The estate of an Illinois woman can sue one Chicago hospital for missing brain bleeding in her CT scans, despite the now-deceased patient refusing treatment.

A three-judge appeals court panel reached that determination on Monday, reinstating the lawsuit against Swedish Hospital and its providers. Radiologist Kamran Kamal, MD, had charged that the woman broke the “causal chain of events” when she sought treatment at another hospital. However, the court delivered an early blow to the clinician by disagreeing and allowing the wrongful death case to march forward, Law360 reported March 3.

“Dr. Kamal presented no evidence of a subsequent, intervening cause that broke the causal connection between his alleged negligence and [Shiqian] Bao’s death,” the panel ruled. “Rather, Dr. Kamal speculates that Bao would have refused an offer of treatment that he never made.”

Bao originally presented at Swedish’s emergency department back in July 2013, complaining of a severe headache. Doctors ordered head CT scans, which teleradiologist Kamal determined to be normal, and the hospital later discharged the patient. However, a Swedish attending radiologist took a second look at the images a few hours later, found subarachnoid brain hemorrhage, and the hospital asked her to return.

She did, but refused treatment at Swedish, instead immediately seeking care at Lutheran General Hospital, located 12 miles away in the Chicago suburb of Park Ridge. There, doctors performed another series of tests, failed to spot her brain’s bleeding and discharged her without treatment. Treating doctors at Lutheran also obtained the radiology report from Swedish, but not the actual images. A subsequent CT angiogram was also reported as normal, prior to her discharge.

She died three days later of alleged brain hemorrhage, which her family claimed stemmed from a history of high blood pressure, according to the complaint.

A circuit court had originally sided with Kamal and his practice, International Radiology, ruling that neither was liable for her death from medical negligence, because the missed diagnoses were “not a proximate cause of Bao’s death.”

The appeals court panel disagreed, also charging that the lower court had been “unduly deferential” to the testimony of doctors at Lutheran General. Experts there had previously argued that having access to the actual images from Swedish would not have changed their course of treatment, the report noted. Bao’s family disputed this assessment, with the court requesting a jury to sort out the difference.

Read the rest of the story and original complaint in Law360.