Can I Be Sued As A Radiology Resident?
As radiology medical school applicants, radiology residents, and full-fledged radiologists, we all dread the possibility of a lawsuit when we begin to practice radiology. Very rarely discussed, however, is the possibility of being sued during radiology residency. The good news: it is very unusual! One article stated that there were only 15 legal cases and 10 law review papers that addressed physicians in training and standards of care on 2 large legal databases. And, these cases were not necessarily radiology residency specific. The bad news: although a remote possibility, it has happened several times in the past. So, this makes for an interesting topic that is not frequently addressed but is certainly a possibility. In this article, I analyze a few different sources on the web and in the literature to understand what conditions need to be met in order for a radiology resident to be sued. More specifically, we will analyze what standards of care need to be breached. Also, we will go through several ways radiology residents can prevent lawsuits in the future.
The Grounds for a Lawsuit
In order for a lawsuit to be successful against any physician in general, three requirements need to be satisfied. According to a recent article in Diagnostic Imaging, these are breach, causation, and damages. Breach implies that the physician did not satisfy the requirement of the standard of care. Causation implies that the breach of duty caused the malpractice. And, damages imply that there was significant harm produced by the event. In today’s article, I am going to explicitly discuss the issue of breach without a discussion of causation and damages because the concept of breach is what makes a malpractice case performed by a resident different from a fully trained attending.
Due to the standard of care being different for a resident, the definition of breach for a resident involved in a malpractice event becomes a little more complicated. In fact, over time, the standards of what breach means for the radiology resident have become blurred. I will discuss several cases that have different definitions of what is considered to be “standard of care”, specifically for a resident in training.
Some cases have involved the medical intern. There was one case where an intern failed to identify retained glass fragments and sewed a wound shut. In this case, it was concluded that the criteria for standard of care should be based upon the standards for the typical skills of an intern at that level. Subsequent lawsuits have demonstrated that the first year resident needs to fail to do something that a “physician or surgeon of ordinary skill, care and diligence” would typically do in order to breach the standard of care rule. In other words, a first-year resident without a full license can be required to meet the standards of a general practitioner physician in terms of standard of care.
For residents in a subspecialty level training program, there is added confusion related to the issue of breach of the standard of care. Some cases imply that the sub-specialized resident should meet the requirements of a general practitioner and other cases imply that resident should meet the requirements of a more specialized physician. Adding more confusion to the issue, according to the same article, there was one radiology resident specific case of a misread MRI of a newborn. In this case, the court was unable to determine a specific standard of care for the resident and ruled in favor the defendant. So, the “standard of care” for this radiology/specialist resident was not well defined at all in this case. (1)
In another case with a radiology resident, an AJR article discussed an incident that occurred during radiology moonlighting. The resident was sued for missing an abscess and instead called it a bladder diverticulum on a CT scan. The lawsuit was eventually settled, but prior to the settlement, the court determined that the jury would determine the liability, implying that a standard of care was breached at the level of an attending subspecialist/radiologist.
So, according to the literature, sometimes residents are considered to have lower than the typical standard of care for attendings, other times they are considered to be at the level of the standard of care of a general practitioner, and at other times the resident has to meet the standard of the attending in his/her subspecialty. Confusing, huh?
What Does This All Mean?/Primary Take-home Messages to Reduce Liability
So, now that you are really confused, what does this mean to you? Precept 1: Regardless of the definition of breach for the radiology resident, make sure to get help if you are unsure and the case can lead to patient morbidity. This can reduce the odds of getting sued for a questionable interpretation and allows your fellow attending to take responsibility for the case.
Precept 2: If moonlighting, make sure you have malpractice insurance. Misses do happen and it is possible you may be treated as a fully trained radiologist. So, don’t be caught off guard without proper insurance. In fact, you need to make sure that your insurance will specifically cover you for moonlighting mishaps.
And finally, Precept 3: Although it is infrequent, lawsuits do happen to radiology residents and you are certainly not immune from the ravages of the legal system. So, treat each case as if you are the responsible party and always provide you best effort to make the correct findings, diagnosis, and management.
Final Bottom Line
Although unlikely, residents can still be sued for malpractice. Don’t leave yourself susceptible to the possibility of a lawsuit as a resident!
Clin Orthop Relat Res. 2012 May; 470(5): 1379–1385.
Published online 2012 Jan 26.
Medical Liability of the Physician in Training
Brian Wegman, MD, James P. Stannard, MD, and B. Sonny Bal, MD, JD, MBAcorresponding author