Outsourcing of Radiology Raises Concerns About Quality of Care

The word “x-ray” may still conjure images of doctors standing before backlit panels reviewing transparent x-ray scans and arguing over diagnoses. This bears little resemblance to the reality of modern x-rays. In a practice known as teleradiology, doctors and hospitals outsource x-rays and similar procedures to companies who may be located on the other side of town or the other side of the world. Doctors and technicians employed by these companies review the x-rays and issue a report. This practice, while perhaps increasing efficiency, also increases risks of misdiagnosis or even simple miscommunication, with potentially serious consequences.

A recent article published by MSNBC tells the story of a Pennsylvania woman who went to the hospital on a Friday night in 2005 complaining of a severe headache. The emergency room doctor thought it might be a cerebral hemorrhage, a potentially fatal condition, so he ordered a CT scan. The hospital electronically sent the CT scan data to a radiologist located across the state. The radiologist diagnosed a possible tumor rather than a hemorrhage. Since a tumor was not immediately life-threatening, the hospital sent her home with painkillers.

The woman returned to the hospital by ambulance about seven hours later, in even worse pain. The ER doctor ordered a more detailed CT scan, which was sent to a different radiologist. While the radiologist had a Pennsylvania medical license, his office was in Hong Kong. The radiologist identified an abscess around the mass in the woman’s brain, a condition that is very frequently fatal if not caught in time. The radiologist did not note the significance of his finding, i.e. its likelihood to be fatal, in his report to the hospital. Another radiologist at the Pennsylvania company also noted the abscess but did not report its significance.

The woman went home again, and later collapsed when the abscess ruptured. She spent eleven weeks in a coma while doctors tried to drain the fluids from her brain. She survived with permanent brain damage affecting memory and daily functions. The hospital settled a lawsuit with her family for a confidential amount.

Several experts who reviewed the case concluded that the emergency room doctor could have averted disaster by speaking to any of the radiologists involved. At no time did the doctor have direct contact with any of them. They received CT scan data, reviewed it, and issued a written report. No one compared notes, shared diagnoses, or asked any questions.

Outsourcing testing, radiology, and other functions is an increasingly common practice in modern medicine, and it flies in the face of some common conceptions of a doctor-patient relationship. Patients often still expect that their doctor will have access to all of their relevant test results and data, that the doctor uses all available information in making diagnoses and recommending treatments, and that the doctor is involved in every step of the process. This is no longer the case in many hospitals. Although the decision to outsource certain functions may make sense in saving costs for the hospitals, the hospitals and doctors still bear the responsibility for the accuracy of their diagnoses and treatments. By shifting some of that responsibility to others, doctors do not shift the risk of error. With practices like teleradiology, patients may not always know who is reviewing their x-rays, but they know who is responsible, and liable, for the results.

The Maryland injury lawyers at Lebowitz & Mzhen represent the rights of people who have suffered injury due to malpractice by medical professionals. To schedule a free and confidential consultation, contact the firm today.

More Blog Posts:

$2.5M Maryland Medical Malpractice Verdict to Family of Man Who Died After Suffering Hemorrhagic Shock Following Doctor’s Failure to Diagnose, Maryland Accident Law Blog, August 23, 2011
Are Some Children Undergoing Unnecessary CT Scans? Washington DC Injury Lawyer Blog, May 11, 2011
Montgomery County Jury Awards Silver Spring Woman $2.35M Maryland Medical Malpractice Verdict Over Wrong Diagnosis, Maryland Accident Law Blog, October 4, 2010

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