Malpractice claims plague U.K radiologists

Compelling new data from the U.K. reveal that the most common causes of negligence claims against radiologists are missed fractures, malignancies of the breast, lung, and sigmoid, developmental abnormalities, and subarachnoid hemorrhage.

Greater awareness of high-risk investigations is useful for day-to-day practice and may contribute to the development of more robust investigational algorithms for these procedures, according to a poster presented at the 2004 RSNA meeting.

The authors examined all serious complaints made wholly or partly against radiologists in the National Health Service between April 1995 and March 2004. Data were obtained from the NHS Litigation Authority, which was set up in 1995 to oversee a central fund dealing with medical negligence and litigation.

The researchers found 484 complaints of negligence involving radiology departments in England. About 2% of these resulted in court action, while the remainder were withdrawn or settled out of court. In 91 cases (19%), the claimant received no settlement. Of the 10 largest claims, eight remain open, and only two have been settled.

Total settlements during this period exceeded $107 million. Musculoskeletal complaints were the most prevalent (21.4%), and these paid out $12.4 million. Missed fractures, most commonly of the hands and feet, accounted for more than half of MSK claims.

Breast malpractice cases, second in volume at 17.8%, cost the U.K. government $5.6 million. More than three-fourths of claims were for missed carcinomas on mammograms.

Chest claims (9.9%) paid out $3.5 million, nearly half for failure to spot lung cancer. Gastrointestinal (9.7%) complaints cost $2.4 million. Missed colorectal cancers (particularly sigmoid tumors) on barium enema accounted for 21% of the GI claims.

Failure to detect fetal abnormalities was the basis of almost all obstetric cases (8.6%) and paid out $37 million. Missed subarachnoid hemorrhages and spinal pathologies (mainly tumors) were each responsible for 14% of neurologic complaints. Payments for these claims were $25.4 million.

Nearly 71% of complaints related to missed diagnoses and another 14% to injuries resulting from a procedure. About 5% of cases were due to delayed diagnoses, while 3% of the total resulted from miscommunication, 2% from false-positive diagnoses, 1.9% from a slip or fall, 1% from a reaction to contrast agents, 1% from clerical error, 0.8% from failing to report, and 0.6% from labeling errors.

According to an opinion piece in the British Medical Journal (2005;329: 1353), the current system for determining medical negligence in the U.K. is secretive, unaccountable, and unregulated. Expert witnesses who are central to the system are not subject to a regulatory code, audit, appraisal, and peer review. The quality of reports expert witnesses provide varies greatly, and many present inappropriate source material to support their opinions, wrote Dr. Michael Bishop, a consultant urologic surgeon at Nottingham City Hospital.

A new system based on a national register of coded incidents and their outcomes would promote consistency in the treatment of negligence claims and enable doctors to learn from errors. To restore faith, the profession must make itself transparent, Bishop said.

For more information from the Diagnostic Imaging archives:

Mammographic markers may lead to confusion and liability

Doctors are talented, but so are lawyers

Malpractice data challenge defensive radiology stance

The specter of malpractice