nodule identified in July 2022—for which a Fleischner criteria follow-up chest CT was specifically recommended within 6 to 12 months—was denied that follow-up for nearly three years. … Her prognosis is now terminal. She faces a lifetime of chemotherapy, progressive illness, and loss of the life she had and expected.”
Along with the hospital, the lawsuit also names Roper St. Francis Partners Primary Care and PCP Alexis A. Jesup, MD, as defendants. In a response to the complaint filed on Sept. 16, attorneys for Roper St. Francis denied the allegations, asking a judge to dismiss all claims.
More on the inciting incident
Dr. Jesup allegedly failed to communicate the incidental finding to James and did not order the recommended follow-up CT. A year after the radiologist’s recommendation, James returned to Jesup for another annual check-up. However, the primary care doc allegedly never mentioned the nodule, did not document a follow-up plan, and never ordered the CT.
James allegedly again returned in July 2024 for a physical and stated she had developed new and progressive respiratory symptoms. These allegedly included intermittent wheezing, a chronic cough and exercise-induced shortness of breath. However, Dr. Jesup allegedly attributed these symptoms to allergies and possible asthma, prescribing albuterol and recommending antihistamines.
By early 2025, James’ respiratory symptoms had reportedly worsened, including shortness of breath with minimal exertion. She sought the care of a pulmonologist at an affiliate of Roper Hospital. In preparing for the visit, the specialist reviewed her records, unearthed the 2022 incidental finding, and ordered a chest CT in May 2025—about 2 years and 9 months after first recommendation.
Radiologist Robert Andrews, MD—also not a defendant—compared the 2022 and 2025 scans against each other. This revealed “devastating findings,” attorneys charge. These new abnormalities were “highly concerning for metastatic malignancy, likely lung origin,” with recommendations for a PET scan and tissue sampling.
Further testing confirmed stage 4 non-small cell lung cancer. She later visited the MD Anderson Cancer Center in Houston for another opinion in June 2025. There, specialists confirmed the diagnosis, with James reportedly now pursuing a treatment plan that is “palliative and not curative.”
Plaintiff attorneys charge the hospital and its physicians failed to have adequate protocols and systems in place to ensure incidental radiologic findings result in specific imaging follow-up recommendations. This should have been acted upon within the required timeframes communicated to patients. They’re seeking unspecified damages and a jury trial to decide the matter.
Local TV news first reported word of the lawsuit on Wednesday. You can read the related court documents for the case here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.