Half of radiologists will be sued by age 60, study suggests

The chances of a radiologist being the defendant in at least one medical malpractice suit is 50% by age 60, but the difference in frequency and average number of suits varies by state and sex, according to a new study published online in Radiology.

"The specter of malpractice action remains a matter of concern for the specialty of radiology in general and for individual practitioners in particular," wrote lead author Dr. Stephen Baker, from the University of Medicine and Dentistry of New Jersey-New Jersey Medical School, and colleagues.

Baker's group used sex and age, state of residence, and board certification status of enrollee data from the credentialing files of One Call Medical, a specialized preferred provider organization that offers diagnostic imaging services for the workers' compensation, group health, and auto insurance industries (Radiology, November 28, 2012).

One Call Medical collects data of its members' malpractice histories from two sources, according to Baker's team. For claims in which a judgment was made against the radiologist, the record of the case is obtained from the files of the National Practitioner Data Bank (NPDB). In addition, radiologists seeking to become or remain members of One Call Medical are also obligated to disclose the circumstances of other malpractice claims in which they had been named as a defendant, including the following:

  • Those resolved in favor of the plaintiff
  • Those announced but not pursued before any further action was taken
  • Those that proceeded to some extent and then were withdrawn, for which the circumstances were unclear
  • Completed claims for which the radiologist was exonerated

The study interval ranged from 1955 to 2010 and included the malpractice histories of 8,265 radiologists (24% of the 34,503 radiologists in the U.S, according to the authors) who were credentialed members of One Call Medical as of August 2010. No physicians from Hawaii, North Dakota, South Dakota, or Vermont were enrolled with One Call Medical during the study period.

The District of Columbia and 10 states -- Alaska, Delaware, Iowa, Idaho, Montana, New Hampshire, Rhode Island, Washington, West Virginia, and Wyoming -- each contributed fewer than 50 radiologists to the pool of imaging interpreters, and because of this, radiologists from these states were excluded from comparisons between individual states, Baker's team wrote.

Of the 8,265 radiologists included in the study data, 6,787 (84.9%) were men, 1,209 (15.1%) were women, and for 269 a sex was not listed. Physician age was known for 7,896 of the 8,265 subjects; the group had a mean age of 50.7 years. The mean age of enrolled male radiologists was greater than the corresponding average for female radiologists (51.2 years versus 47.8 years, respectively). Study data included 4,741 claims against 2,600 radiologists.

In Utah, Kansas, New York, New Jersey, and Missouri, more than 40% of radiologists had a history of being the defendant in at least one malpractice suit, while fewer than 20% of radiologists had ever been sued in Wisconsin, Alabama, North Carolina, Arkansas, Mississippi, and Nebraska, Baker and colleagues found.

In total:

  • 1,515 radiologists had been sued once in their career
  • 599 had been sued twice
  • 486 had been sued three or more times

Radiologists in New York, Indiana, New Jersey, Utah, Florida, and Pennsylvania were more likely to have been sued multiple times than those in almost every other state, Baker's team found.

"As expected, as years in practice lengthen so, too, does the likelihood of being sued at least once," the authors wrote. "Though the percentage of men sued compared with their female counterparts of the same age is variable by age group, the overall odds of ever being a defendant in a case are greater for men than for women when controlling for age and state of residence."

Cold, hard cash

How much was paid out for these suits? Of 99 cases that ended in a court-directed judgment, the defendant was ordered to make payment in 44.4% of cases, and the average award paid on behalf of the radiologist in these cases was $411,112. Also, 2,109 of 2,293 cases settled out of court resulted in payment made on behalf of the radiologist, at a mean of $295,993 and median of $150,000.

Median awards to plaintiffs from radiology malpractice judgments varied more than 14-fold, ranging from $350,000 (Maine) to $24,105 (Colorado); mean awards to plaintiffs from radiology malpractice judgments varied more than ninefold, ranging from $715,707 (Oregon) to $74,373 (Nebraska).

Following those from Oregon, radiologists from Illinois, New Jersey, Maryland, Alabama, and Ohio paid out the highest settlements, with average payments greater than $400,000. Radiologists who paid the least in malpractice suit settlements were from Nebraska, Utah, Colorado, New Mexico, and Indiana, with average awards ranging from $74,373 in Nebraska to $171,813 in Indiana, Baker and colleagues wrote.

What are the causes?

In a related study, also co-authored by Baker and published online in Radiology, Dr. Jeremy Whang and colleagues investigated the most frequent causes of malpractice suits, using the One Call Medical data.

Causes of malpractice suits
Cause Claims per 1,000 person-years
Error in diagnosis 14.83
Breast cancer 3.57
Nonspinal fractures 2.49
Spinal fractures 1.32
Lung cancer 1.26
Vascular disease 1.08
Procedural complications 1.76
Inadequate communication with patient 0.40
Inadequate communication with referrer 0.71
Failure to recommend additional testing 0.41

"There is justification for [anxiety about the threat of malpractice actions] because suits against [radiologists] are not rare nor are they declining in frequency," Whang and colleagues wrote. "Although radiologists comprise 3.6% of all American physicians, they rank sixth among all specialists in the number of closed claims for which they have been defendants."

Study disclosures

Dr. Baker is medical director of One Call Medical.
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