A chilling effect

The eye-popping jury award to the daughter of a Boston woman who succumbed to lung cancer could not have come at a more sobering time. The specialty of radiology is preparing to embark on a new public screening initiative in the form of low-dose CT lung-cancer screening, and a radiologist is successfully sued for missing a nodule on an x-ray in 2005, a notoriously difficult read under any circumstances, but especially in the ED, with little or no access to patient history.

Even the plaintiff’s attorney was moved to justify the $16.7 million award to the Globe reporter in explaining that the daughter was an only child of a single mother, and therefore the loss was magnified.

I can’t help but wonder—and surely others out there are doing the same—how this jury award and radiology’s growing involvement in lung-cancer screening will affect already steep malpractice costs. Perhaps the large award is some measure of comfort to the deceased’s daughter, whose loss I do not intend to minimize, but in what universe does the outsized award match the alleged transgression?

Brigham & Women’s Hospital maintains that the standard of care was observed, and the radiologist’s attorney intends to ask for a new trial. In the meantime, radiology stands forewarned. The case underscores the need for standardized protocols for the management of screening-detected nodules on CT. Clearly delineated and carefully articulated areas of responsibility for the care team and the patient are necessary. Frankly, this is not only for the protection of the patient, but the care team as well.