Could have the lawsuit over failed follow-up for CT findings been avoided? On March 24, 2014, Cynthia Hawthorne was experiencing pain in the lower, left side of her abdomen. She decided to seek treatment at the Brattleboro Memorial Hospital’s (BMH) emergency department. To determine the reason for her abdominal pain, a computed tomography (CT) scan was ordered. The emergency room physician suspected that she was suffering from diverticulitis, and According to the CT scan results, she was.
However, she also had a highly suspicious renal mass in her left kidney. Hawthorne was unaware of this mass and the emergency department physician neglected to inform her of these findings. By the time she was informed of the mass more than two years later, it had already developed into renal cancer that had spread to her lungs. On March 2, 2019, she passed away due to complications related to her renal cancer. Despite her passing, her son was able to move forward with her malpractice lawsuit. In September 2019, Hawthorne’s suit against the hospital, clinic and radiology group was settled out of court, for an undisclosed amount.
Hawthorne Visits the Emergency Department at Brattleboro Memorial Hospital
Hawthorne decided to visit BMH’s emergency department on March 24, 2014, because she was suffering from abdominal pain. She received pain medication, intravenous liquids and a computed tomography scan of her abdomen during the visit. The scan was ordered to determine if she had diverticulitis. Diverticulitis occurs when small pouches (diverticula) that have formed in the colon become infected or inflamed. Her CT scan showed that she was suffering from this infection. But the scan also indicated that there was a mass in her left kidney. The radiologist referred to this mass as being highly suspicious for renal cell carcinoma.
Initially, the CT scan performed on March 24, 2014, stated that Hawthorne’s left kidney looked normal. However, later that day, an addendum was added to her report noting that further evaluation revealed a mass in her left kidney.
The radiologist spoke with an emergency department physician about Hawthorne’s renal mass and made several recommendations concerning follow-up. Despite the radiologist’s recommendations for Hawthorne to have the mass biopsied and then to follow-up with a urologist, she was discharged from the Brattleboro Memorial Hospital’s emergency department that same day. Hawthorne left the emergency department with instructions on how to manage her diverticulitis and a prescription for antibiotics. Hawthorne was never informed of the renal mass.
The Claim: Hospital Staff Neglected to Exercise Reasonable Care
Hawthorne’s lawsuit claimed that Brattleboro Memorial Hospital failed to inform her, in a timely manner, of the highly suspicious mass that was identified in her left kidney during a CT scan that was performed on March 24, 2014.
Hawthorne’s medical malpractice case involved three entities:
- Brattleboro Memorial Hospital — which is the facility where she received her emergency treatment.
- Dartmouth-Hitchcock Clinic — which is the company that runs the emergency department at Brattleboro Memorial Hospital.
- Windham Radiology Associates — which is BMH’s in-house radiology group.
Hawthorne also filed a civil suit against Brattleboro Memorial Hospital and Dr. George Terwilliger, who was the director of the hospital’s emergency department at the time of her visit
According to court documents, Dr. Terwilliger was the physician who discussed Hawthorne’s CT results with the Windham radiologist who discovered the mass on March 24, 2014. Although the two agreed that further evaluation was necessary, the Windham radiologist, the hospital and Dr. Terwilliger neglected to continue investigating the mass through additional evaluations, and/or tests. Furthermore, they failed to inform Hawthorne that she had a renal mass.
On March 17, 2017, the Division of Licensing and Protection Visits BMH
The Division of Licensing and Protection (DLP) visited BMH seeking information about Hawthorne’s care. According to the DLP report, one of the radiologists with Windham Radiology Associates did issue a warning concerning the mass located in Hawthorne’s left kidney. Although Windham’s radiologist recommended that Hawthorne have a biopsy performed and then follow-up with a urologist, this information was never communicated to the patient.
The DLP Cites BMH for Violations Related to Hawthorne’s Care
The Brattleboro Memorial Hospital received two citations from the DLP. One was for violating Hawthorne’s rights of being informed of her health status as well as her right to be actively involved in the planning of her care and treatment, including for her right to either request or refuse treatment. The other citation referenced BMH’s failure to thoroughly investigate why Hawthorne never received her CT results.
Hawthorne’s 2012 Abdominal Scan Also Revealed the Renal Mass
Hawthorne’s March 24, 2014 visit to the emergency department at Brattleboro Memorial Hospital for abdominal pain was not the first time she sought treatment there for this problem. On Jan. 23, 2012, she went to BMH’s emergency department complaining of abdominal pain. At that time, Hawthorne also had a CT scan, which revealed a small renal mass in her left kidney. Despite the scan being conducted and read by radiologists, physicians, employees, providers, contractors and/or agents of Brattleboro Memorial Hospital, her patient report does not even mention the renal mass that was found on her 2012 CT scan.
Hawthorne Finally Learns of the Mass
On Sept. 26, 2016, Brattleboro Memorial Hospital informed Hawthorne for the very first time that she had a mass in her left kidney. A mass that could be cancerous. This is two-and-a-half years after her March 2014 emergency department visit, and four years after her January 2012 emergency department visit.
By the time Hawthorne was informed of the mass, it had already developed into renal cancer that had spread to her lungs. In addition, this delay in treatment resulted in Hawthorne requiring emergency surgery to remove her left kidney. She underwent chemotherapy as well as other treatments that caused her a tremendous amount of pain.
Despite all the treatment, Cynthia Hawthorne passed away due to renal cancer on March 2, 2019. She was only 58 years old. On April 25, 2019, Hawthorne’s attorneys filed an amended complaint naming her son, Justin Johnston, as the new plaintiff. The case finally settled for an undisclosed amount in September 2019.
The delays that resulted in this tragic loss could’ve been avoided
Dhruv Chopra, CEO of Collaborative Imaging, states, “The delays that resulted in this tragic loss could’ve been avoided”.
He continues to explain that, “Expectations placed on radiologists continue to grow. Gone are the days where a radiologist’s job is limited to viewing images and rendering interpretations. Today, radiologists have to take on more administrative tasks, and unfortunately, in some cases clerical work, to ensure their diagnostic interpretation is delivered and action is taken at the same time. Despite these growing demands placed on radiologists, reimbursement for interpretations continues to decline, and, given the shortage of radiologists, this additional work effort, in conjunction with lower reimbursements has resulted in the growing burn-out-rate that is plaguing the radiology industry.
“The expectations that referring physicians and healthcare executives place on radiologists are not necessarily un-achievable. However, technology solutions must be deployed to facilitate those demands.”
The other missed opportunities that may have saved Hawthorne’s life:
- On March 27, 2014, and April 14, 2014, Hawthorne was seen again; however, neither time did her providers note that she had a left renal mass.
- On June 19, 2014, Hawthorne saw one of BMH’s physicians. Despite finding the renal mass on Jan. 23, 2012, and seeing the mass again on March 24, 2014, the physician’s note does not mention that the mass was ever discussed with Hawthorne.
Preventing Missed Opportunities
There is no doubt that a radiologist has a role to play in relaying abnormal findings. To this end, Collaborative Imaging has developed a state-of-the-art solution to identify and notify referring physicians of such abnormal and critical findings. Collaborative Imaging’s CEO, Dhruv Chopra says, One reason why consolidation is growing in the radiology industry is that groups are not being able to cope with the increasing demands placed on radiologists.
So, we had to do something to preserve the practice of independent radiology. Our solution is designed to allow radiologists to focus on their studies. Also, ensuring the necessary processes such as identifying the correct referring physician and their preferred notification method is adhered to and all abnormal findings are relayed in a time-sensitive manner. Our solutions have returned to the radiologist their very valuable time. The time they use to render patient care by interpreting studies in a more efficient manner.
Some of the benefits of Collaborative Imaging’s notification software include:
- A real-time solution designed to identify any anomalous studies with built-in escalations and notifications.
- These notifications can be customized to meet the needs of the referring physician, or hospital system, such as relaying the notification directly to the referring physician through our secure, proprietary applications or just passing the same on to the hospital system’s electronic medical record. electronic medical records
- Interactive sharing of key images with a one-touch, real-time video conference between the radiologist and referring physician.
- Real-time logging and reporting of all actions and notifications taken
- Immediate feedback to update the radiologist interpretation to conform to compliance and documentation requirements reflecting who was notified of the findings and at what time.
What Dhruv Chopra Says
Dhruv Chopra says, “Our solutions are designed to help ensure cases such as Hawthorne’s do not occur in the future. By taking a holistic view of the delivery of care in conjunction with our decades of experience in the healthcare space, we have been able to apply our proprietary computer-aided technology to workflow processes to ensure a repeatable and reliable approach is in place to identify and relay critical, incidental, and abnormal findings.
Radiologists, administrative, and clinical staff are actively involved throughout the process as appropriate. But we do not lose sight of the fact that radiologists are highly qualified and specialized, and as such should not be spending their valuable time performing clerical tasks such as trying to find out who the referring physician is or obtain the correct number to call a referring physician.”