A 29-year-old woman was referred to the radiology department of a hospital for a whole-body radionuclide scan using iodine-131. The patient had undergone a total thyroidectomy for papillary carcinoma 4 years earlier and was being examined for metastases. Images obtained 48 hr after oral administration of 2 µ Ci (74 MBq) of iodine-131 disclosed no evidence of functioning thyroid tissue or metastatic disease.Three weeks later, the patient discovered that she was pregnant. The patient's obstetrician consulted with the radiologist, who suggested that the patient consider terminating the pregnancy because of potential damage to the fetal thyroid gland. The patient rejected this course of action, however, and elected to continue the pregnancy. At term, the patient delivered a baby afflicted with severe hypothyroidism. Six months later, the mother filed a medical malpractice lawsuit on behalf of her infant child and herself against the radiologist and the hospital, alleging that the defendants' failure to ascertain whether the patient had been pregnant at the time of iodine-131 administration constituted negligence.
Medical-Legal IssuesDefense attorneys representing the hospital and the radiologist immediately reviewed the pertinent medical records. They found that the patient indeed had been unknowingly 15 weeks pregnant at the time of iodine-131 administration. The attorneys discovered that the routine practice in the department was for nuclear medicine technologists to ask each patient undergoing a radionuclide procedure specific questions, including one about the possibility of pregnancy, and to record the response on a form. On the questionnaire filled out for this patient, a nuclear medicine technologist had checked off "no" next to the question, "Is patient pregnant?" When questioned, the technologist told the attorneys that he specifically remembered asking the patient whether she was pregnant and that the patient had appeared reliable and had answered, "No." The form was later reviewed and countersigned by the radiologist.The defense attorneys then reviewed the radiology department policy that covered procedures for examinations using radionuclides. The policy stated, in part, that "[d]etermination should be made prior to administration of iodine-131 that female patients in the childbearing age are not pregnant." Furthermore, the policy also stated that signs containing the language, "If you are pregnant or think you are pregnant, please notify technologist or radiologist" should be posted in plain view throughout the nuclear medicine department.Before formal legal discovery proceedings began, the attorney for the plaintiff produced an affidavit signed by the patient stating that she had no recollection of ever having been asked by the technologist at the time of the iodine-131 administration whether she was pregnant. The patient also claimed that she may have been "vaguely aware" of signs posted in the department that advised patients to notify a technologist if they were pregnant but that she "did not pay att...