Sample Medical Malpractice Expert Report: Radiology/OB

IN THE HEALTH CARE ALTERNATIVE DISPUTE RESOLUTION OFFICE OF MARYLAND

HESTER PRYNNE
Claimant

v.

UNITED STATES RADIOLOGY SERVICES and
ROGER CHILLINGWORTH, M.D.
Health Care Providers

Report of Arthur Dimmesdale, M.D.

I am Professor of Radiology at Boston University Medical Center with special expertise in ultrasound and am board-certified in Radiology. I am Director of Ultrasound and Co-director of High Risk Obstetrical Ultrasound at Massachusetts General Hospital. In those roles, I perform, interpret and report ultrasound studies and train radiology and obstetrical and gynecological residents and fellows in ultrasound. I also teach ultrasound to practicing radiologists and obstetricians and gynecologists around the country at a number of medical continuing education courses and meetings. In the course of my practice, I train, supervise and otherwise work with non-physician sonographers. All of these professional activities have occurred within 5 years of the acts or omissions giving rise to this cause of action. Through my education, training, review of the medical literature and my other professional activities, I am familiar with the standard of care as it pertains to the practice of obstetrical ultrasound in this country, including in localities that are the same or similar to the areas of Maryland where I understand the ultrasound at issue was performed and/or interpreted. Further, I am familiar with that standard of care as it existed in 2008-2009.

I have reviewed the United States Radiology Services obstetrical ultrasound films on Kathy Ann Barnes and her fetus dated December 10, 2008 and February 18, 2009. I have also reviewed the report of the December 10, 2004 ultrasound and the report and Fetal Anatomy Survey of the February 18, 2005 ultrasound. Further, I have reviewed reports of the following studies on Brianna Vann: report of the head CT of June 30, 2009; neurologic consultation by Beverly Crusher, M.D. of July 1, 2009; report of MRI–head/brain of September 20, 2009. I intend to render opinions in the area of standard of care, causation and damages. My opinions are based on my review of the records and radiologic studies in this case, on my education and training, on my knowledge of the relevant medical literature, my understanding of the facts of this particular case, and on my experience and expertise in the field of radiology, with a special interest in the field of ultrasound.

My opinion is that the Health Care Providers, United States Radiology Services and Roger Chillingworth, M.D., directly and through their actual and/or apparent agents, servants and/or employees, departed from the acceptable standard of care by failing to properly perform, interpret and /or document the obstetrical ultrasound done and interpreted by them on February 18, 2009. It is further my opinion that these breaches in the standard of care proximately caused semi-lobar holoprosencephaly in Pearl Prynne to go misdiagnosed during the time during which the pregnancy could have and would have been terminated, thereby proximately causing the injuries to her parents.

Hester Prynne, Pearl Prynne’s mother, became pregnant in 2008 and underwent two ultrasound procedures at the Defendants’ facilities. The first one was performed on December 10, 2004, when the pregnancy was at 10 weeks gestation. As would be expected at this gestational age, semi-lobar holoprosencephaly was not detectable on the December 10, 2008 ultrasound.

A subsequent ultrasound was performed at the Defendants’ facility on February 18, 2009 when the gestational age was 19.8 weeks. The indication given for the ultrasound was “size and dates.” A Fetal Anatomy Survey was also performed. The “sonographer” for the ultrasound and fetal anatomy survey was M. Hibbins, and the “physician” was Roger Chillingworth, M.D. The report and anatomy survey are on United States Radiology Services stationery. The Health Care Providers United States Radiology Services and Roger Chillingworth, M.D., directly and by and through their actual and/or apparent agents, servants and/or employees breached the applicable standard of care for like Health Care Providers in the performance, interpretation and/or documentation of the February 18, 2009 ultrasound and fetal anatomy survey.

The standard of care required that the lateral ventricles of the fetal brain be properly imaged, properly interpreted and properly documented by the named Health Care Providers, all of which they failed to do.

Health Care Provider Roger Chillingworth, M.D., directly and as the actual and/or apparent agent, servant and/or employee of Health Care Provider United States Radiology Services, had a duty to examine the lateral ventricles, to instruct the sonographer to image the lateral ventricles correctly, to interpret the ultrasonic findings of the lateral ventricles properly, to supervise the sonographer, and to document the portions of the fetal anatomy concerning which comments are made in the report and fetal anatomy survey. There are no images of the lateral ventricles of the fetal brain documented on the February 18, 2009 ultrasound fetal anatomy survey, and yet the lateral ventricles are reported as normal in violation of the standard of care, which requires that images of all fetal anatomy commented upon be preserved. With reasonable medical probability, semi-lobar holoprosencephaly would have been present on the images of the lateral ventricles on the February 18, 2010 ultrasound had the images been taken, but the lateral ventricles were interpreted as “normal”, which with reasonable medical probability they were not. Roger Chillingworth, M.D. either improperly imaged the lateral ventricles, improperly interpreted the ultrasonic findings of the lateral ventricles, failed to supervise M. Hibbins, and/or reported as “normal” images that she did not personally examine, in violation of the standard of care. As a direct and proximate result of these violations of the standard of care by Roger Chillingworth, M.D., directly and as the actual and/or apparent agent, servant and/or employee of Health Care Provider United States Radiology Services, semi-lobar holoprosencephaly was not diagnosed during the time period that termination of the pregnancy could have and would have occurred.

The corporation in this case, Health Care Provider United States Radiology Services, had an independent duty to ensure that policies, procedures and protocols were in place to ensure that obstetrical ultrasounds were properly performed, interpreted and documented, and also had a duty to ensure that their agents, servants, and/or employees were familiar with and followed such policies, procedures and protocols. They breached these duties by either failing to have appropriate policies, procedures or protocols, or by failing to ensure that their agents, servants, and/or employees followed them, as evident by the failure to document and to preserve the images of the lateral ventricles on the February 18, 2009 ultrasound and the misinterpretation of them as “normal” when with reasonable medical probability they were not. As a direct and proximate result of these violations of the standard of care by Health Care Provider United States Radiology Services, semi-lobar holoprosencephaly was not diagnosed during the time period that termination of the pregnancy could have and would have occurred.

I know from the reports I reviewed concerning Pearl Prynne’s condition after birth that she was born with semi-lobar holoprosencephaly. Had the semi-lobar holoprosencephaly condition in Hester Prynne’s fetus been timely diagnosed, the report of the findings would have been communicated to her obstetrician, she would have been given appropriate counseling and informed consent and would have humanely and legally terminated the pregnancy. Therefore, as a direct and proximate result of the failure of the Health Care Providers United States Radiology Services and Roger Chillingworth, M.D., directly and through their actual and/or apparent agents, servants and/or employees, to comply with the applicable standard of care as outlined in my report, Pearl Prynne was born with semi-lobar holoprosencephaly, a serious congenital brain disorder that causes severe physical and mental disabilities. The emotional and financial burdens associated with taking care of a child with semi-lobar holoprosencephaly are well-documented throughout the medical literature.

I hold all of my opinions with a reasonable degree of medical probability.

This report is not intended to be a complete or final statement of my opinions, and I reserve the right to expand, modify or otherwise amend my opinions as the discovery process proceeds.

I do not spend more than 20% of my professional activities in activities directly relating to testimony in personal injury cases.

Arthur Dimmesdale, M.D

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