I spent yesterday in Waco, Texas, taking the deposition of a vascular surgeon that we sued on behalf of a client of Painter Law Firm for botching the evaluation, management, and surgical repair of an abdominal aneurysm.
The surgeon materially disagreed with a lot of the findings of an interventional radiologist who interpreted an abdominal CT angiogram of the patient that identified a celiac artery aneurysm. The disagreements include:
• Radiologist: Non-emergent, Surgeon: Emergent
• Radiologist: Consider endovascular catheter-directed stent placement, Surgeon: Do open surgery instead
• Radiologist: It’s a small aneurysm, Surgeon: It’s a large aneurysm
• Radiologist: The aneurysm is located on the celiac artery near the aorta (proximal), Surgeon: The aneurysm is located far from the aorta (distal)
By the time we stopped discussing the differences, I almost wondered if the radiologist and the surgeon were talking about the same patient.
Should clinical doctors call radiologists?
We retained a vascular surgery expert to look at this case and he believes that there was no reason to perform the surgery at all, at least initially. In fact, the expert says that the standard of care requires waiting six months to see if this type of aneurysm is stable, or unstable and growing.
In the deposition, I asked the surgeon if he knew how long the patient had the aneurysm—was it 20 years or 20 days? He said he had no way of knowing.
This got me to thinking about why the surgeon was in such a big hurry. After all, the radiologist identified a non-emergent aneurysm that was small and located near the aorta, which is an optimal location to treat it, if needed, with a minimally-invasive catheter procedure.
So, during the deposition I asked the surgeon how many celiac artery aneurysm repairs he had done in his decades of medical practice. His answer? Zero.
Next, I asked him if he picked up the phone and call the radiologist who had such radically different opinions about this aneurysm than the surgeon did. His answer? He could not remember doing so.
The crux of the problem is that, according to our expert, if the vascular surgeon had just waited and watched the aneurysm for six months, or alternatively had gone with the radiologist recommendation, the patient wouldn’t have had permanent injuries, including terrible infections and losing her spleen. Instead, the surgeon pulled the trigger on an unnecessary, invasive surgery and his patient is still paying the price.
Should radiologists call clinical doctors?
There’s a related issue about calls going the other way. The American College of Radiology has issued guidelines for communicating diagnostic imaging findings. For many years, the College’s standard was that a radiologist interpreting an x-ray, CT scan, MRI, CT angiogram, MR angiogram, or other diagnostic radiology study was in a safe harbor by simply writing a final report discussing findings.
In 2010, the College revised the guidelines to require direct communication with the treating or referring physician. In other words, it’s no longer sufficient for the radiologist just to write a report in three significant situations:
• When the radiologist identifies a finding that suggests the need for immediate or urgent intervention.
• When the radiologist has a finding that’s different from the previous interpretation of the same scan, and the failure to act may adversely affect the patient’s health.
• When the radiologist has a finding that he or she believes may be seriously adverse to the patient’s health and is unexpected by the treating or referring physician.
In other words, in these situations, the standard of care requires radiologists interpreting diagnostic scans to look up from their computer screens and call or walk down the hall to speak to the clinical doctor who ordered the scan and talk about the concerns.
In modern medicine, all kinds of different providers are involved in providing patient care. There are clinical physicians of various specialties, radiologists, nurses, techs, and many other healthcare providers. To keep patients safe, they must have open lines of communication with each other to make sure everyone stays in the loop and nothing falls through the cracks.
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If you or a loved one has been seriously injured by hospital or physician care, then the experienced medical malpractice stroke attorneys at Painter Law Firm, in Houston, Texas, are here to help. Click here to send us a confidential email via our “Contact Us” form or call us at 281-580-8800.
All consultations are free and, because we only represent clients on a contingency fee, you will owe us nothing unless we win your case. We handle cases in the Houston area and all over Texas. We are currently working on medical malpractice lawsuits in Houston, The Woodlands, Sugar Land, Conroe, Dallas, Austin, San Antonio, Corpus Christi, Bryan/College Station, and Waco.
Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2018, by H Texas as one of Houston’s top lawyers. In May 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.