Picture archiving and communication systems (PACS) and the loss of patient examination records.

A 63-year-old man who had been complaining for 2 weeks of " aching " in his lower abdomen was referred by his family physician to the radiology department of a hospital for CT of the abdomen and pelvis. Two days after the CT examination , the physician telephoned a secretary in the radiology department, stating that he had not received a report of the CT. The secretary replied that she would investigate the matter and forward a report to him. Four days later, a nurse at the physician's office again telephoned the radiology department to complain that a report of the CT examination still had not been received. There is no evidence that anyone in the radiology department followed up on these telephone calls. Eight days after the CT examination, the patient experienced acute onset of excruciating pain in the lower abdomen and back. The patient was rushed to the emergency department of the hospital, where he was found to be profoundly hypotensive and tachycardic. Sonogra-phy was ordered and disclosed a 7-cm-diameter dissecting aneurysm of the abdominal aorta. The patient underwent emergency surgery, which revealed a ruptured abdominal aortic an-eurysm. Surgical repair was attempted, but the patient died on the operating room table. Nine months later, the wife of the deceased patient filed a medical malpractice lawsuit against the hospital, the family physician, and the radiology department's chair and head of the CT section. The lawsuit alleged that the pa-tient's death was the result of needless delay in the diagnosis and treatment of the abdominal aortic aneurysm; it specifically charged the ra-diologists with " gross negligence " in failing to provide in a timely manner a report of the CT examination. The lawsuit sought $250,000 in compensatory damages and $500,000 in puni-tive damages. All of the codefendants notified their professional liability insurance carriers of the lawsuit , and the carriers quickly appointed legal counsel for each. The defense attorneys, along with the hospital's risk manager, undertook a thorough investigation of the incident. It soon became apparent that the major problem in the case centered on the radiology department. Three months before the patient's death, the hospital's radiology department had completed installation of a new picture archiving and communication system (PACS) and radiology information system. The radiology information system tracked all procedures from initial request through examination completion, and ar-chived radiologists' reports. The radiographic images for all modalities except mammogra-phy were …