Medical malpractice cases are damaging for radiologists, even if they win. And in some states, like Pennsylvania, the costs are higher.
As a case in point, a Pennsylvania appeals court recently upheld a jury verdict in favor of a radiologist who did not identify a chest wall lesion later diagnosed as cancerous.
In a nonprecedential decision, a three-judge panel of the Superior Court of Pennsylvania affirmed the outcome of the medical malpractice lawsuit brought by the family of Vijendra Shenoy. Shenoy died after his tumor went undetected for two years.
After reviewing Shenoy's CT scan -- ordered by an oral surgeon in 2017 for the evaluation of jaw pain and swelling, the interpreting radiologist noted a small lymph node but did not identify any chest lesion, according to court records. A 2.4‑cm mass was later found in 2019 and ultimately diagnosed as chondrosarcoma, a type of malignant bone cancer.
Shenoy sued the radiologist. The case was pending at the time of Shenoy's death, but became a wrongful death claim. On the plaintiff's side, the case rested on the jury accepting the expert witness's opinion that the appearance of the lesion was so obvious that failure to recognize it amounted to negligence, the February 10 filing noted.
To counter, the defense evoked testimony that, while the abnormality may have been obvious when viewed through hindsight and framing biases, it was subtle enough that failure to observe and report it was not a deviation from the standard of care.
"We note that there was no suggestion that the radiologist lacked the training and experience necessary to review Decedent’s CT images, employed inappropriate techniques in doing so, or chose not to report any abnormality that he in fact had observed," President Judge Anne Lazarus, Judge Mary Jane Bowes, and President Judge Emerita Kate Ford Elliott noted in their recent decision.
The jury initially concluded that the radiologist had not been perfect but had operated within the bounds of reasonable care, ending both the direct negligence claim and derivative claims against the corporate defendants named, according to the filing.
Typical radiology lawsuit
Andrew Wilmot, MD
"I was motivated in part by my own experiences with the medical malpractice system and also by seeing its effects on my colleagues and the healthcare system in general," Wilmot explained in an email. "What people should understand is that even when a radiologist -- or any doctor -- is released from a case or found not liable by a jury, they do not receive any apology or compensation for the missed days of work, the sleepless nights, etc."
In Pennsylvania, medical malpractice lawsuits have weighed on radiologists heavily enough that they have begun to leave the state to practice in less plaintiff-friendly states, according to Wilmot, who works in the division of teleradiologists that covers evenings and weekends throughout the expanding West Virginia University (WVU) Health System.
Out of the 25 members of Wilmot's group, 16 were working as onsite radiologists for hospitals in Pennsylvania as recently as five years ago, but now work primarily or exclusively for other states, he said. This is because the relative risk of a malpractice lawsuit is nearly four times greater for radiologists reading for hospitals in Pennsylvania, compared with other states, according to Wilmot.
State medicolegal winds
Pennsylvania's medicolegal environment has shifted in recent years.
After a medical malpractice crisis first surfaced in the early 2000s, legal reforms strengthened requirements of expert witnesses, sanctions for attorneys filing frivolous claims, and statutory limits on filing claims.
Until 2023, the "venue rule" limited where a case could be filed based on the county where the cause of action (alleged harm) occurred. However, the Pennsylvania Supreme Court rescinded that rule in 2022. Wilmot and others had credited the venue rule for reducing Philadelphia filings.
"This eased the pressure, but with the more recent repeal of the venue rule in the state, there has been a surge of medical malpractice cases since 2022," Wilmot wrote in his editorial.
Beginning in January 2023, lawyers could resume "venue shopping" or filing lawsuits in counties with a higher tendency toward finding for the plaintiff and higher rates of awarding nuclear verdicts (verdicts in excess of $10 million), the editorial highlighted.
The state's Civil Procedural Rules Committee could reexamine the impact of the medical liability venue rule change every two years; however, the Pennsylvania Supreme Court on February 18, 2026, issued an order permanently removing that provision.
Venue rule or caps
In a February 22, 2026, post, the Pennsylvania Coalition for Civil Justice Reform (PCCJR) remarked on the court's decision, saying, "It is disappointing that the Supreme Court passed on this opportunity to undo the damage to health care caused by its rescission of the medical liability venue rule."
"This rule was in place for twenty years and was a major factor in quelling the medical malpractice crisis of the early 2000s," the coalition said. "The rule prevented attorney forum shopping for jackpot verdicts."
PCCJR noted that "the battle is not over."
As part of his systemic critique, Wilmot said the single most significant issue is that Pennsylvania trial attorneys have succeeded in avoiding caps on damages and limits on the fees they can charge.
"This is where the meat is at in terms of fixing the system," he said.
Crisis coming in Pa.?
Judy Eschberger, executive director of the Pennsylvania Radiological Society, told AuntMinnie that when the Pennsylvania legislature enacted a special venue rule directing medical malpractice claimants to file such claims “only in a county in which the cause of action arose,” medical malpractice claims filed in Philadelphia in one year had fallen from 1,365 to 577, a decline of 58%.
Judy Eschberger, executive director of the Pennsylvania Radiological Society
"Unsurprisingly, there has been a large uptick in cases filed within the Philadelphia court’s jurisdiction since the rule was rescinded [in 2022]," Eschberger explained in an email. "Many consider the Philadelphia courts the equivalent of 'hitting the jackpot' with its $1 million plus verdicts."
As a result of the February 18, 2026, court decision, it is imperative that practitioners remember that they can include contractual venue provisions in agreements so that they can ensure that should a filing of a case be sought by a patient, it may only be filed in a court that is not hostile to doctors, hospitals, and defendants generally, Eschberger noted.
The Pennsylvania Radiological Society is monitoring the work of the PCCJR, which remains vigilant in its efforts to draw attention to the harmful consequences that venue/forum shopping and the failure to enact meaningful tort reform have on the Commonwealth’s healthcare providers, she added.
"It is clear from a recent report commissioned by the Hospital and Healthsystem Association of Pennsylvania (HAP) that the Commonwealth is headed toward a healthcare crisis if rising medical liability insurance costs continue," Eschberger warned, noting that Pennsylvania's 11% lower Medicaid reimbursement rate when compared to peer states combined with increased liability premiums are contributing factors to the financial strain on hospitals and healthcare practices in the Commonwealth.
"The report notes that Pennsylvania has the highest malpractice payout per capita of any state at $43 per resident, with total payments of $557 million in 2024," she said. "This is simply unsustainable."
Fair or foul play?
Does the Pennsylvania legal system play fair with physicians?
To see how physicians fare by state, AuntMinnie first turned to the National Practitioner Data Bank (NPDB), a federal information clearinghouse created by the U.S. Congress and administered by the U.S. Department of Health and Human Services (HHS). The system was created to prevent physicians who had lost privileges or paid malpractice claims in one state from jurisdiction-hopping or quietly relocating and practicing as if their record were clean elsewhere.
However, the NPDB also collects any medical malpractice payment made on a physician's behalf to resolve a malpractice claim. A settlement is most often a financial disposition of a case without a decision on the merits, according to the American College of Radiology (ACR) in an April 30, 2025, blog post.
To gather data for this article, AuntMinnie used the NPDB site to produce reports on the number of MDs, including radiologists, involved in malpractice cases. These cases included those who were settled not because the physicians were negligent, but because the math favored a settlement.
Venues matter. Comparing data available over the 2020 through 2025 five-year window, AuntMinnie found that Pennsylvania, with 38,908 unique MD practitioners, leads the nation in the number of medical malpractice payouts (64.8 per 1,000 MDs), narrowly edging out New York, a state with more than 54,429 practitioners (63.6 payouts per 1,000), NPDB data showed.
Georgia and Florida trailed together next, with 46.3 payouts per 1,000 MDs in the universe of 18,753 unique practitioners and 41.4 payouts per 1,000 among 60,654 unique practitioners, respectively.
California and Texas, which both have significantly larger shares of physicians (101,022 and 82,604, respectively), were both below 15 payouts per 1,000 over the five years, according to the data. These two states appear to have a cap on malpractice damages or a strongly enforced cap.
| State | Total reports (payouts $250K+) | Unique MD practitioners | Payments per 1,000 MDs |
| Pennsylvania | 2,520 | 38,908 | 64.8 |
| New York | 3,464 | 54,429 | 63.6 |
| Georgia | 869 | 18,753 | 46.3 |
| Florida | 2,509 | 60,654 | 41.4 |
| Illinois | 1,065 | 32,825 | 32.4 |
| California | 1,405 | 101,022 | 13.9 |
| Texas | 562 | 82,604 | 6.8 |
| State | Total reports (payouts $250K+) | Unique MD practitioners | Payments per 1,000 MDs |
|---|---|---|---|
| Pennsylvania | 2,520 | 38,908 | 64.8 |
| New York | 3,464 | 54,429 | 63.6 |
| Georgia | 869 | 18,753 | 46.3 |
| Florida | 2,509 | 60,654 | 41.4 |
| Illinois | 1,065 | 32,825 | 32.4 |
| California | 1,405 | 101,022 | 13.9 |
| Texas | 562 | 82,604 | 6.8 |
| Data retrieved from the National Practitioner Data Bank (NPDB) Data Analysis Tool on March 10, 2026, reflecting medical malpractice payment reports filed between January 2020 and December 2025, all physician MDs across all specialties, and payouts of $250,000 and higher. Claims per 1,000 MDs calculated from NPDB unique practitioner counts. (Source: npdb.hrsa.gov/analysistool/) | |||
Emerging hot-button area
For Wilmot, teleradiology has offered a potential safe haven. His conversation with AuntMinnie started on the point that most radiologists in his group were working as on-site radiologists for hospitals in Pennsylvania, but now they work primarily or exclusively for other states.
Radiology is the one medical specialty in a unique position to leave the state, "not physically but virtually," Wilmot wrote in his 2025 editorial.
However, teleradiology could be an emerging hot-button area for medical malpractice lawsuits. National teleradiology company Virtual Radiologic (vRad) has been studying the issue for over five years.
4.9% of the network's imaging volume results in 18.7% of the malpractice payouts
Analyzing internal data from 2017 through 2020, the company found that the state of Pennsylvania accounted for 4.9% of its imaging volume and 18.7% of its malpractice payouts. vRad also found New Mexico to be an outlier, like Pennsylvania, due to similar suspension of venue rules.
vRad Chief Medical Officer Ben Strong, MD, explained how the company is responding and how it advises its radiologists facing medical malpractice claims. The company employs 550 radiologists and covers 1,200 facilities nationwide, with work in all 50 states, according to Strong, who estimated that vRad radiologists read about 7 million studies per year.
"We're doing the math essentially right now and determining exactly what sort of increase would offset the medical malpractice risk of practicing in those states," Strong told AuntMinnie.
vRad is considering pricing measures to address surging medical malpractice lawsuits in some states, including Pennsylvania. What do radiologists need to know if faced with one? Ben Strong, MD, explains.
A second in-depth analysis is underway, Strong noted. For radiology practices, a thorough analysis of malpractice risk takes time and requires complete information. Important for vRad's analysis, the company maintained the same insurer, and the cases studied were closed.
"If you've jumped from one provider to another, that tends to fragment the data and make it very difficult to acquire and interpret."
When it comes to payouts, of all the factors that contribute to medical malpractice proceedings, venue could be the single most important one, Strong noted.
"Suspending the venue regulations and allowing people to choose the specific venue in which these are tried allows them to really curate the potential jury pool to their advantage," he explained. "What plaintiff lawyers tend to do is go for the most affluent and liberal communities, because their jury pools tend to side with the plaintiff more times than not, and also tend to award larger indemnities."
Costliest radiology misses
Not only did vRad identify the states that are the highest risk but its analysis also identified pathologies that impart the greatest risk of a medical malpractice case. Strong augmented understanding of quality assurance (QA) data dating back 20 years with his medical malpractice analysis and determined that certain pathologies, when missed, carry the highest risk of conversion to a medical malpractice case.
"There were real standouts that if you look at the most common misses, intracranial hemorrhage and pulmonary embolism, the likelihood of those converting to a medical malpractice case are actually fairly low," Strong explained for AuntMinnie. "They're far below, they're hundredths of a decimal point percentage risk because they're missed very frequently and they don't always result in a horrific patient outcome.
"In contrast, the real outliers from a medical malpractice standpoint, aortic dissection, spinal epidural abscess, and superior mesenteric artery occlusion -- those will range between 1% and 3% as far as the likelihood of converting to a medical malpractice case," he continued. "Still surprisingly low, right? But they're orders of magnitude greater than the most frequently missed entities."
Taking that information to the next level, vRad built pathology-specific AI algorithms to function as a safety net for the practice, which were specifically directed to "The Big Five," Strong said. In addition, vRad's educational materials focus predominantly on those pathologies to warn radiologists.
Ultimately, Strong also said his analysis found that the medical malpractice system was basically serving as a safety net for the un- and underinsured, to pay medical bills that might otherwise go unpaid.
