White Paper: Incidental Findings Management: Protecting Patients, Providers, & Healthcare Systems

Failures to make a timely diagnosis of lung cancer often falls to either the family physician or radiologist. This is generally caused by misreading a chest CT scan; the ordering physician fails to see an abnormality in the report or recognize the significance of incidental findings, or when recognized, the finding does not receive proper attention and communication to the patient. A nationwide U.S. survey by Whang et al (4), identified error in diagnosis as the most common cause for radiology malpractice suits, followed by inadequate communication of important findings to the referring physician or clinician who is caring for the patient, and failure to recommend additional testing.

Oftentimes, radiologists detect such unexpected abnormalities in imaging studies done for other purposes, but health systems frequently lack the processes to ensure that patients and providers follow through. Experts estimate that compliance for follow-up ranges from 29% to 77% (1).

Failing to identify cancer and potential symptoms or communicate such findings, can deprive patients of life-saving treatment options. Also, to a patient experiencing several health problems, including premature death, health systems can be held responsible for significant monetary reparations to cover the costs of further treatment, lost wages, and pain and suffering associated with an untimely or avoidable death.

• 2017, Illinois $7,500,000 Settlement: Male patient had sought care at the University of Illinois for possible venous stenosis in his kidney, which included a CT scan of his abdomen and pelvis. The radiologist spotted a mass on his lungs and recommended additional tests, but did not share that info with the patient. The patient returned 18 months later after experiencing pain and swelling in his shoulder and chest. A new CT scan revealed lung cancer that had metastasized after a few months of treatment and the patient died at age 63. The Chicago-based hospital settled for $7.5 million over the delayed lung cancer diagnosis.
• 2017, Virginia $1,470,000 Settlement: 77-year-old male developed a persistent cough and underwent a Chest x-ray at urgent care, which was interpreted as showing a density in his left lung. The patient was referred to a pulmonologist. A second x-ray was ordered and the radiologist read it as normal, failing to compare the two films. The following year the patient was diagnosed with Stage IV lung cancer with metastasis to his brain and bones and died four months later. The jury found both the pulmonologist and radiologist were jointly and severally liable for negligence in failing to timely diagnose lung cancer and the parties settled for $1.47 million.
• 2018, Massachusetts $1,000,000 Settlement: Female patient in her early 70s underwent a CT scan as part of her treatment for cardiac disease. The radiology report identified a potentially suspicious mass in the patient’s lung and recommended a 6-month follow up CT scan. The report was sent to the primary care physician, but no 6-month follow up (or any follow up) was performed. By the time the lung cancer was diagnosed, it had spread to her liver and bones and she died shortly after. The primary care doctor was sued for negligently failing to follow up with the 6 month CT scan and the case was settled for $1 million.
• 2017, Maryland $461,862 Verdict: 79-year-old male with a history of smoking underwent chest CT scan as a part of a lung cancer screening clinic at GBMC. The radiologist identified two “nodular areas” in the patient’s lungs and submitted findings to the patient’s primary care physician, but without a clear diagnosis or recommendation. The primary care physician did not perform any follow-up exam. Two years following the CT scan the patient was diagnosed with Stage IV lung cancer and died soon after. A jury found the primary care doctor was negligent and awarded the estate $461,862.

While federal and state statutes may not directly address the physician’s duty to return incidental or secondary findings to patients, medical malpractice law has interpreted the potential legal liability a clinician might face for failing to identify and disclose such findings.