Misdiagnosing Patient MRIs

A lawsuit was brought by 2 former employees alleging ProScan of using lower-paid physician assistants to “ghost read” MRI images resulting in frequent misdiagnoses and missed diagnoses (1). The result were misreadings, misdiagnoses, and “grave concerns” by experts in the field. The article used the example of a misdiagnosis of a horse race jockey which originally resulted with “no acute pathology,” on the MRI. However when reviewed by an expert neurologist, it was found to be life-threatening and serious – “two severe spinal cord injuries in the jockey’s neck and a complete tear of the ligament that stabilized his neck.” This comes to light as the case was recently unsealed.

“A federal judge unsealed a whistleblower lawsuit on Thursday accusing ProScan – one of the largest MRI-reading companies in the nation – of using physician assistants, instead of doctors, to improperly read hundreds of MRIs each day and wrongly diagnose patients (1).

This contradicts what the Proscan website (2) says:

“Founded by Stephen J. Pomeranz, M.D., ProScan Reading Services (PRS) is comprised of a dedicated team of highly specialized, board-certified, and fellowship-trained radiologists. The ProScan radiology team has one of the most extensive combined case experiences in the world and our radiologists are recognized experts in MR, CT, PET, and Ultrasound (2).”

This article and this blog IS NOT about mid-level practitioners, individual integrity of practitioners, or scope of practice (although it very well could be), but more about how there is this trend in healthcare to cut corners, use cheaper alternatives, and cheaper labor with disastrous results. We see it all the time. How many times do you want to put your elderly patient on 1:1 status in the hospital so she doesn’t fall, and you are scorned because there isn’t enough staff to do the job – and then she falls? How many times are you told your patient’s insurance won’t cover any more days, but he’s still septic on IV antibiotics with encephalopathy? How many times are you told by the pharmacy that the drug you ordered isn’t covered and you have to use a cheaper alternative that you don’t want? How many times are you denied a brain MRI or CT because the acute mental status changes/delirium is a clinical diagnosis, and you’re told there is no added value to the imaging? How many MD/DOs are getting canned and being replaced by cheaper mid-level providers? How many times have you referred to a MD/DO specialist and get the notes back that they didn’t end up seeing said specialist you referred to? The list goes on ad nauseam. This article is a case in point. We’re caught up in a day and age where health care is less and less about medicine and more and more about business and money. Money itself is not a bad thing, but when the priority in healthcare comes down to money over health, corners get cut, best practices go out the window, and we see disastrous things like in this article. Have a great day. 

REFERENCES:

  1. https://www.wcpo.com/news/i-team/whistleblower-lawsuit-accuses-proscan-of-fraud-misdiagnosing-patient-mris?fbclid=IwAR3bN0uVHqxS1UM2pxHQcMT7sgXariRQmaWRTJDBdK5lGteVrmqwB_7N2r0
  2. https://proscan.com/physician-resources/proscan-reading-services/

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Robert Duprey MD

Robert P. Duprey Jr studied medicine as a 2nd career medical student who went to medical school in his 40’s after honorable discharge and ‘retirement’ from 25 years in the US Military (USCG & US Army). He was a registered nurse (RN) with specialty training as a psychiatric RN in the US Army for 15 years. During this time he also became a Master’s level psychotherapist in 2002. While on US Army active duty he also became a Psychiatric Nurse Practitioner while working full time in 2011. He served as a Psych NP on active duty, to include a combat tour in Iraq, until his ‘retirement’ in 2014 and moved to Philippines with his 3 children. At this time he started medical school overseas at Oceania University of Medicine based out of Samoa accredited by Philippine Accrediting Association of Schools, Colleges and Universities (PAASCU). He continued to work as a Psych NP throughout medical school to support his children and to not have to take out loans for medical school tuition. Originally from Rhode Island, he completed medical school clerkship rotations throughout the USA with a graduation in May 2019 earning the esteemed credential of MD. He has successfully completed USMLE Steps 1, 2CS, and 2CK. He will take Step 3 this September as he applies for Psychiatry Residency. Having been and RN, NP and now MD, he is a believer of Physician led multidisciplinary healthcare teams 

  5 comments for “Misdiagnosing Patient MRIs

  1. Celia B Entwistle MD
    September 27, 2019 at 6:59 pm

    This reminds me of the argument I have seen before— do not let an insurance company deny services without finding out the name of the responsible physician or nurse. Give this information to the patient. Find out if the physician ( or, in this case, radiologist or assistant) even has a license to practice in the state. Practicing without a license should get the DA and the Medical Board involved. Play their damn game better than the bad guys play it!

  2. Beth K
    September 26, 2019 at 7:50 pm

    To me, as a patient who pays into the whole system, it is ludicrous to pay for an expensive test, such as a PET scan or MRI, and to not have the results read by an expert in reading such tests. Why spend $30K on PET scans, only to have the results read by someone with a HS diploma and a class of 30 contact hours of training, who probably charges a few hundred less than a physician with a relevant specialty, with years of training and years of experience?

    This is one example of “Penny wise and pound foolish.”

  3. Dave Mittman, PA
    September 26, 2019 at 2:25 pm

    Robert:
    These “assistants” might have been PAs but also could have been “radiology assistants” which have nothing to do with PAs. As you know, there are few PAs specializing in radiology and if they are the are more involved in procedures. That being said, all of us in medicine have to show competencies as to what we do and do it well.
    These people seem to have some explaining to do.
    PERSONAL OPINION ONLY

  4. Steven Zeitzew
    September 26, 2019 at 12:06 pm

    You must remember that the insurance company or hospital administrator cannot discharge your patient, and is not liable for the consequences if you do so prematurely. Give your patient honest good advice and information. The Pharmacist cannot write orders on your patient, and is not liable for the consequences of the orders they suggest that you write. Stand your ground and do the right thing. If you do not think the patient should be discharged then don’t write the order. It is the patient’s responsibility to choose their insurance company, and to face the consequences of their rules. Doing the right thing will have consequences for you. Hospitals do not like to lose money. Patients do not like to pay high costs. Your bottom line might suffer from always doing the right thing. Mine has. Your integrity is not for sale. Giving in to the nonsense will make it worse. Your patients expect and deserve the truth. They can make their own decisions after you provide truthful guidance. – Sir Geon of Bones

  5. Steve O'
    September 26, 2019 at 9:01 am

    A widely-accepted and unfounded assumption underlying much of our society is that not merely some actions, but all actions – and even worse, all thoughts – can be described as EXPLICIT, i.e. infinitely divisible into simpler and simpler elements until the most basic actions or thoughts can be arrived at. The assembly of these elemental thoughts and actions can then constitute the entirety of the original in a way that is indistinguishable from the original.
    An example is the incredible ability of computers to play chess, once the rules are programmed into it, and it is refined. Computers now can defeat any human at the chessboard. People take that fact to infer that all things – not just chess – only require explicit knowledge.
    The corollary of explicit knowledge is TACIT knowledge. To believe in the modern superstition requires one to absolutely reject the proposition that there are thoughts and actions that result from understanding that cannot be dissected and simplified.
    The “MRI-reading-company” is an artificial construct based on the proposition that MRI’s can be fed into it, and accurate results come out. The reading of an individual MRI is also subject to this dangerous and unfounded superstition.
    Although people may wish otherwise, there are some things which respond to only tacit knowledge derived from experience and wisdom – human characteristics. Much of our suffering derives from our inability to accept this possibility.

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