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Medical malpractice involving radiologic colon examinations: a review of 38 recent cases
1Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
Objective:
Our purposes were to determine the causes of malpractice claims against radiologists performing contrast examinations of the colon and to design strategies to reduce litigation and diminish patient morbidity.
Materials And Methods:
Reports of malpractice claims were collected from legal journals and databases between 1985 and 1994. For this period, 38 plaintiffs raised 52 allegations of malpractice that involved radiologists performing barium or Hypaque (meglumine diatrizoate; Winthrop Pharmaceuticals, New York, NY) colon examinations. For the 38 cases, 18 plaintiffs for decedents alleged that failure to diagnose colorectal cancer by barium enema examination caused delay in treatment and the patient's death. Eighteen plaintiffs alleged that improper performance of barium (17 cases) or meglumine diatrizoate (one case) colon examinations caused perforation of the colon, resulting in significant morbidity (15 cases) or death (three cases). Miscellaneous causes for malpractice claims were recorded in two cases.
Results:
In 18 cases of failure to diagnose colorectal cancer, the initial radiographs were interpreted as follows: normal findings in 14 cases, diverticulosis in one case, and spastic bowel in two cases; in the remaining case, colon cancer was missed because of nonopacification of the cecum. In retrospect, 17 of 18 colorectal cancers were visualized. The delay in the diagnosis of colorectal cancer ranged from 5 to 72 months. Missed colorectal cancers occurred in the cecum (two cases), transverse colon (two cases), rectosigmoid area (nine cases), or unspecified area (five cases). In 18 cases of colon perforation, the site was the cecum (one case), transverse colon (one case), extraperitoneal rectum (seven cases), rectosigmoid area (one case), colostomy stoma (two cases), or unspecified area (six cases). One patient experienced anaphylactic shock that required hospitalization. One underwent unnecessary surgery because barium enema films showing colon cancer were mislabeled with her name.
Conclusion:
On the basis of our analyses of malpractice claims, we suggest strategies to prevent medicolegal litigation. Strategies include communicating with the patient about the type and indications of the barium enema examination, performing digital rectal examinations on all patients to detect distal rectal lesions or strictures, recognizing colon perforation, and obtaining immediate surgical consultation if colon perforation occurs. The number of missed colon cancers may be reduced by reading twice or reviewing at a later time all barium enema examinations.
Insights
Malpractice claims in colon radiology often stem from missed colorectal cancer diagnoses and colon perforations. Implementing strategies like thorough patient communication and double-checking barium enema examinations can reduce litigation and improve patient outcomes.
Area of Science:
- Radiology
- Medical Malpractice Law
- Gastroenterology
Background:
- Malpractice claims against radiologists performing colon examinations present significant medicolegal challenges.
- Analyzing these claims is crucial for identifying systemic issues and improving patient safety.
Purpose of the Study:
- To determine the primary causes of malpractice claims related to radiologist-performed colon examinations.
- To develop actionable strategies for reducing litigation and mitigating patient harm.
Main Methods:
- A comprehensive review of malpractice claims from legal journals and databases (1985-1994).
- Analysis of 52 allegations across 38 cases involving barium or meglumine diatrizoate colon examinations.
- Categorization of claims into failure-to-diagnose colorectal cancer and colon perforation.
Main Results:
- Failure to diagnose colorectal cancer was alleged in 18 cases, with delays ranging from 5 to 72 months; 17 of these cancers were visible in retrospect.
- Colon perforation during barium or meglumine diatrizoate examinations was alleged in 18 cases, leading to significant morbidity or death.
- Miscellaneous claims included anaphylactic shock and misinterpretation of examination findings.
Conclusions:
- Key strategies to reduce malpractice claims include enhanced patient communication regarding examination indications and risks.
- Performing digital rectal examinations and promptly recognizing/managing colon perforations are vital.
- Implementing double-reading or delayed review of barium enema examinations can decrease missed colorectal cancer diagnoses.