The Medical Malpractice Deposition: A Review for Radiologist-Defendants.

Depositions are critical components of any medical malpractice lawsuit and seek to help uncover the facts of the case to allow justice to be served. Depositions often create considerable anxiety for physician-defendants, including radiologists. Defendants unfamiliar with the rules of questioning or interviewing techniques used by plaintiffs' attorneys may fail to appreciate important and nuanced details of questions from the plaintiff's attorney, which in turn could impact the outcome of the case. Thorough and informed deposition preparation is thus essential. Highlighting issues relevant to radiologist-defendants, we discuss the role and structure of medical malpractice depositions as well as common scenarios, lines of questioning, and attorney strategies.

Relative Prevalence and Characteristics of Malpractice Litigation Involving Radiology Trainees.

PURPOSE: To assess the prevalence and characteristics of medical malpractice litigation involving radiology trainees. METHODS: Using a LexisNexis legal database keyword search, we identified all state and federal lawsuits between 2009 and 2018 yielding formal appellate and lower court opinions (precedent setting "complex litigation") potentially involving physician trainees. Available judicial records were systematically reviewed to identify malpractice matters with material trainee involvement. Cases were categorized by criteria including specialty and location. Incidence rates were calculated for all specialties. Radiology lawsuits were characterized further. RESULTS: Initial LexisNexis Boolean database search yielded 8,935 potentially relevant cases with 580 confirmed as malpractice materially involving physician trainees. Annual cases trended downward (high 70, low 37). Most originated in New York (195 of 580; 33.6%), Ohio (41; 7.1%), and Pennsylvania (34; 5.9%) and involved surgery (204; 35.2%), obstetrics and gynecology (114; 19.7%), and medicine (105; 18.1%). The case incidence rate for all trainees was 0.63 per 1,000 trainee years. Of 309 cases with known outcomes, defendant physicians prevailed in 238 (77.0%). Radiology trainees represented only 23 cases (4.0%), corresponding to an incidence rate ratio of 0.79 (confidence interval 0.52-1.20). Radiology litigation most frequently involved alleged missed diagnoses (14 of 23; 60.8%) and procedural complications (7; 30.4%). Defendant radiologists prevailed in 9 of the 13 cases with known outcomes (69.2%). CONCLUSION: Complex medical malpractice litigation involving physician trainees is infrequent and decreasing over time. Lawsuits involving radiology trainees are uncommon, less likely than for many nonradiology trainees, and typically involve alleged missed diagnoses or procedural complications. Defendant radiologists usually prevail.

Distribution and Characteristics of Malpractice and Nonmalpractice Litigation Involving Interventional Radiologists in the United States from 1983-2018.

PURPOSE: To describe the distribution and characteristics of both malpractice and nonmalpractice litigation involving interventional radiologists (IRs). METHODS: Using Westlaw and LexisNexis court legal databases, we identified all United States federal and state cases between 1983 and 2018 yielding appellate court or judicial opinions (legally precedent setting "complex litigation") potentially involving IRs. Relevant court documents were individually and systematically reviewed to confirm IR involvement. Cases were categorized by type, jurisdiction, time, and disposition. RESULTS: Initial Boolean searches resulted in 251 and 575 potentially relevant Westlaw and LexisNexis cases, respectively. After eliminating duplicative (eg, multiple appeals) matters from the 123 cases individually confirmed meeting inclusion criteria, 85 unique cases were identified. Of these, 51 (60.0%) involved malpractice allegations, of which vascular interventions were most common (23/51; 45.1%). Of 34 (40.0%) nonmalpractice cases, employment (21/34; 61.8%) and disability (4/34; 11.8%) disputes dominated. Involved IRs prevailed in 56.9% (29/51) of malpractice and 11.8% (4/34) of nonmalpractice cases. In state courts, the Northeast accounted for 35.7% (20/56) of all litigation and 43.2% (19/44) of all malpractice litigation. Nationally, complex litigation has increased over time, from a low of zero cases in 1983 to a high of 11 in 2013. CONCLUSION: Litigation involving IRs typically surrounds not only malpractice matters, but also employment and disability disputes. With only 85 unique cases over 35 years, complex litigation is uncommon but increasing. IRs seeking to minimize litigation should not neglect the risks associated with employment contracting and disability insurance.

Medical Malpractice in Image-Guided Procedures: An Analysis of 184 Cases.

PURPOSE: To report types and outcomes of a small subset of malpractice lawsuits filed against physicians performing image-guided interventions in the United States. MATERIALS AND METHODS: In total, 1,312 cases involving common image-guided procedures were reviewed from the Westlaw and LexisNexis databases in the United States from 1963 to 2018. Social Security, disability, employment contract, product liability, criminal, and government employment claims were excluded. The final legal cohort comprised 184 (14.0%) cases. They were categorized into vascular (113/184; 61.4%), inferior vena cava filter (n = 22; 12.0%), neurointerventional (n = 13; 7.1%), gastrointestinal and genitourinary (n = 17; 9.2%), foreign body (n = 7; 3.8%), biopsy related (n = 9; 4.9%), and oncologic (n = 3; 1.6%) interventions. Claims were also organized by defendant type and by specialty, complication stage, verdict, and year. RESULTS: From 2001 to 2018, 58.7% of claims (n = 108) were reported. Procedural complications related to arteriography were most commonly litigated (63/113; 55.8%). Claims arising from intra-procedural and early post-procedural complications were common (84/184; 45.7%). Community hospitals were most often named as defendants (61/184; 33.2%). In reported outcomes, courts sided with defendants in 81.9% (104/127) of the cases, similar to national malpractice trends. Unreported outcomes comprised 31% (57/184) of the data. CONCLUSIONS: For the small subset of claims published within national legal databases, intra-procedural and early post-procedural complications after diagnostic arteriography were most commonly litigated. Most (81.9%) claims with reported outcomes sided with the defendant physician.

Prone Transradial Catheterization for Combined Single-Session Transarterial Embolization and Percutaneous Posterior Approach Cryoablation of Solid Neoplasms.

Transradial access (TRA) has been associated with improved post-procedure hemostasis and patient satisfaction, and decreased hemorrhagic complications, sedation requirements, recovery times, and procedure-related costs when compared with traditional transfemoral catheterization. Supine TRA has been described for the treatment of myocardial infarctions, aortoiliac and femoropopliteal stenoses, and a variety of neoplasms. This original research describes prone transradial catheterization to facilitate combined single-session transarterial embolization and percutaneous cryoablation of solid neoplasms from a posterior approach without repositioning. Prone TRA access, transarterial embolization, and percutaneous cryoablation were successful in all cases described. Mean procedure time was 210 min (range: 140-250 min). One minor complication, transient bacteremia which responded to antibiotics, was reported. No major complications occurred.