The fear of being hit with a malpractice suit is an ongoing source of anxiety for radiologists, especially breast imagers. But the number of radiology malpractice claims has remained relatively stable over the past decade -- and most do not result in payments, says a new study in the Journal of the American College of Radiology.
Recent studies have suggested that one in every two U.S. radiologists will be involved in a malpractice claim by the time they are 60 years old, and that "failure of correct diagnosis" is the most common allegation. Yet a team led by Dr. H. Benjamin Harvey of Massachusetts General Hospital found that the number of claims has remained steady, and only 38% of these claims are actually paid out.
"The issue of malpractice and professional liability is of keen interest to most clinicians, particularly radiologists," Harvey told AuntMinnie.com. "But when you look at the number of radiology claims compared to other medical specialties, we're about where we've been in the past."
No news is good news
Harvey's team used data from Crico Strategies' Comparative Benchmarking System, a private database of about 300,000 open and closed medical malpractice claims, representing about 30% of all U.S. malpractice claims. (The other 70% of claims are handled by liability insurers that don't participate in the database.)
Dr. H. Benjamin Harvey of Massachusetts General Hospital.The researchers extracted all unique closed malpractice claims between January 2008 and December 2012. They then determined the total number of malpractice claims and the sum total paid loss for 11 medical services: anesthesiology, emergency medicine, internal medicine, nursing, obstetrics and gynecology, oral surgery and dentistry, pathology, pediatrics, psychiatry, radiology, and surgery (JACR, October 7, 2015).
For radiology cases, Harvey and colleagues parsed the data according to the following factors:
- Clinical setting in which the claim arose (outpatient, inpatient, or emergency)
- Severity of the alleged malpractice injury (graded as high, medium, or low based on the National Association of Insurance Commissioners scale)
- Disposition of the claim
- Indemnity paid to claimant, if a payment was made
- Primary imaging modality involved
- Primary diagnosis underlying the claim
Radiology was the eighth most likely service to be sued out of the 11 services analyzed, with surgery, medicine, and obstetrics and gynecology taking the top three spots.
"[This finding suggests] no dramatic shifts in the relative burden of radiology malpractice claims over time," Harvey and colleagues wrote.
What body regions were associated with the most malpractice claims? Breast and musculoskeletal imaging were high on the list, the group found.
| Body regions most likely to result in radiology malpractice claims | |
| Body region | Percentage of cases |
| Musculoskeletal | 21.4% |
| Breast | 20% |
| Other | 16.1% |
| Thoracic | 14.7% |
| Neurological | 14.5% |
| Abdominal and genitourinary | 13.3% |
In terms of payouts, radiology had the seventh highest total paid loss (which includes the indemnity payment, defense costs, and administrative expenses). Of 879 radiology claims, the total paid loss was $180.7 million in aggregate, with a median total paid loss of about $30,000 per case.
But of the total 879 claims, only 37.7%, or 331, resulted in indemnity payments, Harvey and colleagues wrote. The high percentage of cases without any payout may be explained by three factors, according to the researchers: a low proportion of valid claims, missed findings or diagnoses not being categorized as violations of the standard of care, or the error or missed diagnosis not being associated with any damages.
"Our study found that the most likely outcome of a claim involving radiology is no indemnity payment to the claimant," they wrote.
Pay attention to the outpatients
Forty-eight percent of radiology malpractice claims asserted injuries of medium severity, with 45.3% having high-severity injuries and 6.7% having low-severity injuries. Radiology claims were most likely to arise from outpatient care, at 66.1% of claims, and the allegations that sparked the suits were mostly diagnosis-related (57.3%), followed by medical or surgical treatment (26.7%), safety and security (7.7%), and communication (1.3%).
The fact that most claims arose out of ambulatory care situations probably reflects the increased prevalence of outpatient imaging, the authors wrote.
"The most common clinical context giving rise to radiology claims in our study was failure to diagnose or delayed diagnosis in the ambulatory setting," they wrote. "For [example], at our large academic institution, outpatient cases represent nearly 55% of all studies interpreted."
Be proactive anyway
When it comes to avoiding malpractice suits, what can radiologists do? Even though Harvey and colleagues found that the percentage of communication failures as the basis for claims was low, at 1.3%, radiologists can continue to focus on making their communication clear.
"There's been a strong quality assurance push around improving communication methods between radiologists and referring doctors -- making sure unexpected or critical results are communicated promptly and effectively," he told AuntMinnie.com. "We found that communication-related malpractice exposures have significantly decreased as a result of the concerted risk management effort."
In any case, the study results should be reassuring, Harvey said.
"There is a higher proportion of claims in the outpatient setting, and it's worth looking into why," he said. "But overall, the number of malpractice cases is low, and radiologists' exposure isn't overwhelming."
