CT scan equipment malfunction resulted in extra scan w/significant extra radiation

[BluePlanet]

Hi - I recently received an abdominal CT scan in preparation for an upcoming surgical procedure. FYI, abdominal CT scans expose the patient to a significant amount of x-rays, approximately 2.5 years' worth of normal background radiation. This is among the highest exposures of any x-ray/CT scan procedure generally given. (This fact was a concern for me, but it was necessary for the procedure). Also, it's important to note that I had to pay for the CT scan in advance: $1,046.00 out of pocket. And, the imaging business is owned by a large, national radiology group.

I was driving away when I received a call from the facility indicating that the machine had malfunctioned and I needed to return for a second scan. I was not at all pleased to hear this, but I effectively had no choice: I had to get the scan or the surgical procedure couldn't happen (remove painful kidney stones). It was the lesser of two evils. But effectively, I received over 5 years' worth of normal radiation in a matter of 20 minutes. (Am I going to die from that? Very unlikely, but the risk of cancer definitely goes up, and that's key).

After the second scan, I emailed and later spoke with the manager of the imaging facility about this problem. The obvious remedy in this situation is a refund of my out of pocket costs, which I requested. The manager apologized, said it was "extremely unfortunate" and that she was "very sorry." She said she would see about a refund.

She called me back today. She said she spoke with her corporate office and they said "no refund." I asked why, and she kept saying the same thing: "I was told that we cannot extend a refund." She was less conciliatory and "nice" on this second call -- it seems she had been coached by corporate lawyers.

I did obtain escalation names / emails and I'm preparing a letter to that effect (everything is very well documented). But I'd appreciate any thoughts / advice. Do I have a case here? It seems that I do, but it's harder to definitively prove damages, other than "more radiation is worse for you than less, and you gave me significantly more than you should have." Is there a certain way you might approach this to increase odds of success? Any other suggestions?

Thank you for any thoughts!

 

[Neil Maley]

They performed the required scan. IMO you are not due a refund. They didn’t charge you for a second scan- if they had then you would be due a refund.

Is this the first time you’ve had a CT scan? I’ve had more than I can count and am still healthy. If having two were dangerous, they wouldn’t have done a second one.

 

[Chris in NC]

Do I have a case here? It seems that I do, but it's harder to definitively prove damages, other than "more radiation is worse for you than less, and you gave me significantly more than you should have." Is there a certain way you might approach this to increase odds of success? Any other suggestions?

Thank you for any thoughts!

No, you don't.

You weren't billed for 2 CT scans. You were billed for 1.

 

[VoR61]

This article from Harvard Health Publishing may help you understand the risk: Do CT scans cause cancer?

of note is this quote:

"Radiation-related risk in anyone above 65 years of age from a diagnostic CT of the chest or abdomen is negligible to none," says Dr. Dushyant V. Sahani, associate professor at Harvard Medical School and director of CT imaging at Massachusetts General Hospital. "The doses are very low and the time it takes cancer to develop can be 20 years or more."
​

Like Neil, I have been subjected to a number of scans and quickly learned to request MRIs. They can cost the same and do not expose you to radiation.

 

[BluePlanet]

They performed the required scan. IMO you are not due a refund. They didn’t charge you for a second scan- if they had then you would be due a refund.

Is this the first time you’ve had a CT scan? I’ve had more than I can count and am still healthy. If having two were dangerous, they wouldn’t have done a second one.

Thanks for the thoughts. Yes, of course they didn't charge for a second scan because it was their error. But in this case, more scans is not better, more is worse (although necessary). More radiation is worse than less. I stress that this CT scan procedure exposes recipients to the 2nd highest radiation dose of any CT scan available. Does that not give you any pause / concern? 5 years worth of background radiation?

 

[BluePlanet]

No, you don't.

You weren't billed for 2 CT scans. You were billed for 1.

Thank you for your thoughts, but to reiterate some points: of course I wasn't billed for two procedures, but the fact that the 2nd procedure had to be performed exposed me to a significant amount of additional radiation. It seems people don't think this matters much. The CT scan I received exposes the patient to the second highest level of ionizing radiation of any CT scan available (again, FIVE YEARS worth of normal background radiation). This demonstrably increases one's risk for cancer, even though that risk may be small to start with.

 

[Neil Maley]

The issue of the radiation really hasn’t anything to do with being billed. They performed a service for which there is a charge. You aren’t due a refund.

 

[BluePlanet]

For those who feel this complaint may be frivolous: there are a number of lawsuits against imaging facilities / hospitals / etc. for radiation overexposure, including many which are essentially identical to my situation: the imaging facility messed up, had to do additional scans, and therefore exposed the patient to much more radiation than what should have been the case. Considering the dollar amount involved, I'm not going to file a lawsuit, but the point is I'm struggling to see how this is a non-issue.

 

[Neil Maley]

We aren’t saying it’s a non-issue. You have two separate problems. One is you feel you were exposed to too much radiation having to have the scan done twice.

The other is you are asking for a refund for a medical procedure because you had to have the procedure done twice and were exposed to radiation twice. The service was performed - a refund isn’t due.

For the worry about the exposure- you can contact an attorney and see if you have a malpractice issue.

But you aren’t due a refund because you think you were over exposed to radiation.

 

[SoCalTraveler]

I'm not here to minimize your concern, or suggest you do not have a claim. You should consult a malpractice lawyer.

You have a significant issue to deal with. A lawsuit can't pay for for speculative damages.

 

[Chris in NC]

For those who feel this complaint may be frivolous: there are a number of lawsuits against imaging facilities / hospitals / etc. for radiation overexposure, including many which are essentially identical to my situation: the imaging facility messed up, had to do additional scans, and therefore exposed the patient to much more radiation than what should have been the case. Considering the dollar amount involved, I'm not going to file a lawsuit, but the point is I'm struggling to see how this is a non-issue.

Then you need to consult with a personal injury or medical malpractice attorney. There is no further advice a consumer advocacy forum can offer.

But, as far as billing is concerned, you were billed for the correct service performed. If you opted NOT to have the 2nd CT scan performed, and they charged you, then you have a legitimate grievance for being billed.

 

[krisseye]

I'm currently in cancer treatment so I've had a lot of imaging done as you can imagine. I'm sympathetic to your concerns.

Let me see if I can put it into perspective for you. Let's say that we get 10 units of background radiation a year. So by age 70, we'll get 700 units. Adding your first scan to that makes your lifetime total 725. Adding your second scan brings us to a grand total of 750. That second scan added 4% more radiation than you would have gotten otherwise.

I'm exposed to extra radiation in so many non-medical ways. I lived in Denver for a while. I live pretty far north of the equator. I fly to Australia from Seattle pretty regularly. I fly a lot for someone who doesn't travel for work. I've had a ton of dental procedures over 30+ years.

So would it be nice if I didn't need imaging? Of course. But in the end I don't think it makes a ton of difference in my lifetime exposure.

 

[BluePlanet]

I appreciate the pressure testing of the various options available.

What I'm reading is this: (1) I do not have a legitimate case for a refund, but (2) I may have a legitimate case for a malpractice lawsuit. But what I'd propose to the company is let's refund the fees so that we don't have to get to a potentially costlier/messier/worse for everyone lawsuit. Either way it's a monetary settlement. You can't reverse the radiation overdose. So why not ask the company for a refund as a solution? Or do I need to approach this option a different way? Should I not term it a "refund", even though that's exactly what it would be?

It seems you think senior leaders will reject any refund request (remember: local management apologized multiple times; they know and admitted they messed up). But if they reject a simple refund (and probably me signing something saying I won't sue), they know they have the threat of a much costlier lawsuit on their hands. I'm not sure why you're saying these options shouldn't be connected. Money is fungible -- either settle through a refund (or call it something else) or settle monetarily through a lawsuit -- but money is money.

 

[Patina]

It appears you want to receive some sort of 'settlement' for enduring more radiation than you expected. As others have stated, this falls into the area of needing an attorney. But, from a layman's perspective, you will not receive anything for the potential of damage from extra radiation. The fact that there are many people who have numerous CT scans done and fare well over the long term is not going to bode well for any case you think you may have.

Of those lawsuits you mentioned, have any been successful in receiving compensation? Are those cases exactly like yours in that they had to endure one extra scan?

In the last three years I have had more CT scans than I would like but, as my oncologist says, the radiation is minimal compared to the exposure we endure on a regular basis just going through life. When talking about damage from numerous CT scans, studies show that children are the ones at risk as opposed to adults. And those children who are enduring CT scans every few weeks are the ones who have long term effects.

I know that you are looking for support/suggestions from this site regarding your case but, as you can see, we don't feel you have a strong case and don't have any suggestions to strengthen your position. While only you can decide how to handle the situation, if it were me, I would chalk it up to bad luck and move on, focusing on the upcoming surgery and subsequent recovery.

 

[Chris in NC]

I appreciate the pressure testing of the various options available.

What I'm reading is this: (1) I do not have a legitimate case for a refund, but (2) I may have a legitimate case for a malpractice lawsuit. But what I'd propose to the company is let's refund the fees so that we don't have to get to a potentially costlier/messier/worse for everyone lawsuit. Either way it's a monetary settlement. You can't reverse the radiation overdose. So why not ask the company for a refund as a solution? Or do I need to approach this option a different way? Should I not term it a "refund", even though that's exactly what it would be?

The company will hold firm because they know that 1) you have no case, 2) no attorney will entertain or take your case, and 3) there is no basis for a monetary settlement. You *MAY* have a basis for injury if you can prove that the company intentionally botched the CT scan out of malice, or if you were delivered a high enough of a basis of radiation that you developed acute radiation sickness (we're talking Chernobyl first responder doses here).

Unintentional mistakes happen in life all the time. From the perspective of the company, they hate that this happened here. They had to 1) repeat the CT scan, costing them a time slot for another patient, 2) repeating the CT scan may have resulted in the rescheduling of another patient's appointment, and 3) resulted in your patient dissatisfaction. Your dissatisfaction will result in complaining on social media (i.e. here), and bad word of mouth. No company would want any of this.

But, let's look at the technical data
Background radiation data is approximately 3 mSv/year. Over 70 years you are looking at 210 mSv.
Live in Denver? add another 1.5mSv/year. Over 70 years you are looking at an additional 105 mSv
Live in Vail? add another 3mSv/year vs sea level
Fly NY to LA? 0.06mSv per round trip flight
Fly LA to Sydney? 0.18mSv per round trip flight
Live in a brick house? Add another 0.1 mSv/year
Eat a banana? That's 0.0001 mSv/banana
A radiology technologist is allowed an annual exposure limit of 50mSv/year.

The highest dose CT scan is a CT of the Abdomin and Pelvis with and without contrast. This delivers approximately 15 mSv. But a CT scan with and without contrast is actually 2 CT scans, because it is performed once without contrast and once with contrast.

So, assuming that you had a CT with and without contrast repeated, your maximum dose is approximately 30mSv. While there *MAY* be a theoretical increased risk of cancer solely due to the radiation exposure, there are so many other risks that it is nearly impossible to prove direct causation.

Cancer risk is cumulative with time. A 80 year old will never live long enough to develop any cancers from radiation exposure where as children under 10 years old, especially those under 12 months old are at the highest risk. Epidemiological data suggest risks of up to 0.6% lifetime risk of a single CT scan of the head or abdomen causing a de novo neoplasm in a 12 month old. Ultimately, the decision to proceed with a radiology procedure is based on the BENEFIT vs RISK and there are situations where CT scans are unavoidable.

Finally, causation of cancer is multi-factoral, and radiation is one of many causes. Did you smoke? Do you enjoy grilled hamburgers? Have you ever used pesticides? Spilled gasoline on yourself? Do you live in an area with high radon levels? It will be impossible to "prove" that an extra 15mSv of radiation caused you harm. It is theoretical (as others have pointed out).

@Patina gives the best advice here. Focus on your surgery and recovery.

 

[weihlac]

I appreciate the pressure testing of the various options available.

What I'm reading is this: (1) I do not have a legitimate case for a refund, but (2) I may have a legitimate case for a malpractice lawsuit. But what I'd propose to the company is let's refund the fees so that we don't have to get to a potentially costlier/messier/worse for everyone lawsuit. Either way it's a monetary settlement. You can't reverse the radiation overdose. So why not ask the company for a refund as a solution? Or do I need to approach this option a different way? Should I not term it a "refund", even though that's exactly what it would be?

It seems you think senior leaders will reject any refund request (remember: local management apologized multiple times; they know and admitted they messed up). But if they reject a simple refund (and probably me signing something saying I won't sue), they know they have the threat of a much costlier lawsuit on their hands. I'm not sure why you're saying these options shouldn't be connected. Money is fungible -- either settle through a refund (or call it something else) or settle monetarily through a lawsuit -- but money is money.

You do not have a case for a malpractice lawsuit. CT scanners are very complex mechanical/electronic/computerized devices. Like everything from the simple Model-T Ford to the unimaginably complex Space Shuttle, things break. Needing a repeat CT scan because of a variety of technical issues happens regularly, although not frequently. Unless the CT scanner was operated in a negligent manner (very unlikely since the protocols are computerized) or the maintenance was shown to be faulty and the operator knew about it, there is no negligence or deviation from the standard of care that is required to file a lawsuit.

You would need to prove negligence, and then prove you had a quantifiable loss/damages due at least in part to the alleged negligence.

You are welcome to consult a malpractice attorney which can easily be done online where you input your case facts and they will give you a free assessment of your case.

Malpractice attorneys work on contingency fees, meaning that they fund the entire cost of a case without your contribution. They are paid a % of any eventual settlement. It costs an attorney $50,000-$100,000++ and 2-5 years of work to take a case to trial, and if they lose they recoup nothing. For this reason, many legitimate malpractice cases with lower damages are not pursued because the cost exceeds any settlement recovered.

I am posting this with 50 years of medical experience and 30+ years of experience as an expert medical malpractice witness to defense and plaintiffs' attorneys.

 

[BluePlanet]

UPDATE: A corporate representative called me first thing this morning and they have refunded the charges. It was a short call, very much along the lines of "we neither confirm nor deny that we did anything wrong, but let's just make this go away." It seems they don't want to deal with any potential headaches. I already see the reversal on my credit card.

I sincerely appreciate your thoughts. You are very kind to share your experiences and suggestions. I must admit, I am still a bit perplexed by the suggestions that I shouldn't even be asking for a refund, that this request itself is almost inappropriate or frivolous. The company made a mistake, the local manager admitted it, etc. I think it's reasonable to request recompense in such a case. But again, thank you for all opinions.

 

[Neil Maley]

I’m glad they were able to resolve this to your satisfaction. That says a lot about the company. Best of luck on your upcoming surgery.

 

[woodworker]

Adding my two cents: just because the company refunded your money does not mean they were wrong and you were right, or that you were entitled to anything. I would have never asked for a refund - I guess that is just me. Sorry that perplexes you.

 

[Carol P]

I would like to know if your insurance had covered this at 100% and you had no out of pocket expense, would you have pursued a refund for the insurance company? I understand your concerns but I wonder if it the money had not come out of your pocket if you would have reacted differently. Of course you are concerned for your health and that would have been a possible malpractice case in the future.