CHAPTER 42 Radiology
Dr. Oldtimer, a semiretired, non-board-certified radiologist, was on his first day of working as a weekend locum for Dr. Exploiter at Hogwarts Community Hospital, an 80-bed facility in rural Hogsmeade. Hogwarts had no MRI or angiography suite, but did have an old single slice CT scanner. On Dr. Oldtimer’s first night, Mrs. Dumbledore, a 43-year-old woman, was brought to Hogwarts’ small Emergency Room by her husband, Professor Dumbledore, complaining of severe frontal headaches. A nonenhanced CT was ordered by Dr. Snape, the Emergency Room physician. After a few hours, the on-call CT technologist came in and performed a CT scan of her brain. Dr. Oldtimer, who was staying at Dr. Exploiter’s home while he was away, viewed the CT scan by teleradiography (Figure 42-1) and then called Dr. Snape, and told him that it was completely normal. The next morning, after a good night’s sleep, Dr. Oldtimer saw something on the scan that he didn’t see the night before. He dictated in his final written report that there was a “minute region of high density just anterior to the corpus callosum which is felt to more likely represent some normal blood within the inferior sagittal sinus than bleeding in the corpus callosum.” His conclusion was that the nonenhanced CT scan of the brain was “within normal limits.” Dr. Oldtimer went down to the Emergency Room to see Dr. Snape since he was concerned that he had previously told Dr. Snape the night before that the CT scan was “completely normal.” However, Dr. Snape was off duty and Dr. Oldtimer left the Emergency Room mumbling, to no one in particular, that they would get the written report shortly. The final written report was printed on Monday and signed by Dr. Exploiter; Dr. Oldtimer, who had only covered for the weekend, had already left.
Figure 42-1 Nonenhanced CT scan of the brain of a 43-year-old woman complaining of severe frontal headaches.
The problem was that the CT scan of the brain was not “completely normal” or even “within normal limits.” The “minute region of high density” was actually hemorrhage into the cistern of the lamina terminalis from a leaking aneurysm (Figure 42-2). Mrs. Dumbledore was sent home the evening before by Dr. Snape since he was told by Dr. Oldtimer that the CT scan was “completely normal.” Ten days later, Professor Dumbledore called 911 for an ambulance to take her from home to the Emergency Room as she was unresponsive. A nonenhanced CT scan of the brain was again performed (Figure 42-3).
Figure 42-2 Arrow points to hemorrhage into the cistern of the lamina terminalis from leaking aneurysm.
Mrs. Dumbledore was then transferred to St. Elsewhere Hospital, a major medical facility, where an aneurysm of the anterior communicating artery was identified by angiography. Fortunately, she stabilized and the aneurysm was later clipped. However, she was left with significant residual disability and initiated a lawsuit against Dr. Oldtimer, Dr. Exploiter, Dr. Snape, and Hogwarts Community Hospital. She alleged that both Dr. Oldtimer and Dr. Exploiter provided negligent and improper medical care by failing to timely and adequately diagnose and/or communicate the abnormality. She further alleged that Dr. Snape, the Emergency Room physician, also provided negligent and improper medical care for failing to timely and adequately diagnose the abnormality. She also sued Dr. Exploiter for negligent hiring and negligent supervision, and Hogwarts Community Hospital for negligent credentialing, negligent supervision, and apparent agency.
Dr. Oldtimer claimed that, although his impression was “within normal limits,” the body of the report should have suggested to Dr. Snape that there was some abnormality and that Mrs. Dumbledore should have then been referred to a neurologist or neurosurgeon. He also claimed that he should not be held to the same standard as a neuroradiologist since he was only a general radiologist and had completed his radiology training before CT was a clinical modality, and never had any formal training in CT interpretation. He further claimed that he should not be responsible for knowing that the hospital required the radiologist to call all abnormal reports or that radiologists needed to be board certified, since he was only covering for Dr. Exploiter for the weekend. Dr. Exploiter claimed that he signed the report by Dr. Oldtimer merely to expedite delivery of the report, although he did not read the report or review the CT scan. Dr. Snape claimed that he is not a radiologist and that he relied on the oral report by Dr. Oldtimer that the CT scan of the brain was normal.
