I don't see where the radiologist would be obligated to take over patient care from an imaging center or hospital. Many times I have copies in hand before the radiologist has even read them, report typically follows the next day. The job of the radiologist is to report to the doctor what was found on the film and then informs the doctor of what should be done next (bone scan, MRI etc). Typically the radiologist will report to the referring doctor immediately if findings warrant it. He doesn't take control of the patient and send the patient immediately to the appropriate specialist. That's the job of the referring doctor.
Two parts to this. First, the hospital. Here is one legal opinion on EMTALA:
"In 2000, CMS issued new amendments to the rules under 42 CFR 489.24, expanding the responsibility of the emergency room to respond to any "presentation" on the hospital campus or at any provider-based off-campus facility of the hospital. In 2003, these rules were significantly revised.
The 250-yard rule comes from the definition of "Campus" found at 42 CFR 413.65:
"Campus means the physical area immediately adjacent to the provider's main buildings, other areas and structures that are not strictly contiguous to the main buildings but are located within 250 yards of the main buildings, and any other areas determined on an individual case basis, by the HCFA regional office, to be part of the provider's campus."
This definition comes into play in connection with the complicated regulations which define "provider-based" facilities.
The significance for EMTALA under the 2000 regulations was that provider-based status was considered to bring some (but not all) off-campus facilities within the sphere of the hospital's responsibility. For those facilities, a patient who presented to a facility requesting treatment, or who appeared and was perceived to be in need of treatment, had to be provided with the medical screening examination prescribed under EMTALA, and provided with stabilizing medical treatment if an emergency medical condition is found." {emphasis added}
Now, I assume you will trust me that the MSE requires that the standards of care for a given condition be met? As no chiropractic care falls within the medical definition of "standard of care", a chiropractic patient, who presents on a hospital campus for a test (x-ray, MRI etc.) and who is "requesting treatment, or who appeared and was perceived to be in need of treatment", must be seen, evaluated and, if need be treated, by a physician. I have to believe, but can not cite case law, that requesting an x-ray would be construed as "requesting treatment". At the very least, if pathology is discovered there is absolutely a perception of being in need of treatment. And again, chiropractors fall outside this rule, while you are not held to it, your "evaluations" or "treatments" can not be used to meet the requirements of it. So that ends that.
As for the freestanding imaging center. Looking at a tort, several features must be met. First, the physician must have a duty toward the patient, this is a given if a radiologist is reading a patient's film. Second, there must be a breech of the standard of care. As the "standard of care" described refers to the radiologist, not the ordering physician or chiropractor, here is where the trouble would occur.
"Typically the radiologist will report to the referring doctor immediately if findings warrant it. He doesn't take control of the patient and send the patient immediately to the appropriate specialist. That's the job of the referring doctor."
You are correct, but they do contact the referring doctor immediately. If the radiologist discovers pathology, he or she is legally obligated to insure that proper follow-up is arranged. This is why so many radiologists are dragged into lawsuits throughout the hospital. They can not merely state that they a technologists without responsibility. It doesn't work that way. They are physicians for a reason. You better believe that when I take a phone report from a radiologist concern a patient with severe pathology, they are apprised of the treatment plan. In fact, they often suggest alterations to the plans based on their findings. Chiropractic simply doesn't meet the medical "standard of care". Back to tort, causation must be proved. In the event (for example) of a pathologic fracture at C5 who was later adjusted (don't laugh, saw it this week), I would think this easy to prove. All that must be shown is that for the failure to meet the standard of care this patient would not have been injured. In the C5 fracture (IRL) the initial films were done in a chiropractor's office, but if they were performed at a freestanding clinic and the radiologist referred the patient back to the chiro without arranging medical intervention, this would be simple to prove. Then damage to the patient must be shown. Again, easy to prove if an untoward event occurs. So where in this do you not see the problem? Find me any textbook or other citation that makes an argument for chiropractic treatment as the standard of care for significant pathology of any kind. If you can't (and we know you can't) then the radiologist is "on the hook" if he or she sends the patient back to their chiropractor for treatment once such pathology is uncovered.
- H
