The Malpractice Liability of Radiology Reports: Minimizing the Risk

Data are lacking on the proportion of physicians who face malpractice claims in a year, the size of those claims, and the cumulative career malpractice risk according to specialty. We analyzed malpractice data from 1991 through 2005 for all physicians who were covered by a large professional liability insurer with a nationwide client base (40,916 physicians and 233,738 physician-years of coverage). For 25 specialties, we reported the proportion of physicians who had malpractice claims in a year, the proportion of claims leading to an indemnity payment (compensation paid to a plaintiff), and the size of indemnity payments. We estimated the cumulative risk of ever being sued among physicians in high- and low-risk specialties. Each year during the study period, 7.4% of all physicians had a malpractice claim, with 1.6% having a claim leading to a payment (i.e., 78% of all claims did not result in payments to claimants). The proportion of physicians facing a claim each year ranged from 19.1% in neurosurgery, 18.9% in thoracic-cardiovascular surgery, and 15.3% in general surgery to 5.2% in family medicine, 3.1% in pediatrics, and 2.6% in psychiatry. The mean indemnity payment was $274,887, and the median was $111,749. Mean payments ranged from $117,832 for dermatology to $520,923 for pediatrics. It was estimated that by the age of 65 years, 75% of physicians in low-risk specialties had faced a malpractice claim, as compared with 99% of physicians in high-risk specialties. There is substantial variation in the likelihood of malpractice suits and the size of indemnity payments across specialties. The cumulative risk of facing a malpractice claim is high in all specialties, although most claims do not lead to payments to plaintiffs. (Funded by the RAND Institute for Civil Justice and the National Institute on Aging.).

To develop and test a radiology peer review system that adds minimally to workload, is confidential, uniform across practices, and provides useful information to meet the mandate for "evaluation of performance in practice" that is forthcoming from the American Board of Medical Specialties as one of the four elements of maintenance of certification. RADPEER has radiologists who review previous images as part of a new interpretation record their ratings of the previous interpretations on a 4-point scale. Reviewing radiologists' ratings of 3 and 4 (disagreements in nondifficult cases) are reviewed by a peer review committee in each practice to judge whether they are misinterpretations by the original radiologists. Final ratings are sent for central data entry and analysis. A pilot test of RADPEER was conducted in 2002. Fourteen facilities participated in the pilot test, submitting a total of 20,286 cases. Disagreements in difficult cases (ratings of 2) averaged 2.9% of all cases. Committee-validated misinterpretations in nondifficult cases averaged 0.8% of all cases. There were considerable differences by modality. There were substantial differences across facilities; few of these differences were explicable by mix of modalities, facility size or type, or being early or late in the pilot test. Of 31 radiologists who interpreted over 200 cases, 2 had misinterpretation rates significantly (P < .05) above what would be expected given their individual mix of modalities and the average misinterpretation rate for each modality in their practice. A substantial number of facilities participated in the pilot test, and all maintained their participation throughout the year. Data generated are useful for the peer review of individual radiologists and for showing differences by modality. RADPEER is now operational and is a good solution to the need for a peer review system with the desirable characteristics listed above.

The ACR adopted its "Guideline for Communication: Diagnostic Radiology" in 1991. Since its adoption, the guideline has been the subject of considerable discussion and controversy. In response to more than a decade of debate, the ACR appointed a task force in the summer of 2003 to research and analyze claims and litigation decisions that have been related to the communication or reporting of imaging studies by radiologists. Furthermore, the task force was charged with making recommendations regarding the status and impact of the existing communication guideline. The only specific directions to the task force were to take into account the ACR's motto, "Quality is our image," in the recognition that communication plays an essential role in safety and quality. The task force consulted outside legal counsel, reviewed claims data from many sources, and performed a survey of the ACR's membership. Furthermore, the task force was divided into four working groups to focus on the data and make specific recommendations. The products of the working groups were assembled into a final report that was presented to the ACR Board of Chancellors in the winter of 2004. This report, including five recommendations, and a draft for a new communication guideline were presented to the ACR Council at the annual meeting in May 2004.