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Outpatient imaging centers and the increased risk of brain injury or death

Lacking preparation for cardiac or respiratory arrest emergencies after giving CT or MRI contrast to patients

We’ve been working on a tragic case involving the death of a middle-aged man who went for a routine CT scan for contrast at an outpatient imaging center in the Dallas area. His primary care doctor referred him there because of suspected kidney stones.

The autopsy revealed that this father and husband died from an anaphylactic reaction to the iodine-containing CT contrast media that a CT technologist administered to him intravenously (by IV) shortly before his CT scan.

A constant thought that I have about this case is how this man would likely still be alive today if his physician had referred him to a hospital for this CT scan with contrast, rather than a freestanding imaging center that was unprepared to handle medical emergency.

As we do in any medical malpractice case, whether wrongful death is involved or not, we review all of the available records closely with medical experts. We quickly uncovered some system problems.

Both the standard of care and the facility’s own policies and procedures require the facility to have a competent physician located on site to supervise CT contrast administration and to be immediately available to respond in case of emergency.

When this patient was given CT contrast, though, no doctor was physically present in the outpatient imaging center’s suite. When the patient collapsed, staff members ran next door to her neurology clinic and retrieved a neurologist, and later, a radiologist working there. Neither was sure if providing contrast coverage and supervision was his responsibility, and the facility didn’t give either of them advance notice of the CT contrast exams.

Then there’s the issue of the CT technologist. Under the standard of care and the imaging centers own policies and procedures, technologists are required to have certification and cardiopulmonary resuscitation (CPR), which is also referred to as Basic Life Support (BLS).

The CT technologist who administered IV contrast to this patient has no evidence in her personnel file of active BLS certification. Perhaps rusty training and a lack of preparation explains why she chose to continue with the scan even though the patient started coughing and heavy breathing problems midway through the contrast injection.

According to the CT tech’s notes, the patient was gasping for air and she couldn’t detect a pulse. Under the BLS Adult Algorithm, this means that she should have done the following:

• Initiate the immediate, high-quality CPR 30 compressions; 2 breaths

• Use an automated electronic defibrillator (AED) as soon as it is available (one was located nearby)

• Shock when prompted by the ADD advice

• Resume CPR immediately for two minutes after shock or no shock signal from the AED

This is the pathway that should’ve been continued until emergency medical technicians (EMTs) arrived on scene after 911 call. Instead, the CT tech and, later, the two physicians who were retrieved from next door didn’t start CPR.

By the time EMTs assess the patient, they noted that he had agonal breathing. Agonal breathing means that a patient is essentially having his last breaths before death. Although the EMTs began immediate CPR and other measures, it was simply too late. They took him to a nearby hospital and he was pronounced dead.

Based on my experience, I would be comfortable in having a CT or MRI without contrast at a freestanding outpatient imaging center. If contrast is required, though, I would go to a hospital. Hospitals offer a full complement of emergency equipment staff, and higher likelihood of survival is something goes wrong. Many independent imaging centers cut corners with emergency supplies and staff training, and it shows when a patient goes into respiratory or cardiac arrest from a contrast reaction.

If you’ve been seriously injured because of poor imaging or health care in Texas, then contact a top-rated, experienced Texas medical malpractice lawyer for free consultation about your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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