Doctor Liability for Erroneous Assessments in Radiology and Pathology Reports

What is Erroneous Evaluation in Radiology and Pathology Reports?

Erroneous evaluation in radiology and pathology reports refers to harm to a patient due to the failure to examine imaging or tissue sample results with the care and attention required by medical science, overlooking or misinterpreting existing findings, incomplete reporting, or lack of follow-up by a clinical physician.

Radiology enables the detection of diseases through imaging methods such as X-rays, ultrasounds, mammograms, CT scans, MRIs, PET-CT scans, angiography, and similar techniques. Pathology, on the other hand, involves the microscopic and, when necessary, immunohistochemical/genetic evaluation of biopsy, surgical specimens, smears, cytology, or tissue samples. These two fields play a vital role in the diagnosis of cancer, internal bleeding, fractures, vascular occlusions, cerebral hemorrhages, tumors, infections, organ damage, and chronic diseases.

An error in a radiology or pathology report can lead to delayed diagnosis, incorrect treatment, unnecessary surgery, cancer progression, organ loss, the need for intensive care, or death. Therefore, these reports are not merely "technical documents," but fundamental medical records that determine the direction of the treatment process.

The Patient Rights Regulation governs a patient's right to receive information regarding their health status, planned procedures, potential complications, and the course of their illness; it also regulates the patient's right to review and obtain copies of their medical file and records, either directly or through a representative. This right also includes diagnostic documents such as radiology images and pathology reports.

Is every incorrect medical report a doctor's error?

Not every incorrect or subsequently changed report automatically means medical error. In medical science, some findings may not be clear in the initial stages. Small lesions, early-stage tumors, insufficient sample size, poor image quality, patient movement, limited biopsy material collection, or atypical disease course can make evaluation difficult.

However, this does not completely absolve the radiologist, pathologist, clinical physician, or hospital of responsibility. The legal assessment is based on the following questions: Could the finding have been noticed if the existing image or tissue sample had been carefully examined? Was the report clear, sufficient, and guiding? If there was a suspicious finding, were further investigations or biopsies recommended? Did the clinical physician follow the warning in the report? Was a repeat biopsy requested if the sample was insufficient? Was the patient informed of the result?

For example, if a nodule visible on a CT scan of the lungs is not included in the report, and the patient is diagnosed with advanced lung cancer a year later, this could be grounds for a claim of radiology report error. If a suspicious mass or microcalcification is missed on a mammogram, breast cancer may be diagnosed late. If a malignant finding is reported as "benign" in the pathology report, the patient may not receive the necessary treatment for months.

Therefore, the issue is not simply that the report later turned out differently, but whether it would have been possible for a careful expert to reach the correct conclusion with the medical data available at the time the initial report was prepared.

In what situations do radiology report errors occur?

Radiology report errors can manifest in various ways. The most common error is the omission of a finding present in the image. For example, a lung nodule, breast mass, brain hemorrhage, abdominal mass, spinal fracture, blood vessel blockage, or internal organ injury may be visible in the image but described as "normal" in the report.

The second mistake is underestimating the significance of the finding. The report might state "simple cyst," "reactive lymph node," "insignificant lesion," or "no follow-up required"; however, it may later be understood that this finding indicates cancer or a serious illness. In this case, the expert re-evaluates the imaging findings as of the date of the report.

The third error is the failure to recommend follow-up or further investigation in the report. Some findings cannot be interpreted as definitive cancer or disease; however, they require follow-up, further imaging, biopsy, or clinical correlation. If the radiologist has such a suspicion, they should state it in their report. The clinical physician should also follow this recommendation.

The fourth mistake is failing to relate the report to the clinical picture. A radiology report cannot be evaluated in isolation; it must be considered in conjunction with the patient's complaints, physical examination, laboratory results, and previous images. For example, if a patient has prolonged bleeding, weight loss, persistent pain, or neurological findings, and clinical suspicion persists despite a "normal" report, the physician should conduct further investigations.

In what situations do pathology report errors occur?

Errors in pathology reports often have more serious consequences. This is because, especially in cancer diagnosis, the pathology report is the cornerstone of treatment. An incorrect pathology report can lead to unnecessary surgery or, conversely, prevent a patient from receiving vital treatment.

One of the most common pathology errors is false negative reporting. This means that even though cancer or a serious disease is found in the tissue sample, the report is issued as "benign," "inflammatory," "normal," or "no malignancy." In this case, the patient may be discontinued for follow-up under the assumption that it is safe, and the disease may progress.

The second type of error is a false positive report. In this case, the patient is diagnosed with cancer or a serious illness, but in reality, no such illness exists. A false positive pathology report can lead to unnecessary surgery, organ loss, chemotherapy, radiotherapy, psychological distress, and economic losses.

The third error is insufficient sample size or sample mix-up. If the biopsy material is insufficient for diagnosis, this should be clearly stated in the report and resampling should be recommended. If samples are mixed up in the laboratory, very serious legal liability arises. This is because the patient's genetic, oncological, and surgical treatment process may have been determined entirely based on the wrong material.

The fourth error is that the report lacks details that guide treatment. If cancer type, grade, findings aiding staging, surgical margin, lymphovascular invasion, hormone receptors, immunohistochemical staining, or molecular tests are not evaluated, treatment may be planned incorrectly.

False Negative Report and Late Cancer Diagnosis

One of the most serious consequences of radiology and pathology errors is the late diagnosis of cancer. A false negative report leads to the patient being told "there is nothing wrong." Therefore, the patient may discontinue follow-up, the doctor may not order further tests, and the opportunity to detect cancer in its early stages may be lost.

For example, a mammogram might not show a suspicious mass; the patient might be diagnosed with advanced breast cancer two years later. A precancerous lesion might be missed during a colonoscopy biopsy. Malignant cells might not be detected during a prostate biopsy. A nodule on a lung CT scan might not be followed up. Significant cellular changes might be overlooked during a cervical smear or biopsy evaluation.

In such cases, simply re-examining the old report is insufficient. The old images themselves, pathology slides, paraffin blocks, biopsy material, clinical follow-up records, and the patient's subsequent diagnostic documents must be evaluated together. The expert must answer the questions, "Could the findings have been visible at the time of the initial report?" and "Would the patient's chances of treatment have been different if an accurate report had been provided?".

False Positive Report and Unnecessary Treatment

A false positive report can have just as serious consequences as a false negative report. If a patient is diagnosed with cancer when they do not actually have it, they may be subjected to unnecessary surgery, chemotherapy, radiotherapy, or organ loss. This results in both physical harm and severe emotional distress.

For example, a pathology report might state thyroid cancer, the patient might have their thyroid gland removed, and it might later be discovered that the report was incorrect. A breast biopsy might give a malignant diagnosis, resulting in an unnecessary mastectomy. A radiology report might suggest a serious vascular blockage or tumor, leading the patient to undergo an unnecessary invasive procedure.

In such cases, not only pathology or radiology specialists but also clinical physicians are evaluated. If the physician sees an inconsistency between the report and the clinical picture, they may request a second opinion, repeat biopsy, repeat imaging, or a multidisciplinary evaluation. Confirmation of the diagnosis is especially important before irreversible surgical procedures.

Clinical Physician's Responsibility for Following Up on the Report

In radiology and pathology reports, responsibility does not rest solely with the specialist who wrote the report. The clinical physician who requested the report and treated the patient also has an obligation to read the report, explain it to the patient, plan necessary further investigations, and follow up on them.

If a report contains phrases such as "suspicious lesion," "clinical correlation recommended," "biopsy recommended," "follow-up MRI recommended," "malignancy cannot be ruled out," or "follow-up recommended," the clinical physician must take these statements into account. If the physician ignores these warnings, diagnosis may be delayed even if the radiology or pathology report is correct.

Similarly, the report may never have been communicated to the patient. The patient's pathology results may have been entered into the system, but the doctor or hospital may not have contacted the patient. The report indicating suspected cancer may have remained in the patient's file, and the patient may not have been called for a follow-up. In this case, an organizational failure at the hospital also comes into question.

The Patient Rights Regulation stipulates that a patient has the right to receive information about their health status, the course of their illness, and its outcomes. Therefore, the failure to disclose important radiology and pathology results to a patient constitutes not only a lack of medical follow-up but also a violation of patient rights.

Hospital and Laboratory Organizational Defects

The hospital's organizational responsibility in radiology and pathology errors should also be examined. Because an erroneous report cannot always be explained solely by the doctor's individual lack of attention. The quality of the imaging equipment, the imaging protocol, technician error, report volume, access to previous images, duplicate reading systems, critical result reporting, and archival procedures can all contribute to errors.

From a pathology perspective, the sample acceptance process, barcoding, tissue tracking system, slide-paraffin block archive, staining quality, immunohistochemistry, second pathologist opinion, critical result notification, and transmission of the report to the clinical physician are all important. If there is sample mixing, labeling error, or block loss in the laboratory, the hospital and laboratory may face serious liability.

The Constitutional Court has emphasized that whether a medical intervention has been performed in accordance with medical standards can often be determined by examining the records from the diagnosis and treatment process; and that the responsibility for recording and storing this data for a reasonable period rests with the healthcare institution. According to the Constitutional Court, if the failure to provide information or documents that should be in the patient's file prevents the assessment of the healthcare institution's responsibility, this deficiency should not be interpreted against the patient.

This decision is particularly important in radiology and pathology files. Because if there are no images, slides, blocks, reports, request forms, or records, the patient often has difficulty proving the error. However, the responsibility for keeping and storing records rests with the healthcare institution.

Evidential Value of Radiology Images and Pathology Slides

In these cases, not only the report text but also the raw medical data should be examined. It is important that radiology files, such as MRI, CT scans, mammograms, ultrasounds, or PET-CT images, are obtained in DICOM format. This is because the report may be inaccurate; the actual assessment is made based on the image itself.

Pathology files should include slides, paraffin blocks, biopsy material records, staining protocols, and immunohistochemistry results. Re-examining the pathology material can significantly alter the course of the case, especially if the cancer diagnosis, type, grade, stage, or surgical margin is being debated.

The patient or their representative must request these records in writing from the hospital and laboratory. Article 16 of the Patient Rights Regulation explicitly regulates the patient's right to examine and obtain copies of files and records related to their health condition. Furthermore, Article 17 covers the right to request the completion, clarification, and correction of incomplete, unclear, and erroneous medical information.

Radiology or Pathology Report Error at a Private Hospital

If a radiology or pathology error occurs in a private hospital, private imaging center, private laboratory, or private medical center, private law liability arises. The private hospital is responsible not only for the specialist physician who wrote the report but also for the imaging equipment, laboratory organization, patient record system, results reporting system, archives, and quality control processes.

Since private hospitals or laboratories provide their services for a fee, consumer law may also come into play depending on the specific case. The Law No. 6502 on the Protection of Consumers covers all types of consumer transactions and practices directed at consumers; in cases where private healthcare services are received for a fee, claims for defective service, unfair billing, and compensation may be evaluated separately.

However, if cancer progression, organ loss, unnecessary surgery, permanent disability, or death occur due to radiology or pathology errors, the case should not be treated solely as a "reimbursement of service fees." In such cases, the aspects of material and moral compensation, disability, care expenses, treatment costs, loss of support, and criminal investigation should be considered together.

Radiology or Pathology Report Error at State Hospital

If the error occurred in a state hospital, city hospital, training and research hospital, or public university hospital, the legal recourse in most cases falls under administrative law. Diagnostic and treatment services provided in public hospitals are public services. If this service is poorly performed, delayed, or not performed at all, the administration's fault in providing the service arises.

According to Article 13 of the Administrative Procedure Law, individuals whose rights have been violated by administrative actions must apply to the relevant administration for the fulfillment of their rights within one year from the date they learned of the action, and in any case within five years from the date of the action, before filing a lawsuit. If the request is rejected or no response is given within thirty days, a full judicial review lawsuit may be filed within the lawsuit period.

Therefore, if there is an allegation of a reporting error in a public hospital, instead of directly filing a compensation lawsuit in the courts, a detailed application should first be made to the relevant administration. The application should clearly state the date of the report, the incorrectly evaluated examination, the subsequently revealed true diagnosis, how the harm was aggravated, the requested records, and the items of material and moral compensation.

What types of compensation can be claimed?

Patients who suffer harm due to an error in a radiology or pathology report can claim both financial and non-financial compensation. Financial compensation may include additional treatment costs, surgery expenses, chemotherapy and radiotherapy expenses, medication costs, intensive care costs, private hospital expenses, re-biopsy and imaging costs, rehabilitation expenses, caregiver expenses, temporary and permanent disability, loss of earnings, and disruption of economic future.

According to Article 49 of the Turkish Code of Obligations, a person who causes harm to another through a negligent and unlawful act is obligated to compensate for that harm; Article 50 of the same Code stipulates that the burden of proof for the damage suffered by the injured party and for the negligence of the perpetrator rests with the injured party.

For example, if cancer is diagnosed late due to a false positive diagnosis, the patient may be subjected to more aggressive treatment. If a disease that could be treated surgically in the early stages has metastasized, the treatment costs and loss of quality of life become much more severe. If unnecessary organs are removed due to a false positive pathology, organ loss, medication, prosthetics, psychological support, and loss of work capacity become issues.

Compensation for moral damages is claimed due to the patient's fear of death, trauma from misdiagnosis, unnecessary treatment, organ loss, disease progression, reduced life expectancy, violation of bodily integrity, impact on family life, and psychological devastation. If the patient has passed away, their relatives may claim compensation for loss of support, funeral expenses, and moral damages.

Can a criminal investigation be opened?

If a radiology or pathology report error results in serious injury, organ loss, permanent disability, or death, a criminal investigation may be initiated. The provisions regarding negligent injury or negligent homicide will be discussed depending on the specific circumstances. However, in criminal investigations concerning medical procedures and practices related to examination, diagnosis, and treatment by healthcare professionals, the Professional Responsibility Board process may be initiated under Article 18 of the Annex to Law No. 3359 on Basic Health Services.

A criminal investigation and a compensation lawsuit are not the same thing. A criminal case investigates the criminal liability of a physician or healthcare professional. A compensation lawsuit, on the other hand, aims to compensate the patient or their relatives for material and moral damages. However, forensic medical reports, expert reports, expert opinions, and medical records obtained in a criminal case can be important evidence in a compensation lawsuit.

How are radiology and pathology errors proven?

In these cases, proof relies on technical and medical records. The first step is to collect all records completely. The patient should request not only the printed report but also radiology images, pathology slides, paraffin blocks, biopsy request forms, surgical notes, clinical examination records, consultations, and subsequent diagnostic documents.

The second step is to establish a chronology of events. When did the first complaint begin? When were the tests performed? What did the report say? When did the doctor see the report? Was the patient informed of the results? Was a follow-up or biopsy recommended? When was the actual diagnosis made? Did this delay affect the stage of the disease or the chances of successful treatment?

The third step is to compare the old data with the new diagnosis. If cancer or a serious illness was discovered later, the old images and pathology material should be re-evaluated by experts. The claim of an erroneous report should be strengthened not only by stating "a different diagnosis was made later," but also by demonstrating that the existing finding was noticeable at the time of the initial report.

The fourth step is establishing the causal link between the harm and the cause. When would the patient have received a diagnosis if there had been no false report? Would a milder treatment have been possible? Could organ loss have been prevented? Was life expectancy or quality of life affected? These questions are central to the expert examination.

The Importance of Expert Reports

In cases of errors in radiology and pathology reports, the expert report determines the fate of the case. Depending on the type of incident, the expert panel should include a radiologist, a pathologist, a specialist in the relevant clinical branch, an oncologist, a surgeon, a forensic medicine specialist, and, if necessary, a genetic or nuclear medicine specialist.

The expert witness must answer the following questions: Were there any discernible findings in the radiology image as of the date of the report? Was the pathology material sufficient for diagnosis? Was the report prepared in accordance with medical standards? If there were suspicious findings, should further investigation have been recommended? Did the clinical physician follow the report correctly? Did the error in the report lead to a delayed diagnosis or incorrect treatment? Is there a causal link between the harm and the error?

Incomplete expert reports must be challenged. In particular, general statements such as "there is a margin of error in medical science," "the lesion may be small," or "the cancer may have progressed aggressively" are insufficient. The report must concretely evaluate the image itself, pathology slides, past and new findings, the clinical follow-up process, and changes in the chances of successful treatment.

What should the patient or their relatives do?

If there is suspicion of an error in a radiology or pathology report, the first step is to request all medical documents in writing. A complete copy of the report, images, DICOM records, slides, blocks, biopsy material information, and patient file should be requested from the hospital or laboratory.

The second step is to obtain a second expert opinion. Especially if there are allegations of cancer, organ loss, unnecessary surgery, or delayed diagnosis, previous images and pathology material need to be evaluated by independent specialists.

The third step is to correctly distinguish between private and public hospitals. In private healthcare institutions, private law, consumer law, and malpractice liability come into play; in public hospitals, administrative appeals and full judicial review cases arise.

The fourth step is to identify the damages. If the patient is alive, additional treatment costs, disability, organ loss, invalidity, care expenses, and moral damages should be prepared; if the patient has passed away, loss of support, funeral expenses, and claims for moral damages by relatives should be prepared.

Conclusion: Reporting errors can fundamentally alter the diagnosis and treatment process

Radiology and pathology reports are among the most important diagnostic tools in modern medicine. Errors in these reports can delay a patient from receiving an accurate diagnosis or lead to completely incorrect treatment. Incorrect reports have serious consequences, especially in areas such as cancer, internal bleeding, brain hemorrhage, vascular occlusion, fractures, organ injuries, and infections.

Not every discrepancy in a report constitutes medical error. However, legal liability arises if a finding that could have been carefully assessed in the image or tissue sample is overlooked, if a suspicious finding is not followed up, if sample insufficiency is not indicated, if the patient is not informed of the result, if the clinician disregards the warning in the report, or if the hospital fails to keep and present the records.

In such cases, a strong legal process is possible not only with the claim that "the report was incorrect," but also by evaluating old images, pathology slides, patient files, clinical follow-up records, new diagnostic documents, and damages together. A patient who has suffered harm due to radiology and pathology errors can claim compensation for treatment costs, organ loss, disability, care expenses, economic future loss, and moral damages. If the patient has passed away, their relatives can claim compensation for loss of support and moral damages.