CT SCAN

Verdicts & settlements April 27, 2009: CT scan case settles for $3.25M. (South Carolina)

Verdicts & settlements April 27, 2009: CT scan case settles for $3.25M. (South Carolina)

Legal Issues in medicine

The plaintiff's lawsuit charged all five codefendants with negligence for failure to diagnose the cervical spine fracture-subluxation at the time of admission to the hospital's emergency department, claiming that a prompt diagnosis would have led to "immediate neurosurgical intervention and avoidance of the paraplegia that ensued." With regard to the codefendant radiologist, the lawsuit in addition specifically alleged that the radiologist had been negligent for failing to "order and obtain a CT scan" (Daffner, 2006) at the time he had rendered his interpretation of the cervical spine radiographs.

During the discovery period, numerous records were examined and depositions taken that related to the conduct of the various defendant physicians and hospital nurses. For purposes of this article, I shall focus only on the testimony related to the defendant radiologist.

Radiographic procedure

A radiology expert witness retained by the plaintiff testified at a deposition that the defendant radiologist who had interpreted the initial cervical spine radiographs breached the standard of care for failing to call for an immediate CT scan.

The plaintiff's expert asserted that the defendant radiologist should have telephoned the emergency department physician and apprised him of the need for CT on the basis of the fact that the standard of radiologic care in the United States regarding evaluation of cervical spine injuries had "changed over recent years, moving from plain radiographs to helical CT." The expert pointed out that it was "common knowledge within the radiological community" (Stiell, Wells, et al, 2006) that "a great many cervical spine fractures are missed on plain radiography and are seen only by CT." When cross-examined by the attorney representing the defendant radiologist, the plaintiff's radiology expert acknowledged that he could find no abnormalities on the radiographs of the patient's cervical spine, but then added, "that was all the more reason for the defendant radiologist to have ordered a CT scan." (Mirvis, Diaconis, 2005)

The defendant radiologist and a radiology expert retained by the defense attorney each testified that no standard of care required a radiologist interpreting cervical spine radiographs to order a CT examination unless that radiologist observed a suspicious finding that needed further analysis. Both stated that it was the duty of the examining physician, not the radiologist, to order a CT scan if that physician believed it was clinically indicated. "It is the clinician, not the radiologist, who examines the patient and has before him or her all of the medical data to determine whether a CT is required," (Stiell, Wells, et al, 2006) asserted the defense's radiology expert.

As the discovery proceedings came to an end, the attorneys defending the five codefendants, along with the claims managers of the involved malpractice insurance companies, met to decide their course of action. They concluded that because the defense would have virtually no chance to prevail at a jury trial, they should undertake negotiations with ...