KittyParty
2d ago
Prenuvo, the preventative full body MRI company, missed a finding related to a stroke. Is being sued. Tried to go to arbitration, failed. Tried to sue in California for lower torts, also failed (Interesting strategy. The scan was in NY).
The specifics is that the radiologist missed a middle cerebral artery stenosis of 60% and the guy subsequently had a devastating stroke likely from it.
/r/medicine is having a field day of it: https://old.reddit.com/r/medicine/comments/1pzre3d/prenuvo_whole_body_mri_misses_impending_stroke/.
Scattered thoughts:
- The plaintiff’s neurologist is a silly guy. Probably a hired goon. He says that the stroke could have been prevented with a stent. We have randomized controlled trial data on this. You don’t stent an asymptomatic stenotic intracranial artery. Hell, you don’t even stent the vast majority of symptomatic intracranial arteries. Just completely outside of the standard of care. This isn't new or controversial. It's very well established that stenting is NOT recommended in most cases of intracranial stenosis.
- My best guess is that with aggressive stroke risk factor control and a baby aspirin, we could have reduced the stroke rate by up to a ½-1/3 yearly, which compounds quite a bit over the long term. So it's not that we couldn't do anything. It's just that the legal team and the goofy neurologist felt it more compelling to make a case about a missed, "intervention."
- Meddit is myopic and hysterical about it. The funny thing is that if they did catch it, prenuvo might have actually prevented a devastating stroke with medical therapy. And vigilance could have helped him warm his family/friends for prompt stroke symptom recognition. The earlier you get to a hospital, the better you do. This is actually a great example of a good finding that could have led to preventing a devastating stroke.., obviously assuming they actually noticed the finding.
- Getting into the medical weeds: That’s assuming the stenosis was atherosclerotic to begin with, and not an alternative cause of stenosis (which you would be obligated to monitor and work up in a 30 some year old).
- Commenters have mentioned the radiology report looks like AI. I disagree. It just looks like a normal radiology report. But brings up a big issue with AI in radiology. Who do you sue? This one will probably be in the tens of millions if successful. A nice thing for the system about doctors is that we really don't have that much money. 5-10mil at most by retirement. 1-2mil early career. Malpractice limits aren't really that high. The outrageously big bucks are hospital systems and companies. Juries are not going to find AI companies as sympathetic as doctors.
- Miss rates with whole body MRI’s are higher than normal. There aren’t any symptoms. A part of a radiologist’s search pattern is to pay EXTRA attention based on the history. For example, if this came through my shop for left sided weakness symptoms, I would give the R MCA/ICA/CCA extra attention. Such a stenosis would not be missed. In coding terms, imagine being given a project and being told, “It works perfectly fine. But find everything currently wrong with it or could go wrong with it,” instead of, “the publish button doesn’t work.”
- It would be reassuring to have two radiologists read these reports. It seems like a trivial cost to inoculate against missing these sorts of findings, which is their entire business model. A radiologist is paid ~300-700/hr. A full body MRI probably takes like an 30-60mins to read thoroughly. It really all boils down to the numbers. How many of these lawsuits is worth not hiring a second radiologist. Med mal can climb into the dozens to hundreds of millions.
- It's unsustainable for the system if prenuvo loses dozens of millions. It perverts incentives to see all patients as potential multi-million dollar lawsuits. This doesn’t just go for prenuvo, but all of medicine. A part of the job of the healthcare system is to say no to low yield medical care. There will be misses. We cannot afford to treat every patient like a saudi prince at the mayo clinic.
Yeah, agreed that any individual case comes down to an unpredictable and likely lowbrow jury.
But a lot of legislative theory crafting lives at the level of cocktail parties. Politicians often have physician friends and family. If not politicians, then their aides. The chattering class does have power. This was the level where the woke mandate was mostly pushed. Tort reform exists at this level.
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