Malpractice and radiologists in Cook County, IL: trends in 20 years of litigation

The purpose of this article is to report the prevalence and nature of malpractice litigation involving radiology over a 20-year period and to identify trends among types of lawsuits filed. By recognizing where medicolegal risks lie in radiology, risk-management processes can be developed to minimize malpractice exposure and to improve patient care.

We conducted a retrospective study of all malpractice lawsuits (18,860) filed against physicians in the greater Chicago area between January 1, 1975, and December 31, 1994. About twelve percent (2219) involved radiologic procedures or radiologists. These lawsuits were divided into six groups: slip-and-fall, radiation oncology, failure to order a radiologic examination, complications, missed diagnoses, and miscellaneous. The yearly percentage of each category relative to the total number of radiology-related suits was determined, and then each group was further divided by specific diagnosis or incident.

Along with all medical malpractice lawsuits, radiology-related suits rose dramatically until 1985, when there was a marked but temporary decline caused by tort reform measures enacted in Illinois. Since then, lawsuits have resumed their annual upward climb, although the overall percentage related to radiology has remained relatively constant (10-15%). The relative number of radiology-related lawsuits in specific categories has changed over the past two decades: the percentages of slip-and-fall, radiation oncology, and miscellaneous cases have decreased, but percentages for the remaining three groups have increased. Lawsuits related to missed diagnoses, which account for the largest category of radiology-related cases, have increased from 34% to 47% of the total. The greatest increase in this category is for breast cancer. Lawsuits claiming injury from complications, the largest subgroup of which is angiography, have grown slightly, but cases alleging failure to order a radiologic examination have shown the greatest percentage increase in the 20-year period, growing from 20% in 1975-1979 to 30% in 1990-1994. This rise is attributed to the greater number of claims involving mammography, CT, MR imaging, and angiography. The growth in failure-to-order lawsuits will have important ramifications as managed care and health reform proposals attempt to limit use of radiologic services.

Notwithstanding the fact that tort reform measures in Illinois decreased the frequency of malpractice litigation temporarily in 1985 and will likely do so again in 1995, medical malpractice is likely to continue to plague radiologists unabatedly for many years to come.