Academic journal article Rutgers Computer & Technology Law Journal

Teleradiology: The Perks, Pitfalls and Patients Who Ultimately Pay

Academic journal article Rutgers Computer & Technology Law Journal

Teleradiology: The Perks, Pitfalls and Patients Who Ultimately Pay

Article excerpt

I. INTRODUCTION II. TELERADIOLOGY--A BRIEF HISTORY III. QUESTIONS RAISED BY TELERADIOLOGY        A. Who Is Responsible?            1. Teleradiologist                a. Standards Governing Radiologists                b. On-Site Versus Working from Home                c. Equipment Guidelines and Standards                d. Intangible Interpretation Factors            2. Teleradiologist's Employer            3. Treating Physician            4. Hospital's Liability                a. Ostensible Agency                b. Non-Delegable Duty Doctrine IV. JURISDICTION AND SERVICE OF PROCESS V. CONCLUSION 

The business side of medicine is driven by profits. Changes have been implemented to achieve this goal of profits through the utilization of such things as electronic medical records, e-prescriptions, the increased use of generic drugs, and the reduction in the number of diagnostic imaging and blood tests ordered. A less well-known area of change is teleradiology, the ability of healthcare providers to transmit radiological images, like X-rays, CT Scans and MRIs, from one location to another for diagnostic or consulting purposes. The premise is that a radiologist can diagnose images remotely from anywhere in the world as long as there is a phone or internet connection. This allows a medical facility, regardless of its size, to have a radiologist on call at any hour to quickly review diagnostic studies, without having to employ such a specialist on premises. The business advantages of teleradiology are obvious, but who is responsible when something goes wrong? While teleradiology services are usually set up as independent contractors, can the healthcare provider escape liability for the malpractice of a radiologist who is not an employee of the hospital or urgent care center? The complex and sometimes far-removed relationships that teleradiology creates can make ascertaining who is liable and how to seek legal redress uncertain. This article will address the myriad legal issues that arise with the use of this technology in the practice of medicine.

Financial Disclosure

The authors have received no financial aid for the writing of this article nor do they have any financial interest in the topic.

Annie was rushed to the emergency room of a rural hospital complaining of an intense headache. The emergency room doctor ordered a CT of her brain to determine the cause. As is the case with many smaller facilities, the hospital did not have a radiologist on site to interpret and discuss with the treating doctor what the test revealed. The hospital, however, had a contract with an off premise teleradiology company. Digital versions of the films were immediately dispatched to that service, which, in turn, sent the scan to one of its radiologists in California. She returned a written report indicating a small mass in the patient's brain, possibly a tumor, but not a life-threatening one.

Annie was discharged with pain medication and told to schedule an appointment with a neurologist. She returned to the medical facility four hours later in excruciating pain. The same ER doctor ordered a CT angiography to obtain a more detailed image of the brain. (1) The physician again sent the images to the teleradiology company, who forwarded the study to a different radiologist in England. This radiologist also detected the small mass but noted a cloudy ring around it. The ER doctor, finding no cause for concern from the second radiologist's evaluation, again discharged the patient.

The following morning, Annie's father - aware she had been to the hospital--checked in on his daughter. Unable to reach her by phone, he rushed to her house and found Annie unconscious at the bottom of the stairs. She was transported to the same emergency room, where she was now diagnosed with a ruptured brain aneurysm. Annie was in a coma for seven weeks and sustained permanent brain damage. Tier sensory skills are impaired; she cannot drive and has difficulty processing language, leaving her unable to function on her own. …

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