Malpractice issues in radiology. When an expert witness is not an expert

A Review of Professional Liability in IR: Sweeping the Mines

Medical professional liability (MPL) is becoming a substantial issue in interventional radiology (IR), with both impact on health care costs and negative psychological effects on physicians. MPL presents special challenges within IR because of the field's complex and innovative therapies that are provided to a diverse group of patients and complicated by the off-label use of devices and drugs that is pervasive in the field. This review discusses the principles and practices to avoid and manage MPLs that are specific to the field of IR.

Characteristics of Radiologists Serving as Medical Malpractice Expert Witnesses for Defense Versus Plaintiff

PURPOSE

Previous studies have reported higher qualification characteristics for anesthesiologists, neurosurgeons, orthopedic surgeons, and otolaryngologists serving as defense (versus plaintiff) medical malpractice expert witnesses. We assessed such characteristics for radiologist expert witnesses.

METHODS

Using the Westlaw legal research database, we identified radiologists serving as experts in all indexed medical malpractice cases between 2010 and 2019. Online databases were used to identify years of practice experience and scholarly bibliometrics. Using Medicare claims, individual radiologist practice types and mixes were ascertained. Radiologists testifying at least once each for defense and plaintiff were excluded from our defense-only versus plaintiff-only comparative analysis.

RESULTS

Initial Boolean searches yielded 1,042 potential cases; subsequent manual review identified 179 radiologists testifying in 231 lawsuits: 143 testified in one case (58 defense, 85 plaintiff) and 36 testified in multiple cases (10 defense-only, 14 plaintiff-only, 12 both). The 68 defense-only experts had fewer years of practice experience than the 99 plaintiff-only experts (28.3 versus 31.8 years, P = .02), but the two groups were otherwise similar in both practice type (44.6% versus 54.9% academic, P = .62) and mix (63.8% versus 65.8% practiced as subspecialists, P = .37) and as well as numbers of publications (60.5 versus 62.8, P = .86), citations (1,994.1 versus 2,309.2, P = .56), and h-indices (17.2 versus 16.8, P = .89).

CONCLUSIONS

In contrast to other specialists, radiologists serving as medical malpractice expert witnesses for defense and plaintiff display similar qualifications across various characteristics. Published practice parameter guidelines and experts' ability to blindly review archived original images might together explain this interspecialty discordance.

Expert witnesses: neuroradiologists' perspectives

PURPOSE

Physician malpractice expert witnesses may testify on behalf of physicians or patients. The goal of the study was to assess the experience of neuroradiologists as expert witnesses and their attitudes about such testimony.

METHODS

A survey was distributed to the 4,357 e-mail addresses of the members of the American Society of Neuroradiology with questions about expert witnesses.

RESULTS

The survey found that 1,301 of 4,357 answered at least one survey question. Five hundred twenty seven of 1194 (44.1%) of respondents had experience as expert witnesses. Most offer to testify on behalf of both plaintiffs and defendant physicians (324 of 465; 69.7%). Some do not testify/review cases on behalf of a plaintiff because they do not think that physicians should testify against other physicians, even if negligence is a factor (40 of 198; 20.2%). This reason was the most common for not agreeing to be an expert witness for a plaintiff, for all age groups. Of those expressing an opinion, 312 of 874 (35.7%) of neuroradiologists feel negatively about expert witnesses, whereas 434 of 874 (49.6%) say they serve a purpose, and 105 of 874 (12.0%) feel they should be commended for their work on behalf of the justice system.

CONCLUSIONS

Of neuroradiologists answering the survey, nearly half have served as expert witnesses, and most feel comfortable testifying for both plaintiffs and defendants. Substantive negative perceptions (35.7%) of expert witnesses were found.

Guidelines for the ethical use of neuroimages in medical testimony: report of a multidisciplinary consensus conference

SUMMARY

With rapid advances in neuroimaging technology, there is growing concern over potential misuse of neuroradiologic imaging data in legal matters. On December 7 and 8, 2012, a multidisciplinary consensus conference, Use and Abuse of Neuroimaging in the Courtroom, was held at Emory University in Atlanta, Georgia. Through this interactive forum, a highly select group of experts-including neuroradiologists, neurologists, forensic psychiatrists, neuropsychologists, neuroscientists, legal scholars, imaging statisticians, judges, practicing attorneys, and neuroethicists-discussed the complex issues involved in the use of neuroimaging data entered into legal evidence and for associated expert testimony. The specific contexts of criminal cases, child abuse, and head trauma were especially considered. The purpose of the conference was to inform the development of guidelines on expert testimony for the American Society of Neuroradiology and to provide principles for courts on the ethical use of neuroimaging data as evidence. This report summarizes the conference and resulting recommendations.

Breast imaging, standard of care, and the expert

Many radiologists have the opportunity to serve as experts in determining whether a colleague's actions are within standard of care. This is an important responsibility because, in large part, the fairness and success of the judicial system determining whether medical negligence has occurred is dependent on the opinion of the medical expert. Especially in the field of breast imaging, the physician acting as an expert often has to base opinions on judgments rather than incontestable facts. To make judgments of the highest quality, the expert must possess a clear understanding of the concept of standard of care. This article focuses on the role of experts in malpractice cases dealing with mammography and the delay of diagnosis of breast cancer.

Child abuse in the pediatric intensive care unit

Critically ill and injured children due to abusive or inflicted injury represent a growing challenge for pediatric intensive care unit personnel in terms of the number of patients seen each year in the United States and the intellectual and emotional response required to deal with this tragic problem. We present a distillation of the current knowledge of childhood physical abuse with a focus on the child with inflicted injury who is admitted to the pediatric intensive care unit. In addition to a discussion of the epidemiology, clinical presentation, an approach to diagnosis, and treatment strategies, we also explore the legal issues that confront pediatric intensive care unit physicians in relation to determination of brain death, suitability of victims for organ donation, and the physician's role in the criminal investigation of child abuse and as a witness for court proceedings.