Radiologist not liable for damages where missed diagnosis did not affect the patient’s outcome

While a diagnostic error may breach a doctor’s duty of care, it does not necessarily mean the doctor is liable for damages if the court finds that it did not alter the outcome for the patient.

Patient W, aged 18, was referred to an orthopaedic surgeon complaining of hip and lower back pain. Three years earlier (then aged 15) they had been diagnosed with an inflammation of the hip joint (iliac apophysitis left anterior superior iliac spine) and this was managed conservatively.

X-rays revealed that W had a congenital pars defect/dysplastic spondylolysis. However the radiologist, Dr G, did not identify this defect. Their report stated that the x-rays revealed no abnormalities.

The orthopaedic surgeon also missed the spondylolysis on the x-ray and relied on the report. They recommended conservative management, including cortisone injections, rest and physiotherapy. The expectation was that the condition would resolve as W’s growth plates developed.

W continued to suffer pain and their condition continued to deteriorate. Approximately one year later, further x-rays revealed 15% spondylolisthesis at L5 on S1. They were scheduled for urgent spinal decompression and fusion. W developed secondary chronic pain after the surgery and brought a claim for damages.

At trial, the parties accepted that the surgery had been performed competently, but that the chronic pain was a direct result of the surgery.

W claimed the radiologist was negligent in failing to identify the spondylolysis or spondylolisthesis at the time of the initial x-rays. W argued that had the condition been properly identified and managed at the time, they could have avoided the surgery and secondary chronic pain.

Dr G accepted their failure to identify the pars defect and recommend further investigation was a breach of duty of care.

However, it was argued that W’s condition would have inevitably deteriorated and surgery could not have been avoided regardless of treatment at the time.

The expert evidence concluded that spondylolisthesis had been present when the original x-rays were taken. That meant the corrective surgery was inevitable, and the radiologist’s mistake did not make any difference to W’s outcome.

W’s claim for damages was dismissed at the original trial and again on appeal.

If you do miss an opportunity to identify a symptom or make a diagnosis, you may have breached your duty of care.  However, a diagnostic error may not result in a court awarding damages if the error does not cause the patient’s harm.

If you have made an error, address it as soon as possible. If your hospital or health facility has an open disclosure process, follow it.  You can and should say sorry - apologies are protected at law and can’t be used against you.  Offering an apology may help reduce the risk of a future complaint or claim. Remember, preparation and planning are key to effectily implementing an open disclosure process. If unsure of how best to proceed, seek advice from your MDO.

Avant factsheet - Missed or delayed diagnosis

Avant factsheet - Open disclosure: responding when things go wrong