Radiation Oncologists and Malpractice

Leapfrog80 said:

I've heard that radiation oncologists have less malpractice suits compared to other specialties; is this true? I'm curious what type of lawsuits rad oncs face, and just how much malpractice impacts every day life as a radiation oncologist- i.e., is it common for a radiation oncologist to be sued at least once during their career, or is it a rare event?
Thanks in advance for the replies. I wasn't sure where to go for this type of information, and didn't want to ask faculty members at my school.

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Not been involved in one, but I can guess what kind of things rad oncs may face.

1. Spinal cord radiation myelitis causing paralysis or severe neuro deficit
2. Treating a benign condition with high RT doses for a mistaken malignant tumor (ie. treating a GBM when it's really a brain abscess or something)
3. Treating the wrong site

Leapfrog80 said:

I've heard that radiation oncologists have less malpractice suits compared to other specialties; is this true? I'm curious what type of lawsuits rad oncs face, and just how much malpractice impacts every day life as a radiation oncologist- i.e., is it common for a radiation oncologist to be sued at least once during their career, or is it a rare event?
Thanks in advance for the replies. I wasn't sure where to go for this type of information, and didn't want to ask faculty members at my school.

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My impression is that radiation oncologists get sued far less than other medical specialists. I don't have any good numbers to back up that statement, unfortunately. It'd be nice to see a table comparing the rates of malpractice claims or the cost for malpractice insurance across different specialties, but I've been unsuccessful in locating one.

However, even though it may be less common for a radiation oncologist to get sued, it happens. The moral of the story is it can happen to anyone for any reason. Just google for terms like "radiation oncologist" and "plaintiff" and you'll see they're not too uncommon. Also, see some of the articles about lawsuits in this practice below. Some of the reasons behind the lawsuits are surprising.

One of the nice things about our field is that we get to spend more time with our patients than most physicians do, and doctors who communicate well (and often) with their patients are less likely to get to sit in court. There was an article in JAMA a few years back looking at the factors that place physicians at risk for getting sued, and communication was a biggie.



Here are some resources:
* Pubmed PMID 1995541 - "Professional liability in radiotherapy: experience of the Fletcher Society." Int J Radiat Oncol Biol Phys. 1991 Mar;20(3):563-6.
Eighty-four percent of the members of the society replied to the questionnaire; one-third have sustained a lawsuit with an actuarial probability of 30% at 10 years, 50% at 20 years, and 65% at 30 years.

* PMID 15607155 - "Medical malpractice of prostate brachytherapy." Brachytherapy. 2004;3(4):231-6.

* PMID 16644469 - "Medical malpractice in the age of technology: how specialty societies can make a difference." Brachytherapy.

Things that Rad-oncs could get sued about:
1) Treating without tissue diagnosis (for what later turns out to be benign disease)

2) Having a nasty side-effect (say Grade 3-4 toxicity) that was not adequately explained with informed consent. Even if it is explained, the patient may sue anyway.

3) Accusations of sexual impropriety in the exam room (all the more reason to keep an RN in the room when doing physical exam)

4) Having your name anywhere on a medical chart when a patient dies (malpractice lawyers do the "shotgun approach" when naming defendents).

5) Having an inpatient in unstable condition that you are trying to manage yourself, or having an inpatient get a PE when you haven't given DVT prophylaxis.

All that being said, our malpracitice exposure is a fraction of what OB's or Neurosurgeons experience. Your collegues in other specialties aren't going to feel sorry for you.

The sicker and older your patients, the lower the chance of being sued. The way kickbacks for medmal lawyers are structured, it is the young and juicy cases with a high earnings potential that are the most likely to go to suit or settlement. It is not related to your culpability or the question whether any malpractice has been committed (in radonc that is going to be the 40 year old lumpectomy with skin discoloration, not the 85 year old who herniates and dies after you start treatment for a CNS neoplasm...)

The radoncs I know are sticklers for consent and counseling. Every even most obscure complication of RT is discussed with the patient and documented at length in their consult notes.

Also, radoncs have the advantage that most of their patients have cancer. In my experience, cancer patients who receive treatment are typically appreciative of the physicians actually treating them (they are often less appreciative of the medical providers that saw them in the pre-diagnosis time and 'missed' their cancer.

One way to look at the risk of getting sued is to look at comparative rates. E.g. if you are in the county of Ulster,NY and buy occurence based coverage from MLMIC (NY mutual malpractice insurer, doesn't make profits, doesn't own stocks):

Radonc $15,846
General surgery $50,626
Diagnostic Rads $25,424
EM $24,538
FP (no surg) $11,554
Neurosurg $138,606
OB gyn $84,492

(so one could say that you are slightly worse off than an FP but that your odds to pay-out on that CNS neoplasm you are treating are 1/10th of the neurosurg who took the biopsy that covers your behind....)

you can also be sued for more usual things like missing the symptoms of infection, PE etc.

you can treat the wrong side, use fields that are later felt to be inadequate, or overlaping with old fields. you can treat without path when you should have had it. dose too high, dose to low. etcetetc. you can also be sued for side effects you warned the pt about but a jury can decide you didnt place enough empasis on it, indeed for anything and everything. what they will win is another issue. best way to avoid is have a good relationship with patient and family, call ethics consults and patient relations when need be, and otherwise realize that even at hospitals ranked the best in the country, a huge portion of docs havce been sued, suggesting even the best doctors aren't "good enough" by the standards of the courts.

this can't be right; obs gyne ha ssome of the highest rates and to the point the insurence costs more than the income of some docs in some states. people have fleed the field for it.that looks very low to me but i admit to not being an expert on this.

f_w said:

Radonc $15,846
General surgery $50,626
Diagnostic Rads $25,424
EM $24,538
FP (no surg) $11,554
Neurosurg $138,606
OB gyn $84,492

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stephew said:

this can't be right; obs gyne ha ssome of the highest rates and to the point the insurence costs more than the income of some docs in some states. people have fleed the field for it.that looks very low to me but i admit to not being an expert on this.

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This is pulled of their website. Ulster county is about an hour outside of NYC. I was suprised that OB/Gyn was that close to general surgery, but compared with lets say FP wo OB it is still 8 times the premium.