Don’t Let Those X-Rays Get Away

As the chain of patient care becomes more fragmented, the risk of losing track of relevant medical records increases. All too frequently, CAP sees claims in which the Member released original x-rays to the patient or to subsequent medical providers without keeping copies.

Having a complete set of a patient’s x-rays is necessary to effectively defend a physician’s care and treatment in trial or arbitration. And as one case shows, had a physician immediately retained copies of the patient’s hospital x-rays, even a poor medical outcome could have been avoided.

Dr. O is an orthopedic surgeon specializing in treatment of injuries to the upper extremity. Several years ago, he treated a middle-aged woman’s comminuted fracture of the distal third of the humerus, dominant hand. Prior to the referral, emergency room physicians obtained x-rays and applied a posterior splint. Following the ER visit, the patient was admitted to the hospital and her health plan’s primary care provider requested Dr. O’s consultation.

Following his examination, Dr. O diagnosed a marked displacement of the fracture fragments as well as radial nerve palsy. He then performed an open reduction internal fixation with an A-O plate, with no complications. Dr. O followed the patient for two months, then transferred her to her plan’s general orthopedist.

The patient’s nerve palsy subsequently resolved, but the fracture progressed to a non-union, ultimately triggering a lawsuit.

During the investigation phase of the lawsuit, the hospital could not locate the patient’s post-operative x-rays. Subpoenas of other locations also failed to find the films. The defense expert orthopedist, therefore, reviewed x-rays taken two weeks post surgery and determined that an “acceptable” alignment had been achieved. Based on that determination, the expert was prepared to testify in Dr. O’s defense. When it came time to depose the plaintiff’s expert, however, the defense team found that the witness (who was also a subsequent treating physician) was relying on the “missing” x-rays to form an opinion of negligence!

As it turned out, the immediate post-operative x-rays showed an “excellent” alignment immediately after surgery. When compared to the acceptable x-rays taken two weeks later, the post-operative x-rays, revealed the loss of fixation.

Dr. O had been unaware of the loss of fixation during his care because he did not have the immediate post-operative x-rays for comparison.

The most likely explanation for the unavailability of the post-operative x-rays is that the hospital had sent them to the patient’s plan, which in turn sent them to the subsequent treating physician, who failed to properly respond to a subpoena.

After this claim, Dr. O adopted a policy of having copies of all relevant x-rays of his patients, no matter where taken or stored, sent to his office for his use and custody.

Gordon Ownby is CAP-MPT’s General Counsel.