Failure to Communicate Critical Radiology Findings

The Radiologist's Duty to Communicate

The radiologist duty to communicate findings is a fundamental part of the standard of care. The duty includes:

- Written report: The radiologist must issue a written radiology report describing the findings, the diagnosis or differential diagnosis, and any recommendations for follow-up. The report becomes part of the patient medical record and is available to the referring physician. - Direct communication of critical findings: For critical, urgent, or unexpected findings, the radiologist must communicate directly with the referring physician -- typically by phone call or in person -- not just in the written report. A written report that sits in a chart does not constitute adequate communication of a critical finding. - Documentation of communication: The radiologist should document that the critical finding was communicated, to whom, when, and the response received. - Follow-up on non-communication: If the referring physician cannot be reached, the radiologist should attempt alternative methods of communication, such as contacting the covering physician, the emergency department, or the patient directly.

The duty to communicate is separate from the duty to correctly interpret the imaging study. Even if the radiologist correctly identified the finding, failure to communicate it promptly may constitute negligence.

[Link to: /radiology-errors/communication-failures]

What Are Critical Findings?

Critical findings are findings that require immediate or urgent attention to prevent serious harm or death. The ACR and many institutions maintain lists of critical findings, which typically include:

• Stroke: Acute ischemic stroke or hemorrhagic stroke on CT or MRI. [Link to: /medical-malpractice/stroke-misdiagnosis]
• Intracranial bleeding: Subdural, epidural, or subarachnoid hemorrhage.
• Brain tumor: Any new or enlarging brain mass.
• Aortic dissection: Tear in the wall of the aorta on CT angiography.
• Pulmonary embolism: Blood clot in the lungs on CT angiography. [Link to: /misdiagnosis/pulmonary-embolism-misdiagnosis]
• Tension pneumothorax: Collapsed lung on chest X-ray or CT.
• Bowel perforation: Free air in the abdomen on CT or X-ray.
• Spinal cord compression: Compression of the spinal cord on MRI.
• Acute fracture: Particularly spinal fractures, hip fractures, or pelvic fractures.
• Malignancy: New or suspected cancer on any imaging study. [Link to: /medical-malpractice/cancer-misdiagnosis]
• Internal bleeding: Active bleeding on CT, particularly in trauma patients. [Link to: /radiology-errors/ct-scan-negligence]
• Testicular torsion: Twisting of the testicle on ultrasound, which is a surgical emergency.
• Ectopic pregnancy: Pregnancy outside the uterus on ultrasound.
• Appendicitis: Inflamed appendix on CT or ultrasound. [Link to: /misdiagnosis/appendicitis-misdiagnosis]

The ACR and Joint Commission Standards

The standard of care for communication of critical findings is established by several authoritative sources:

American College of Radiology (ACR) Practice Parameter: - The ACR Practice Parameter for Communication of Diagnostic Imaging Findings requires that critical, urgent, or unexpected findings be communicated directly to the referring physician or their designee. - The communication should be timely (typically by phone call) and documented in the radiology report. - If the referring physician cannot be reached, alternative methods should be attempted.

The Joint Commission National Patient Safety Goals: - The Joint Commission requires that critical results of tests and diagnostic procedures be communicated to the responsible licensed caregiver within a defined timeframe. - Each institution must maintain a list of critical results and define the timeframe for communication.

Institutional policies: - Most hospitals and radiology practices have written policies for communication of critical findings, defining what constitutes a critical finding, how it should be communicated, and the required documentation.

Failure to follow these standards may constitute negligence. Expert testimony from a radiologist is used to establish the standard of care and whether it was breached.

How Communication Failures Happen

Radiology communication failures can occur in several ways:

• Finding buried in the written report: The radiologist identifies a critical finding but does not call the referring physician. The finding is mentioned in the written report, but the report may not be read promptly -- or at all -- by the referring physician.
• Failure to call: The radiologist does not make a phone call to communicate the critical finding, relying solely on the written report.
• Calling the wrong person: The radiologist calls someone who is not the responsible treating physician, or leaves a message that is not received.
• Failure to document communication: The radiologist claims to have communicated the finding but did not document the communication, making it difficult to prove.
• Inadequate follow-up: The referring physician cannot be reached, and the radiologist does not attempt alternative methods of communication.
• Unclear communication: The radiologist communicates the finding but does not clearly convey its urgency, leading the referring physician to delay follow-up.
• Failure of the referring physician to act: The radiologist communicates the finding, but the referring physician does not review the report or act on it. In this case, the referring physician may share liability.
• System failures: The hospital or radiology practice does not have adequate systems for tracking and following up on critical findings.

The Impact of Communication Failures

The impact of a radiology communication failure can be devastating:

- Delayed treatment of stroke: If a stroke is identified on CT but not communicated, the patient may not receive tPA or thrombectomy within the treatment window, leading to permanent brain damage. [Link to: /medical-malpractice/stroke-misdiagnosis] - Delayed treatment of cancer: If a tumor is identified on imaging but not communicated, the patient may not receive timely biopsy and treatment, allowing the cancer to progress. [Link to: /medical-malpractice/cancer-misdiagnosis] - Delayed treatment of internal bleeding: If active bleeding is identified on CT but not communicated, the patient may not receive surgery, leading to hemorrhagic shock and death. - Delayed treatment of aortic dissection: If an aortic dissection is identified but not communicated, the patient may not receive emergency surgery, leading to death. - Delayed treatment of spinal cord compression: If spinal cord compression is identified on MRI but not communicated, the patient may not receive decompression surgery, leading to permanent paralysis. - Delayed treatment of pulmonary embolism: If a pulmonary embolism is identified but not communicated, the patient may not receive anticoagulation, leading to death. [Link to: /misdiagnosis/pulmonary-embolism-misdiagnosis]

In each of these cases, the imaging study correctly identified the life-threatening condition -- but the failure to communicate it promptly prevented the patient from receiving life-saving treatment.

When a Communication Failure Constitutes Malpractice

A radiology communication failure constitutes medical malpractice in New York when the radiologist deviated from the accepted standard of care for communication of critical findings and that deviation caused harm. Key considerations include:

- Was the finding critical, urgent, or unexpected? The duty to communicate directly applies to critical, urgent, or unexpected findings -- not to routine or expected findings. - Did the radiologist communicate directly with the referring physician? For critical findings, direct communication (typically by phone call) is required. A written report alone is not adequate. - Was the communication timely? Critical findings must be communicated promptly -- often immediately or within a defined timeframe. Delaying communication until the written report is issued may be inadequate for urgent findings. - Was the communication documented? The radiologist should document the communication, including to whom, when, and the response received. - Did the referring physician act on the communication? If the radiologist communicated the finding but the referring physician did not act, the referring physician may share liability. - Did the communication failure cause harm? The harm must be causally connected to the communication failure. For example, if a stroke was identified on CT but not communicated, and the patient did not receive tPA, the communication failure caused the patient to miss the treatment window.

Under New York law, expert testimony from a radiologist is required to establish the standard of care. A certificate of merit (CPLR 3012-a) must be filed with the lawsuit.

Shared Liability: Radiologist and Referring Physician

In some cases, both the radiologist and the referring physician may share liability for a communication failure:

- Radiologist liability: The radiologist failed to communicate the critical finding directly to the referring physician, relying solely on the written report. - Referring physician liability: The referring physician failed to review the radiology report, or failed to act on a critical finding that was communicated. - System liability: The hospital or radiology practice did not have adequate systems for tracking and following up on critical findings.

In cases where both the radiologist and referring physician share liability, the plaintiff may pursue claims against both parties. An experienced attorney evaluates all potential defendants and pursues claims against all responsible parties.

The allocation of liability between the radiologist and referring physician depends on the specific facts of each case -- including whether the radiologist communicated the finding, whether the referring physician reviewed the report, and whether the hospital had adequate systems for follow-up. [Link to: /medical-malpractice/radiology-errors]

Proving Your Communication Failure Case

To prove a radiology communication failure case, you need:

- Radiology records: The imaging study, the radiology report, and any documentation of communication (or lack thereof) with the referring physician. - Medical records: From the referring physician and any treating physicians, documenting when (or if) the critical finding was received and acted upon. - Hospital policies: The hospital or radiology practice policies for communication of critical findings, establishing the institutional standard of care. - Expert testimony: From radiologists, establishing that the finding was critical and that the standard of care required direct communication. - Causation evidence: Medical records documenting the harm caused by the communication failure -- delayed treatment, disease progression, or missed treatment opportunities.

[Link to: /resources/how-to-get-medical-records-for-a-lawsuit] [Link to: /radiology-errors/proving-radiology-malpractice]

New York Statute of Limitations and Lavern's Law

Radiology communication failure claims are subject to the 2.5-year statute of limitations for medical malpractice (CPLR 214-a), running from the date of the negligent act (the date the finding should have been communicated).

Lavern's Law may extend this deadline for cancer cases -- giving 2.5 years from the date of discovery, with a 7-year outer limit. This is particularly important when a critical finding (such as a tumor) was not communicated and the patient did not discover the error until the cancer had progressed.

If the communication failure occurred at a municipal hospital (NYC Health + Hospitals), shorter deadlines apply -- 90 days for the notice of claim and 1 year, 90 days for the lawsuit. [Link to: /hospital-negligence/suing-nyc-h-h]

If the communication failure resulted in death, a wrongful death claim under EPTL 5-4.1 must be filed within 2 years of the date of death. [Link to: /wrongful-death-lawyer]

Common Defense Arguments and How We Counter Them

Defense: The finding was in the written report.

Defense attorneys use several arguments in communication failure cases:

• Our Counter: For critical, urgent, or unexpected findings, the standard of care requires direct communication -- typically by phone call -- not just a written report. A written report that sits in a chart does not constitute adequate communication of a critical finding. The ACR Practice Parameter and Joint Commission standards require direct communication of critical results. We use expert testimony to establish that the finding was critical and that direct communication was required.

Defense: The referring physician was responsible for follow-up.

Our Counter: While the referring physician has responsibility for follow-up, the radiologist has a separate duty to communicate critical findings directly. If the radiologist failed to communicate directly, the radiologist may share liability -- even if the referring physician also failed to follow up. We evaluate the actions of both the radiologist and the referring physician, and pursue claims against all responsible parties.

Defense: The finding was not critical.

Our Counter: We use expert testimony from radiologists to establish that the finding was critical, urgent, or unexpected -- requiring direct communication. The ACR and institutional lists of critical findings help define what constitutes a critical finding.

Defense: The communication failure did not cause the harm.

Our Counter: We use medical records and expert testimony to establish that if the critical finding had been communicated promptly, the patient would have received treatment that would have prevented or reduced the harm. For example, if a stroke was identified on CT but not communicated, and the patient did not receive tPA within the treatment window, the communication failure caused the patient to miss life-saving treatment. [Link to: /delayed-diagnosis-lawyer/loss-of-chance]

What to Expect Working with MDLaw Firm

When you contact MDLaw Firm about a potential communication failure case:

• Free Consultation: We listen to your story and review the basic facts.
• Record Retrieval: We obtain all imaging studies, radiology reports, medical records, and hospital policies on communication of critical findings.
• Expert Review: We engage board-certified radiologists to evaluate whether the finding was critical and whether the standard of care for communication was met.
• Causation Analysis: We establish the causal connection between the communication failure and the harm.
• Multi-Defendant Analysis: We evaluate the liability of the radiologist, referring physician, and hospital, pursuing claims against all responsible parties.
• Litigation: We file within the statute of limitations and handle all aspects of discovery and trial.
• Resolution: We pursue maximum compensation through settlement or verdict.

Frequently Asked Questions

The value of a medical malpractice case in New York depends on several factors, including the severity of the injury, the strength of liability evidence, and the economic and non-economic damages involved. New York is one of the few states with no caps on medical malpractice damages, meaning there is no artificial limit on what you can recover. Below are typical settlement ranges based on injury severity.