‘A guilty conscience may linger forever’: The rise of failure-to-communicate lawsuits in radiology
Failure-to-communicate lawsuits are on the rise among radiologists, according to an editorial published in the Journal of the American College of Radiology this month, leaving legal lines of the specialization blurry. It’s an environment where court settlements favor the plaintiff nearly half of the time, Leonard Berlin, MD, wrote—and it’s not rare for blame to fall on the radiologist’s shoulders.
Somewhere around a quarter of ACR members admitted in an as-of-yet unpublished report that they’d been sued for failure to communicate at some point in their careers, Berlin, of Skokie Hospital in Skokie, Illinois, said in JACR. Twenty-nine of those lawsuits were resolved in favor of the radiologist; 59 percent favored the plaintiff alleging malpractice.
“No accurate data regarding incidence of communication lawsuits since 2013 are available, but the number of failure-to-communicate lawsuits filed against radiologists has been increasing steadily,” Berlin wrote. “A recently published survey of radiology and primary care physician residents suggests that failure-to-communicate lawsuits filed against radiologists may continue to be increasing instead of diminishing.”
Rather than stemming from a lack of knowledge or skill, lawsuits alleging adverse health outcomes in hospitals are often the result of failed communication between radiologists themselves and referring physicians, Berlin said. That’s the case 70 percent of the time despite the existence of ACR guidelines for radiologic communication.
Cases that wind up in court usually involve a missed or overlooked finding on an imaging report, Berlin wrote, that eventually leads to a patient’s chronic illness or death. In one case cited in the editorial, a man in his fifties sued a radiologist for negligence, claiming that physician’s failure to directly communicate an abnormal colorectal finding to a referring urologist—despite the radiologist’s failed attempts to make contact—resulted in the patient’s metastatic colon cancer.
This scuffle between hospital staff isn’t new, Berlin said. One survey found 60 percent of primary care residents felt it was a radiologist’s duty to call them with significant abnormal findings and preferred direct communication, while half of radiology residents thought that amount of direct communication was “excessive and superfluous.” It doesn’t help, either, that recent research found 15 percent of physicians skip over radiology reports altogether.
“The ACR parameter for communication is intended to remedy the consequence of such omissions by making sure radiologists actually communicate directly with clinicians and bring to their attention all findings that require follow-up,” Berlin wrote. “Receipt of a faxed report in a physician’s office does not confirm that a significant unexpected finding has been communicated to the referring physician unless the report is actually read by the physician.”
In the case of the radiologist and referring urologist, Berlin said the court eventually reached a $4.5-million settlement in favor of the cancer patient. But, even though the radiologist may have thought his efforts to communicate his entire report with the urologist were sufficient, he’d likely still be held accountable for failing to consummate that communication. Radiologists, if negligent, should be prepared to answer to those shortcomings in spite of other physicians’ own failings, Berlin said.
He said the failure to adhere to communication guidelines could end up violating not only a radiologist’s legal duties, but their ethical and moral responsibilities, too.
“Win, lose or agree to a settlement that precludes a jury verdict, a malpractice lawsuits terminates after a finite period and is eventually forgotten,” Berlin wrote. “However, a guilty conscience may linger forever, especially if a serious patient disability or death could have been avoided by a simple telephone call.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.