When a patient can’t tolerate imaging, what’s your next move? A $22M malpractice case offers a warning
Industry Buzz
A radiologist can do everything right and still end up on the wrong side of a verdict. Unfortunately, despite his accurate interpretation, Dr. Cory got swept up in a verdict that was truly about clinical care.
—Daniel J. Huff, attorney
A patient who couldn’t tolerate a CT scan after a car crash ultimately suffered a devastating spinal injury. Now, a $22 million malpractice verdict is raising questions about what clinicians should do when the imaging they order is simply not an option.[]
Related: Forecast: 103,000 new cancer cases each year because of one increasingly popular test?What happened
The case dates to September 2018, when David Tucker, then 71, and his wife, Carol, were rear-ended in Georgia.[]David reported neck, back, and chest pain and was taken to an emergency department at Habersham County Medical Center.
The ER physician, Christopher Ratchford, MD, reportedly ordered a CT scan of Tucker’s neck. But he apparently could not lie flat for the scan because of his back pain. The CT was canceled, and the physician instead ordered neck x-rays, which were interpreted as showing no serious injuries. A radiologist, Richard Cory, MD, subsequently reviewed the x-rays 2 days later and reached the same conclusion.
Four days after the accident, Tucker returned to work as a truck driver. He subsequently developed severe neurological symptoms affecting his legs and collapsed in a McDonald’s parking lot. At another emergency department, CT imaging revealed fractures in his neck and upper back as well as an epidural hematoma compressing his spinal cord.
Related: Patient awarded $23M after radiologist missed signs of spinal cord compressionHe was transferred to a trauma center for emergency surgery but was left paraplegic. He relied on a wheelchair for the next 6 years, with his wife providing regular care. He died in July 2024 from complications related to his paraplegia.
On June 26, a Rabun County, GA, jury awarded $22 million. The verdict included $6 million for wrongful death, $10 million toward Tucker’s estate, and $6 million for his wife’s loss of consortium.
But there is an important wrinkle for radiologists. The defense argued that Dr. Cory had interpreted the x-rays appropriately. Defense attorney Daniel J. Huff said multiple experts testified that the radiologist’s interpretation met the standard of care. “A radiologist can do everything right and still end up on the wrong side of a verdict. Unfortunately, despite his accurate interpretation, Dr. Cory got swept up in a verdict that was truly about clinical care,” said Daniel J. Huff, an attorney who represented Gainesville Radiology, where Dr. Cory worked.[]
The cervical films did not include the thoracic spine where the epidural hematoma ultimately caused the paralysis, and even the plaintiff’s key witnesses were not able to identify a fracture and noted that the findings were “subtle.”
In other words, the verdict wasn’t necessarily a simple story of a radiologist “missing” an obvious finding. It was also a case about what happened after the preferred imaging study couldn’t be completed.
What docs can learn
A canceled test isn’t the end of the diagnostic workup
When a patient can’t tolerate an imaging study because of pain, positioning, anxiety, altered mental status, or another barrier, the clinical question doesn’t disappear with the canceled order.
The next step should be explicit: What information were we trying to get, and how will we get it now?
That might mean analgesia or repositioning and attempting the study again. It might mean a different imaging modality, additional views, imaging of a different anatomic region, or transfer to a facility with capabilities better suited to the patient’s condition. The appropriate choice will depend on the clinical circumstances.
Don’t let a substitute test create false reassurance. Plain radiographs may be useful, but a negative x-ray does not necessarily answer the same clinical question as a CT. If the patient’s symptoms, mechanism of injury, or examination remain concerning, clinicians need to ask whether the alternative study was actually sufficient to exclude the injury they’re worried about.
Close the loop when the clinical picture doesn’t fit
One of the most important habits in medicine is recognizing discordance. If a patient has significant pain, neurologic symptoms, or an injury mechanism that seems out of proportion to reassuring preliminary imaging, “negative” shouldn’t automatically mean “done.”
That applies across the care team. Emergency physicians, radiologists, technologists, nurses, and consultants may each see a different piece of the diagnostic puzzle. A quick conversation can sometimes be more valuable than another checkbox in the chart.
Related: Family awarded $951 million in Utah's largest malpractice verdict everDocument why something wasn’t completed—and what happens next
A canceled CT is clinically meaningful information. Documentation should capture why the imaging could not be performed, the patient’s symptoms and examination, what alternative testing was obtained, and, when appropriate, the plan for additional evaluation.
Know what the imaging can—and cannot—answer
In this case, the defense emphasized that the radiologist was interpreting cervical films while the eventual source of paralysis was a thoracic epidural hematoma outside the imaged area.
The case is a reminder that diagnostic safety isn’t just about correctly interpreting the images that arrive on the workstation. It starts earlier, with getting the right imaging on the right patient—and recognizing when the available images aren’t enough.
A $22 million verdict makes the stakes impossible to ignore. But the more useful clinical lesson may be simpler: When the planned test fails, don’t let the diagnostic plan fail with it.
Related: The $5.6M lesson in escalation protocol failure every physician should read