Radiologist’s Failure To Follow Up Leads To Death

Plaintiff was a 54 year old male experiencing shortness of breath, cough, fever and chills.The doctor ordering the chest x-ray left his office that Friday afternoon before the X-ray was read. The radiologist interprets the x-ray at 5:10 pm as follows: There is vascular congestion and perihilar infiltrates. Cardiomegaly with congestive changes underlying infiltrate/pneumonia cannot be excluded. The man died on that Sunday in his home of bilateral pneumonia with cardiomegaly.

Would the standard of care require a Radiologist to call either the referring MD or patient under the circumstances?

MEDQUEST EXPERT RESPONSES:

The radiologist’s report is vague and it appears he/she is putting the case back in the referring doc’s lap to “correlate clinically”. Since it was late Friday afternoon and the transcribed report would probably not be available until later, I believe the radiologist does have the duty to call the referring doc if he/she thought pneumonia was a consideration. The American Board of Radiology Practical Guidelines for Communication would support this opinion.
– Dr DF, Radiologist

Given that history it might have been appropriate to call in a report if pneumonia was a real consideration. If they thought it was really just CHF not so much. The fever is the key. This one really depends on the appearance of the chest radiograph.
– Dr LS, Radiologist

The standard of care requires the radiologist to contact the referring physician or a responsible health care provider if there is a probable pneumonia. If someone cannot be reached then the standard would require patient notification. It is also possible that the chest x-ray was incorrectly interpreted and a more definitive diagnosis of pneumonia should have been considered in the context of the history of fever and chills.
– Dr SG, Radiologist

1. Based upon the radiology reading that you have summarized, I would not have assumed bilateral pneumonias to be the most likely diagnosis; I would have first considered pulmonary edema secondary to congestive heart failure. How confident are we that the cause of death was bilateral pneumonias?

2. I would carefully ascertain if a radiology report could have been delivered at 5:10 PM on a Friday. Was a telephone number provided, and, if so, was it covered? Neither of these can be assumed. It is almost never standard of care for the radiologist to directly contact the patient. When this is done, it almost always represents a radiologist’s action above and beyond any reasonable standard.

3. In general, diagnosis, treatment, and prognosis would be based more upon the clinical findings that the radiographic findings. Specifically, if this patient were febrile, with increasing shortness of breath, then the predominate problem would not be non-transmission of radiographic findings, it would be inadequate clinical follow-up. So, no meaningful comment can be proffered without knowledge of the clinical status of the patient on Friday, and on Saturday. If the patient had not been clinically worsening, I would propose that death from bilateral pneumonia would not be the most likely cause of death. Perhaps pulmonary edema or pulmonary embolus would each be more likely. Was there follow-up clinical examination or radiographic study?
– Dr CH Radiologist