Radiologist suspended from ACR for expert testimony

The American College of Radiology has handed down an 80-day membership suspension to Dr. Harwood B. Hance, an ACR fellow, for giving expert testimony deemed to be clinically inaccurate. The action comes less than two months after the college expelled a member for similar circumstances.

The committee on ethics received a complaint last February from an ACR member who alleged that Hance's testimony in a malpractice case violated the college's code of ethics, which states that expert testimony should be nonpartisan, scientifically correct, and clinically accurate.

The case involves a patient who received a contrast-enhanced CT scan of the abdomen and pelvis. About 14 minutes later, the radiologist defendant performed a second contrast-enhanced CT scan of the chest to evaluate a lung mass that had been detected on the first CT.

The patient went into oliguric renal failure and alleged in a suit filed in September 2001 that the radiologist was negligent in administering the second dose of contrast.

During the discovery period, which lasted almost two years, Hance testified that the entire diagnostic study could have occurred with a single dose of contrast. He further stated that the radiologist should have at least discussed the second dose of contrast with the patient or the referring physician. The radiologist's actions fell below the standard of care, Hance testified.

The case never reached trial as the plaintiff withdrew the complaint in November 2003. Three months later, however, the defendant radiologist filed a complaint with the ACR against Hance.

The radiologist alleged that there was no published literature or scientific data to support Hance's testimony - the so-called cumulative dose theory leading to nephrotoxicity, according to Thomas Hoffman, ACR associate general counsel.

Hance had testified that his theory was based on his general experience and acknowledged there was no literature to back it up.

Rather than appear in person before the committee on ethics, Hance sent medical records and assorted articles from different journals to support his testimony. The committee sent the complaint along with Hance's documentation to a third party reviewer, who supplied the committee with a written assessment.

A hearing in August determined that Hance's testimony was clinically inaccurate and scientifically incorrect. The committee on ethics agreed with the independent reviewer that Hance's supporting documentation did not represent a consensus on the standard of care.

Hance accepted the suspension and chose not to appeal to the college's judiciary committee, Hoffman said. He also indicated that he would petition the ACR for reinstatement after he has served his suspension.

The suspension will be reported to the National Practitioner Data Bank. When reached by phone in Redondo Beach, CA, Hance declined to comment.

A large lung mass has a greater likelihood of being cancerous and it's more reasonable to be given contrast for a second CT scan, said Dr. William C. Black, director of chest radiology at Dartmouth-Hitchcock Medical Center in New Hampshire.

"The contrast helps radiologists better evaluate the mass and determine if large lymph nodes in the mediastinum or hilum may reflect metastatic disease. That justifies the use of contrast," Black said.

At Dartmouth-Hitchcock, physicians try to assess a patient's creatinine level if they can before administering contrast. But that practice is not the standard of care and is quite controversial, Black said.

"No one has shown through studies that you have to get creatinine levels on every patient," he said.

The ACR has received 18 complaints of alleged ethics violations, 13 of which deal with suspect expert testimony.

In July, the ACR expelled a neuroradiologist who had had two separate ethics complaints lodged against him regarding expert testimony. In May, the college censured a radiologist who testified as an expert witness in a mammography liability trial. Two other expert witness complaints resulted in no action being taken by the committee on ethics. Seven complaints are currently pending.

"The committee on ethics believes that it is vital to respond to complaints of alleged improper testimony and review them to evaluate whether the physician in question has testified responsibly," Hoffman said. "As with other medical societies, the profession of radiology feels it's important to have radiologists understand the consequences of what they say and to take extreme care that it is nonpartisan and clinically accurate."