Advertisement

La radiologia medica

, Volume 118, Issue 3, pp 504–517 | Cite as

Malpractice claims in interventional radiology: frequency, characteristics and protective measures

  • N. MagnavitaEmail author
  • A. Fileni
  • P. Mirk
  • G. Magnavita
  • S. Ricci
  • A. R. Cotroneo
Ethics and Forensic Radiology / Etica e Radiologia Forense

Abstract

Purpose

The use of interventional radiology procedures has considerably increased in recent years, as has the number of related medicolegal litigations. This study aimed to highlight the problems underlying malpractice claims in interventional radiology and to assess the importance of the informed consent process.

Materials and methods

The authors examined all insurance claims relating to presumed errors in interventional radiology filed by radiologists over a period of 14 years after isolating them from the insurance database of all radiologists registered with the Italian Society of Medical Radiology (SIRM) between 1 January1993 and 31 December 2006.

Results

In the period considered, 98 malpractice claims were filed against radiologists who had performed interventional radiology procedures. In 21 cases (21.4%), the event had caused the patient’s death. In >80% of cases, the event occurred in a public facility. The risk of a malpractice claim for a radiologist practising interventional procedures is 47 per 1,000, which corresponds to one malpractice claim for each 231 years of activity.

Discussion

Interventional radiology, a discipline with a biological risk profile similar to that of surgery, exposes practitioners to a high risk of medicolegal litigation both because of problems intrinsic to the techniques used and because of the need to operate on severely ill patients with compromised clinical status.

Conclusions

Litigation prevention largely depends on both reducing the rate of medical error and providing the patient with correct and coherent information. Adopting good radiological practices, scrupulous review of procedures and efficiency of the instruments used and audit of organisational and management processes are all factors that can help reduce the likelihood of error. Improving communication techniques while safeguarding the patient’s right to autonomy also implies adopting clear and rigorous processes for obtaining the patient’s informed consent to the medical procedure.

Keywords

Interventional radiology Claims Radiologists Damage Consent Malpractice Stress Medical error Liability Ethics 

Il contenzioso in radiologia interventistica: frequenza, caratteristiche ed azioni di tutela

Riassunto

Obiettivo

Il ricorso alle procedure di radiologia interventistica è sensibilmente aumentato negli ultimi anni; di pari passo si è notato un incremento del contenzioso medico-legale ad esse associato. Questo studio mira a sottolineare i problemi all’origine delle denunce per malapratica in radiologia interventistica, ed a valutare l’importanza del consenso informato.

Materiali e metodi

Sono state esaminate tutte le denunce assicurative causate da presunti errori in radiologia interventistica in un periodo di 14 anni, enuncleandole dal data-base assicurativo dei radiologi iscritti alla Società Italiana di Radiologia Medica (SIRM) dal 01/01/1993 al 31/12/2006.

Risultati

Nel periodo in esame sono state sporte 98 denunce contro radiologi che avevano effettuato procedure interventistiche. In 21 casi (21,4%) l’evento aveva causato la morte del paziente. In oltre l’80% dei casi l’evento lesivo era occorso in una struttura pubblica. Il rischio di ricevere una denuncia per presunta malapratica per un radiologo che pratichi tecniche interventistiche è pari al 47 per mille, il che corrisponde ad una denuncia per ogni 21 anni di attività.

Discussione

La radiologia interventistica, attività sovrapponibile per profilo di rischio biologico alle procedure chirurgiche, espone gli operatori ad un elevato rischio di contenzioso medico-legale sia per problemi intrinseci alle tecniche usate, sia per la necessità di operare su soggetti con gravi patologie, e in condizioni cliniche compromesse.

Conclusioni

La prevenzione del contenzioso dipende in gran parte da una riduzione della percentuale di errore medico abbinata ad una corretta ed organica informazione del paziente. L’adozione di buone pratiche radiologiche, la scrupolosa revisione delle procedure e dell’efficienza tecnica degli strumenti usati, la verifica delle procedure organizzative e gestionali sono i fattori che riducono la probabilità dell’errore. Il miglioramento delle tecniche di comunicazione, nel rispetto dell’autonomia del paziente, passa anche attraverso l’adozione di procedure chiare e rigorose per l’ottenimento del consenso all’atto medico.

Parole chiave

Radiologia interventistica Denunce Radiologi Danno Consenso Malpractice Stress Errore medico Responsabilità Etica 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References/Bibliografia

  1. 1.
    Fileni A, Magnavita N (2006) Dodici anni di osservazioni sul contenzioso assicurativo radiologico. A 12-year follow-up study of malpractice claims against radiologists in Italy. Radiol Med 111:1009–1022PubMedCrossRefGoogle Scholar
  2. 2.
    Tomczak R, Schnabel S, Ulrich P et al (2006) Frequency and causes of civil and criminal proceedings in radiology. Analysis of a survey. Radiologe 46:557–566PubMedCrossRefGoogle Scholar
  3. 3.
    Mortier M, Villeirs G (2003) Legal liability of the radiologist in missed breast cancer diagnosis. JBR-BTR 86:1–2PubMedGoogle Scholar
  4. 4.
    Berlin L, Berlin JW (1995) Malpractice and radiologists in Cook county, IL: trends in 20 years of litigation. AJR Am J Roentgenol 165:781–788PubMedCrossRefGoogle Scholar
  5. 5.
    Brenner RJ (1993) Mammography and malpractice litigation: current status, lessons, and admonitions. AJR Am J Roentgenol 161:931–935PubMedCrossRefGoogle Scholar
  6. 6.
    Mitnick JS, Vazquez MF, Plesser KP et al (1993) Breast cancer malpractice litigation in New York State. Radiology 189:673–676PubMedGoogle Scholar
  7. 7.
    Bassett LW, Monsees BS, Smith RA et al (2003) Survey of radiology residents: breast imaging training and attitudes. Radiology 227:862–869PubMedCrossRefGoogle Scholar
  8. 8.
    Cypel YS, Sunshine JH, Ellenbogen PH (2005) The current medical liability insurance crisis: detailed findings from two ACR surveys in 2003 and 2004. J Am Coll Radiol 2:595–601PubMedCrossRefGoogle Scholar
  9. 9.
    Kopans DB (2004) Mammography screening is saving thousands of lives, but will it survive medical malpractice? Radiology 230:20–24PubMedCrossRefGoogle Scholar
  10. 10.
    Studdert DM, Mello MM, Sage WM et al (2005) Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA 293:2609–2617PubMedCrossRefGoogle Scholar
  11. 11.
    Fileni A, Magnavita N, Mammi F et al (2007) Il fenomeno dello stress da malpractice nei radiologi e radioterapisti. Percezione del problema e conseguenze. Malpractice stress syndrome in radiologists and radiotherapists. Perceived causes and consequences. Radiol Med 112:1069–1084PubMedCrossRefGoogle Scholar
  12. 12.
    Magnavita N, Magnavita G, Bergamaschi A (2010) Il radiologo malato. The impaired radiologist. Radiol Med 115:826–838PubMedCrossRefGoogle Scholar
  13. 13.
    Spring DB, Tennenhouse DJ (1986) Radiology malpractice lawsuits: California jury verdicts. Radiology 159:811–814PubMedGoogle Scholar
  14. 14.
    vanSonnenberg E, Barton JB, Wittich GR (1993) Radiology and the law, with an emphasis on interventional radiology. Radiology 187:297–303PubMedGoogle Scholar
  15. 15.
    Ministero della Salute (2000) Dati sul numero di esami di Radiologia Interventistica in Italia nel 2000. www.salute.gov.it/imgs/C_17_pubblicazioni_362_allegato.doc (Last access July 2012)
  16. 16.
    SIR-Society of Interventional Radiology. IR Procedures. Minimallyinvasive treatments performed by interventional radiologists. http://www.cirse.org/index.php?pid=85 (Last access July 2012)
  17. 17.
    Fileni A, Magnavita N (1996) Analisi delle denunce assicurative di responsabilità civile in Radiologia. Primi dati italiani. Radiol Med 91:275–278PubMedGoogle Scholar
  18. 18.
    Fileni A, Magnavita N (1997) Denunce di responsabilità civile contro i radiologi in Italia. Andamento del fenomeno nel triennio 1993–95. Radiol Med 93:284–286Google Scholar
  19. 19.
    Fileni A, Magnavita N (1998) Denunce di responsabilità civile contro i radiologi. Analisi del quinquennio 1993–1997. Radiol Med 95:506–510PubMedGoogle Scholar
  20. 20.
    Fileni A, Magnavita N (2000) Denunce contro i radiologi in Italia. Radiol Med 99:182–187PubMedGoogle Scholar
  21. 21.
    Fileni A, Magnavita N (2001) Denunce di responsabilità civile in radiologia. Otto anni di osservazioni e proiezioni future. Radiol Med 102:250–255PubMedGoogle Scholar
  22. 22.
    Fileni A, Magnavita N (2004) Problemi medico-legali. Radiol Med 107:99–104Google Scholar
  23. 23.
    Fileni A, Magnavita N, Pescarini L (2009) Analysis of malpractice claims in mammography: a complex issue. Analisi delle denunce di responsabilità civile in mammografia. Radiol Med 114:636–644PubMedCrossRefGoogle Scholar
  24. 24.
    Fileni A, Magnavita N (1995) Malpractice lawsuits in Radiology — Comparison of the Italian and American situations. Radiology 197:548–549PubMedGoogle Scholar
  25. 25.
    Fileni A, Magnavita G, Mirk P et al (2010) Radiologic malpractice litigation risk in Italy: an observational study over a 14-year period. AJR Am J Roentgenol 194:1040–1046PubMedCrossRefGoogle Scholar
  26. 26.
    Berlin L (1996) Errors in judgment. AJR Am J Roentgenol 166:1259–1261PubMedCrossRefGoogle Scholar
  27. 27.
    Berlin L (1996) Perceptual errors. AJR Am J Roentgenol 167:587–590PubMedCrossRefGoogle Scholar
  28. 28.
    Berlin L (2005) Errors of omission. AJR Am J Roentgenol 185:1416–1421PubMedCrossRefGoogle Scholar
  29. 29.
    Brenner RJ (1995) Interventional procedures of the breast: medicolegal considerations. Radiology 195:611–615PubMedGoogle Scholar
  30. 30.
    Mavroforou A, Giannoukas A, Mavrophoros D et al (2003) Physicians’ liability in interventional radiology and endovascular therapy. Eur J Radiol 46:240–243PubMedCrossRefGoogle Scholar
  31. 31.
    Hill GQ, Smouse HB (2006) Lessons learned on how to protect an interventional radiologist against malpractice claims. Semin Intervent Radiol 23:315–318PubMedCrossRefGoogle Scholar
  32. 32.
    Warren R, Eleti A (2006) Overdiagnosis and overtreatment of breast cancer: is overdiagnosis an issue for radiologists? Breast Cancer Res 8:205PubMedCrossRefGoogle Scholar
  33. 33.
    O’Dwyer HM, Lyon SM, Fotheringham T et al (2003) Informed consent for interventional radiology procedures: a survey detailing current European practice. Cardiovasc Intervent Radiol 26:428–433PubMedCrossRefGoogle Scholar
  34. 34.
    Habib SB, Sonoda L, See TC et al (2008) How do patients perceive the benefits and risks of peripheral angioplasty? Implications for informed consent. J Vasc Interv Radiol 19:177–181PubMedCrossRefGoogle Scholar
  35. 35.
    Stecker MS (2010) Patient radiation management and preprocedure planning and consent. Tech Vasc Interv Radiol 13:176–182PubMedCrossRefGoogle Scholar
  36. 36.
    Bennett DL, Dharia CV, Ferguson KJ et al (2009) Patient-physician communication: informed consent for imaging-guided spinal injections. J Am Coll Radiol 6:38–44PubMedCrossRefGoogle Scholar
  37. 37.
    Temple-Doig L, Gordon M, Buckenham T et al (2005) Informed consent for vascular intervention. NZ Med J 118:U1630Google Scholar
  38. 38.
    Magnavita N, Magnavita G, Fileni A et al (2009) Ethical problems in radiology. Medical error and disclosure. Radiol Med 114:1345–1355CrossRefGoogle Scholar
  39. 39.
    Ahmed K, Ashrafian H, Hanna GB et al (2009) Assessment of specialists in cardiovascular practice. Nat Rev Cardiol 6:659–667PubMedCrossRefGoogle Scholar
  40. 40.
    Magnavita N (2006) Management of the impaired physician in Europe. Med Lav 97:762–773PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2012

Authors and Affiliations

  • N. Magnavita
    • 1
    Email author
  • A. Fileni
    • 2
  • P. Mirk
    • 3
  • G. Magnavita
    • 1
    • 4
  • S. Ricci
    • 5
  • A. R. Cotroneo
    • 6
  1. 1.Istituto di Medicina del Lavoro dell’Università Cattolica del S. CuoreRomaItaly
  2. 2.Istituto Nazionale di Riposo e Cura dell’Anziano (INRCA)RomaItaly
  3. 3.Istituto di Bioimmagini e Scienze Radiologiche dell’Università Cattolica del S. CuoreRomaItaly
  4. 4.Consiglio Nazionale delle Ricerche presso Ministero dell’AmbienteRomaItaly
  5. 5.Istituto Nazionale di Riposo e Cura dell’Anziano (INRCA)AnconaItaly
  6. 6.Istituto di RadiologiaUniversità “G. D’Annunzio”ChietiItaly

Personalised recommendations