“The Hidden Dangers of Outsourcing Radiology,” Self Magazine

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Jennifer Drumm had the worst headache of her life. The pain was so severe that as she arrived at the Charles Cole Memorial Hospital in Coudersport, Pennsylvania, an emergency room doctor suspected she had a cerebral hemorrhage, which could quickly turn deadly. He ordered a CT (computed tomography) scan of Drumm’s brain.

It was around 6 p.m. on a Friday night. Like many small hospitals, the rural facility did not always have a radiologist on site to interpret scans. Instead, the hospital had a contract with an outside company, Chambersburg Imaging Associates, to read them. In a process known as teleradiology, the hospital took the CT, then sent a digital version by computer, much like sending an email, to a radiologist four hours away in Chambersburg, Pennsylvania. He ruled out a hemorrhage but found a mass in Drumm’s left temporal lobe—a possible tumor.

The diagnosis was frightening but not immediately life-threatening. So, after scheduling a follow-up with an oncologist, the ER gave Drumm painkillers and discharged her. At 9 p.m., Drumm, a 30-year-old computer technician, drove home. But by 4:30 a.m., after a night in tears from pain, she had called an ambulance and was back in the hospital, according to court records obtained by self. The ER doctor ordered a more detailed CT, using contrast dye.

That might have caught the true problem, if only Drumm’s doctor and radiologist had talked over the results. And up until a decade or so ago, that’s what would have happened. “In the old days, the radiology suite was right next to the ER, so the radiologist would walk past the patient on his way to read the scan,” says Lauren Ellerman, a personal-injury attorney in Roanoke, Virginia, who has handled radiology cases. Today, that image of doctors conferring in front of a backlit X-ray is as outdated as Marcus Welby.

With the now common use of teleradiology, the doctors who read your scans may well be across town, several states over or on the other side of the world. And instead of discussing what they see with your M.D., the often far-flung radiologists may send only written reports with little or no interaction. The result can resemble a perilous game of telephone.

In Drumm’s case, the hospital sent a digital copy of her new scan to Chambersburg Imaging. Presumably because of the predawn hour, Chambersburg then sent the film to a subcontracting company that had radiologists standing by in different time zones.

At 6:30 a.m. that Saturday, teleradiologist Edward Wong, M.D., opened Drumm’s file. Dr. Wong’s employer, Virtual Radiologic Consultants, was headquartered in Minnesota. Dr. Wong was licensed to practice medicine in Pennsylvania. But as he studied the images of Drumm’s head, he was at his home in Hong Kong. He saw the mass on his computer—and something more. The contrast dye revealed a ring around the mass, something Dr. Wong noted in his report for the ER. But he did not state what the ring could mean: a buildup of fluid or pus in the brain known as an abscess—an emergency that is almost always fatal if untreated.

The baton pass of films in cyberspace, from Coudersport to Chambersburg to Hong Kong, seemed to lead each physician to assume that someone else was connecting the dots. The emergency room doctor who read Dr. Wong’s report never spoke with him; he later admitted that he did not know the significance of the ring yet didn’t ask. Come Saturday, yet another radiologist working for Chambersburg Imaging read Drumm’s second CT. But he, too, did not contact the ER because he knew Dr. Wong’s report had been sent there, and he agreed with the findings his colleague had made, court documents reveal.

With no radiologists raising the alarm, the ER had discharged Drumm again. On Sunday, her parents rushed to her side from Iowa, planning to bring their daughter to her follow-up at the hospital the next day. But early Monday morning, they found her unconscious on the bathroom floor. Her abscess had ruptured.

Drumm spent the next 11 weeks in a coma, with shunts draining the fluid from her brain. She survived—but with permanent damage to her memory, intellect and ability to function. On Drumm’s behalf, her parents sued the hospital, the radiology contractors and six doctors involved in her care during that four-day period in 2005, although all have denied that their actions were negligent. The resulting settlement is confidential, and none of the parties was allowed to comment for this story.

“I know I’m different, but I can’t say how,” Drumm told a neuropsychologist hired to assess her for her case. Her family told the neuropsychologist that Drumm’s head injury had made her childlike in her vulnerability, with an exaggerated sense of humor and less inhibition. She talks animatedly to strangers in the mall, they said, and once wandered into a hotel hallway wearing only a top and no underwear. At 36 years old, Drumm cannot live on her own and will likely never return to work.

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