Tuesday, April 23, 2013

Teleradiology: Misleading Patients As To Who is Reading Their Film

Although patients know that hospitals have third parties perform laboratory testing, few question the source of their CT scan's reading.

However, recognizing the financial advantages of outsourcing radiological services, hospitals have begun to outsource both beyond their own institution and the United States' borders.

Beyond misleading patients as to whom is providing their care, a patient injured through a teleradiologist not subject to the hospital's credentialing requirement suboptimal reading may have corporate negligence and informed consent claims case against the hospital.

What is Teleradiology

As a result of technological improvements, imaging can be easily transmitted to remote locations preventing physicians from travelling back to the hospital to interpret a study or film that could be done on their home computers.

When teleradiology studies are provided by a Pennsylvania-licensed radiologist directly affiliated with the institution at which the patient is receiving care, teleradiology can be a cost-effective way of improving patient care.

Unfortunately, because digital technology also enables transmitting the images anywhere around the world, overseas radiologists are often used to do interpretations.

Beyond the lack of communication between the clinician and doctor reading the study, the interpretation-providing-overseas-physician's frequent lack of credentials makes teleradiology an inferior form of care.

No Current Bar Against Teleradiology

Although patients and their families often select an institution based on its overall reputation, hospitals are not presently required to disclose the practitioner's interpreting the radiology studies location and credentials.

Further, to get around Medicare's refusal to pay for medical services performed outside the United States, offsite radiology services often perform "preliminary interpretations" contracted and paid for by a local radiology group servicing the hospital which follows up the with a "final reading" that is billed to Medicare.

"Corporate Liability" and "Lack of Informed Consent" Claims

Although there is no presently recognized requirement that treatment recommendations conveyed to the patient or family include a disclosure that they are based upon interpretations provided by practitioners not directly affiliated with the hospital or located in the United States, patients injured as a result of a teleradiologist's suboptimal reading may have corporate negligence and lack of informed consent claims against the institution.

In Thompson v. Nason Hospital, 527 Pa. 330, 591 A.2d 703 (1991), Pennsylvania's Supreme Court recognized that hospitals are directly liable to patients under the doctrine of corporate liability establishing a duty that the hospital owes directly to the patient to oversee all persons who render care and to adopt adequate policies ensuring quality care.

Because corporate liability involves hospital's direct negligence (as opposed to vicarious liability for hospital employee's act) and is based on the institution's negligent acts arising from its policies, an injured party need not establish a doctor's negligence to prevail under a corporate liability theory.

Further, in 2002, Pennsylvania's law of informed consent was legislatively changed to include misrepresentation where a patient was misled as to the doctor's training, experience or credentials.

The use of teleradiology without full disclosure is no less misleading to a patient than a surgeon exaggerating his or her experience performing a procedure and goes to the heart of a hospital's duty to its patients.