Usage of ultrasound has positively impacted caring for women with obstetrical and gynecologic conditions. Most OB-GYN practices in the U.S. have access to this critical diagnostic tool to affordably and efficiently make key determinations. Unfortunately, factors including equipment quality, training, education, and interpretation are not always sufficient. A report by Harry Holdorf, PhD/MPA, regarding legal concerns in sonography showed the average paid malpractice claim associated with these problems cost $300,000. Approximately 40% of the time abnormalities are discovered in delivery. Some common concerns include inaccurate sonographic reporting, poor image quality, and failures to adhere to guidelines.
Ultrasound has become the primary means of evaluating pregnancies and gynecologic conditions. Failure to obtain good quality images is an often cited issue in litigation stemming from:
- Insufficiently training in sonography
- Insufficient or incomplete studying of images, or doing so with low-quality images
- Poor supervision of a sonographer
- Poor maintenance of equipment
Established standards exist in performing ultrasound studies, which are necessary for practice accreditation. Proper and compliant accreditation aids in defending negligence claims.
Inadequate Training or Studies
In years past, staff would learn ultrasound “on the job”, often lacking formalized certification. Today, sonographers are trained, tested and certified in acquiring images and performing studies. Sonographers are subject to Joint Commission requirements of the National Commission of Certifying Agencies and American National Standards Institute. The organizations of formal accreditation include the American Registry for Diagnostic Medical Sonography and American Registry of Radiologic Technologists. Studies are conducted of ultrasound images to facilitate diagnosis. Studies conducted incompletely or poorly heighten the likelihood of liability. The standards for studies are established by the American Institute of Ultrasound in Medicine and American College of Obstetricians and Gynecologists. A commitment to operating guidelines has shown to promote quality studies and reduce liabilities.
The overall quality of equipment in ultrasound has greatly improved and is now more affordable for most practitioners. Practices are expected to employ modern equipment and maintenance standards. Being a core aspect of this medical specialty, usage of older products not supported by a manufacturer is considered unacceptable. Preventative maintenance and care for equipment are critical. Claims related to poor quality images are common when using old or poorly maintained equipment.
- Perception errors: When an irregularity is detected in retrospect rather than during the original study. These claims may be hard to defend, as 80% will not prevail if they are heard by a jury.
- Interpretation errors: When an irregularity is identified but misinterpreted or misclassified. Best practices include a differential diagnosis with appropriate follow up that includes an alternate imaging option and other means of diagnosis.
- Failure to suggest next procedure: Based on findings observed, a sonographer should suggest the next appropriate step or procedure.