$16.7 million verdict in missed Lung Cancer

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If I had an award like that against me I'd probably off myself in spite of the decision. Very, very few things are worth a 16 million dollar award.
 
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A CXR pays about 4-8 bucks to read. Ridiculously low. If you can sue someone for 17 million for a mistake on a CXR, then you have indirectly agreed to pay high for interpretation of that study. High risk job = high pay.

Comments are interesting. One comment says that people expect competence and not perfection. Tell the same guy to pay 10 bucks for a CXR interpretation and he says that this is too much money for 2 minutes of work.

Next time if someone says that 300K income is too high, I will show them this article and tell them "STFU".
 
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WTF wow this is utter bull****.
 
Mother had the kid when she was 14. The kid at the age of 33 is now a millionaire. No overhead. Just a bastard millionaire. I am jealous.

That is your Boston strong. I always forget that the tornado bait trash there is worse than that in Dallas or Chicago.

Ms. Ellis probably never provided for her child until this posthumous verdict that now lets her offspring resume illicit sexual and illicit drug activity.
 
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So how much of the award is covered by this guy's insurance?
 
maxxor said:
ACR recommends 1 million per occurrence / 3 million per year.

So probably that much...
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So the guy has to cover the rest? What's the point of even working then if all your money goes to the plaintiff...
 
Baller MD said:
So the guy has to cover the rest? What's the point of even working then if all your money goes to the plaintiff...
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The better question is what is the point of going into medical school if this is it?

There is much more to it. Having a major lawsuit (and I am talking about amounts much less than 17 mill) can hurt your future opportunities significantly unless you are in academics or an employee of a big system.

Just imagine that this guy wants to change his job, or he loses his job. Do you think he will be able to find another job? Which hospital or pp group want to put the name of this guy on their board?

Or let's say that a family doctor, surgeon, nephrologists, mammographer or .... name comes up on news like this. Do you think patients will go to him anymore?

The 200K or 300K or 400K income that you may make after finishing residency may seem very sexy to general public. But when you take into account all the hours that you put into it, all the years of your life that you have spent, long hours of work, night call, constant decrease in salaries and then all this litigation and BS that you have to deal with, then you think that it may have not been the right path.
 
I like how they partially justified it by saying, "Ellis also had many new nodules throughout her lungs that were not present at the time of the chest X-ray, Higgins said." Is that supposed to be picked up by CXR too? ****ing attorneys.
 
shark2000 said:
The better question is what is the point of going into medical school if this is it?

There is much more to it. Having a major lawsuit (and I am talking about amounts much less than 17 mill) can hurt your future opportunities significantly unless you are in academics or an employee of a big system.

Just imagine that this guy wants to change his job, or he loses his job. Do you think he will be able to find another job? Which hospital or pp group want to put the name of this guy on their board?

Or let's say that a family doctor, surgeon, nephrologists, mammographer or .... name comes up on news like this. Do you think patients will go to him anymore?

The 200K or 300K or 400K income that you may make after finishing residency may seem very sexy to general public. But when you take into account all the hours that you put into it, all the years of your life that you have spent, long hours of work, night call, constant decrease in salaries and then all this litigation and BS that you have to deal with, then you think that it may have not been the right path.
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Shark,
Will this guy have to shoulder the remaining balance? That will ruin the rest of his life.
 
shark2000 said:
The better question is what is the point of going into medical school if this is it?

There is much more to it. Having a major lawsuit (and I am talking about amounts much less than 17 mill) can hurt your future opportunities significantly unless you are in academics or an employee of a big system.

Just imagine that this guy wants to change his job, or he loses his job. Do you think he will be able to find another job? Which hospital or pp group want to put the name of this guy on their board?

Or let's say that a family doctor, surgeon, nephrologists, mammographer or .... name comes up on news like this. Do you think patients will go to him anymore?

The 200K or 300K or 400K income that you may make after finishing residency may seem very sexy to general public. But when you take into account all the hours that you put into it, all the years of your life that you have spent, long hours of work, night call, constant decrease in salaries and then all this litigation and BS that you have to deal with, then you think that it may have not been the right path.
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My bank account and investments would be emptied and you would never see me again.
 
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Mad Jack said:
If I had an award like that against me I'd probably off myself in spite of the decision. Very, very few things are worth a 16 million dollar award.
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Doesn't malpractice insurance pay for it?
 
DermViser said:
Doesn't malpractice insurance pay for it?
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How many people do you know that carry policies that big? Aren't most malpractice policies limited to 1 million per instance and either 3 or 5 million per year total? I'm sure there are more robust policies out there, but honestly I don't know what the average rads guy packs.
 
Mad Jack said:
How many people do you know that carry policies that big? Aren't most malpractice policies limited to 1 million per instance and either 3 or 5 million per year total? I'm sure there are more robust policies out there, but honestly I don't know what the average rads guy packs.
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So then who else would pay it? The radiologist can't. Unless Brigham and Women's will.
 
Mad Jack said:
And now you get why people would disappear/kill themselves/kill the lawyer over a malpractice suit like this. It's life and career ruining.
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Oh, yes, I would completely understand. After all those years of hard work and saving for retirement it's gone in a flash. I don't know why people have this idea that Radiology is "easy". It's cases like this that proves it isn't and this is just one modality.

Thanks for clarifying.
 
Silent Cool said:
Thank you for that answer. That's what I was looking for. So, basically all of his assets will be taken from him???
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There's certain things that are protected in bankruptcy. Basically civil awards would be dealt with like any other debt in a bankruptcy filing but receive higher priority than typical secured and unsecured debts. You get to keep the normal stuff you'd keep in a bankruptcy, such as your primary residence, but your savings and basically everything you own gets liquidated.
 
DermViser said:
Oh, yes, I would completely understand. After all those years of hard work and saving for retirement it's gone in a flash. I don't know why people have this idea that Radiology is "easy". It's cases like this that proves it isn't and this is just one modality.

Thanks for clarifying.
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Miss a malignant mole and even derm can land you well into the 7 or even 8 figures in a civil suit. No specialty is safe, really.
 
Mad Jack said:
Miss a malignant mole and even derm can land you well into the 7 or even 8 figures in a civil suit. No specialty is safe, really.
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True, but at least I'm the one doing the history and physical. I see the lesion, I do dermoscopy, and if I'm really that malpractice scared, I can do a skin biopsy, and even read the dermpath myself, although usually it would be sent to a board certified dermatopathologist. Rads doesn't have that luxury to go to the patient's room and get an H&P.

Radiology is making reads many times with an incomplete picture and have to ask the team what they are looking for. They truly are dependent on other players in the system.
 
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DermViser said:
True, but at least I'm the one doing the history and physical. I see the lesion, I do dermoscopy, and if I'm really that malpractice scared, I can do a skin biopsy, and even read the dermpath myself, although usually it would be sent to a board certified dermatopathologist. Rads doesn't have that luxury to go to the patient's room and get an H&P.

Radiology is making reads many times with an incomplete picture and have to ask the team what they are looking for. They truly are dependent on other players in the system.
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Plus there's just so many ambiguous CXRs due to everything from patient position to technique to body mass. It's just way too easy to miss something, especially a nodule like this.
 
What's the maximum coverage available for a malpractice policy?
 
Mad Jack said:
Plus there's just so many ambiguous CXRs due to everything from patient position to technique to body mass. It's just way too easy to miss something, especially a nodule like this.
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Exactly. That's part of the reason I realized Radiology wasn't for me, bc of the inherent ambiguity with shadows of things, etc. It truly is a learned skill, and I could be wrong, but I don't think it's really something that can be "taught".
 
It can be taught inasmuch as someone has to help residents know what needs to be included in a search pattern. For something like a CXR, this is typically straight-forward and it's something that non-radiologists try to learn too. I know I was taught numerous mnemonics for CXRs as an MS3. But take something like a neck MRI for tongue cancer and what the head & neck surgeons need to know, and you can more easily understand how self-directed learning will only get you so far.

What can't be taught is getting your "eye" (so really your brain) adjusted to looking at a particular study or modality. I remember as a rotating medical student it was difficult at first to even tell which joint I was looking at on MSK MRI, or as an R1 actively trying to discern in conference whether I was looking at a T2 sequence or not. Now, my brain just "knows" and I struggle with the converse - how do I explain to the resident that I know this is a T2FS when my brain has already decided for me (heuristic decision making)?
 
If this was a VA radiologist, would the cap be $250k and he could still practice and not have to pay anything out of pocket?
 
49ers said:
If this was a VA radiologist, would the cap be $250k and he could still practice and not have to pay anything out of pocket?
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VA hospitals are still subject to the state laws in which the alleged tort occurred. The difference is that the plaintiff sues the U.S. Government instead of the individual physician. This protects the physician's personal assets, but he/she can still be reported to the databank if it is concluded that standard of care was not met.
 
It is likely that the radiologist will be responsible for policy limits only. But I have heard through secondary sources of wage garnishment in one case.

In any case, depending on your state, residence is protected if titled correctly, IRAs, 401k, pensions, annuities, 529 plans are protected at least partially. It is highly unlikely that a physician would have assets outside of these accounts that approach 7-8 figures.

Medicare pays 6-7 bucks professional fee for cxr. It is unbelievable that an "easy" read for this much can ruin your professional career.

Medicine is certainly a poor return on investment from a financial and risk stand point. Whereas most poor outcomes outside of medicine results in slap on the wrist, loss of job, we have to deal with career ruining lawsuits and our assets at stake. There have even been rare cases of bad outcomes resulting in criminal trials.

If you wanna help people there are easier ways to do so. Same goes with making a comfortable wage. If you wanna prove something or make your parents proud, there are also easier ways to do it than becoming an MD.
 
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colbgw02 said:
VA hospitals are still subject to the state laws in which the alleged tort occurred. The difference is that the plaintiff sues the U.S. Government instead of the individual physician. This protects the physician's personal assets, but he/she can still be reported to the databank if it is concluded that standard of care was not met.
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But you're not likely to be fired because you work for the government right?
 
So I couldn't tell based on articles: Was it a search pattern "I did not see the lesion" type miss, or a misinterpretation miss "I think this opacity is pneumonia" but it was cancer?

Also is this going to change anyone's practice habits? More follow ups for pneumonia clearance? More strongly pushing for immediate CT with a new rounded opacity?
 
Baller MD said:
But you're not likely to be fired because you work for the government right?
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In general, yes, it is much more difficult to be fired as a federal employee, provided one is beyond his 1-year probationary period. I don't think anyone, VA or otherwise, is in the habit of firing someone for a single adverse ruling. Good radiologists miss things, and whether or not it ends up in litigation is often a function of luck. Firing an otherwise solid radiologist over this would be throwing the proverbial baby out with the bath water.
 
DrBowtie said:
So I couldn't tell based on articles: Was it a search pattern "I did not see the lesion" type miss, or a misinterpretation miss "I think this opacity is pneumonia" but it was cancer?

Also is this going to change anyone's practice habits? More follow ups for pneumonia clearance? More strongly pushing for immediate CT with a new rounded opacity?
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Based on the article, I presumed the former. And that no pneumonia was diagnosed. I don't think there's much to glean from this other than a reminder that the apices truly are the "lawyer zone". If the clinical picture points to pneumonia and the radiographs fit, I think the immediate CT will be of limited utility. Even if the CT shows a consolidation, you'll still need follow-up to exclude adenocarcinom, and common secondary signs of cancer (enlarged lymph nodes, pleural effusion) are too nonspecific to be useful at that time point.
 
colbgw02 said:
Based on the article, I presumed the former. And that no pneumonia was diagnosed. I don't think there's much to glean from this other than a reminder that the apices truly are the "lawyer zone". If the clinical picture points to pneumonia and the radiographs fit, I think the immediate CT will be of limited utility. Even if the CT shows a consolidation, you'll still need follow-up to exclude adenocarcinom, and common secondary signs of cancer (enlarged lymph nodes, pleural effusion) are too nonspecific to be useful at that time point.
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Is it frowned upon to always err on the side of better safe than sorry in radiology? Even at the expense of "wasting" health care dollars?
 
If you hedge too much, give wishy washy impressions or recommend too many follow up exams, your reputation will suffer and depending on where you practice, this may even cost you a job if too many referrerers complain and do not want you to read their studies. This is another stressor for me in this field.
 
Baller MD said:
Is it frowned upon to always err on the side of better safe than sorry in radiology? Even at the expense of "wasting" health care dollars?
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I think so. But I'd like to point out that there are different ways to "play it safe". As radman points out, there's the wishy-washy radiologist that can never make a decision. And then there's the (overly) sensitive radiologist that practices at the top right of the ROC. The latter type comes in two flavors - the kind with introspection and the kind without. The former recognizes that they don't "let things go" frequently, and they've made their peace with it. The latter doesn't understand why everyone else is "missing" all of these things.

Being an eternal hedger is the most annoying, IMO, followed by the clueless overcaller. Of course, there are two sides of this coin, meaning that trying to be too specific means that you'll overlook more things. Personally, I've chosen to practice in a manner that I know I "miss" things that some of my colleagues do not. I also know that I initiate fewer wild goose chases, recommend fewer unnecessary follow-ups, and generally cost the system less money. The problem is that I never get any positive reinforcement for this behavior, but there is negative reinforcement by way of peer review, retrospective "misses", and bad outcomes. The entire system is designed to push people toward hypersensitivity. Conversely there is no "false positive" or "overcall" rating when we do peer review, nor does an ordering provider ever call up and say "Hey, thanks for not calling that questionable asymmetry on the mammogram."
 
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colbgw02 said:
I think so. But I'd like to point out that there are different ways to "play it safe". As radman points out, there's the wishy-washy radiologist that can never make a decision. And then there's the (overly) sensitive radiologist that practices at the top right of the ROC. The latter type comes in two flavors - the kind with introspection and the kind without. The former recognizes that they don't "let things go" frequently, and they've made their peace with it. The latter doesn't understand why everyone else is "missing" all of these things.

Being an eternal hedger is the most annoying, IMO, followed by the clueless overcaller. Of course, there are two sides of this coin, meaning that trying to be too specific means that you'll overlook more things. Personally, I've chosen to practice in a manner that I know I "miss" things that some of my colleagues do not. I also know that I initiate fewer wild goose chases, recommend fewer unnecessary follow-ups, and generally cost the system less money. The problem is that I never get any positive reinforcement for this behavior, but there is negative reinforcement by way of peer review, retrospective "misses", and bad outcomes. The entire system is designed to push people toward hypersensitivity. Conversely there is no "false positive" or "overcall" rating when we do peer review, nor does an ordering provider ever call up and say "Hey, thanks for not calling that questionable asymmetry on the mammogram."
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You're totally getting sued for 17 million in a decade.
 
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