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.
