When Your Cardiac Test Was Never Read by a Doctor

The standard of care requires that an echocardiogram be reviewed and interpreted by a qualified cardiologist. A technician can operate the equipment and capture the images. But diagnosing what those images show — identifying an abnormal finding, assessing its clinical significance, and communicating findings to the ordering physician — requires a physician with specialized cardiology training.

When that standard is not met — when echocardiograms are interpreted by unqualified personnel, when results are not communicated to the patient’s physician, or when significant findings are missed or ignored — patients can suffer strokes, heart failure, cardiac arrest, and death that might have been prevented.

The Standard of Care for Echocardiography

The American College of Cardiology (ACC) and the American Society of Echocardiography (ASE) have established detailed guidelines governing echocardiogram performance and interpretation. These guidelines specify:

• Echocardiograms must be interpreted by a physician with appropriate training in echocardiography — not by a cardiac sonographer or technician operating independently.
• The interpreting cardiologist must produce a complete written report that documents all relevant findings, normal and abnormal.
• Significant or unexpected findings must be communicated promptly to the ordering physician, particularly when they require urgent action.
• The ordering physician is obligated to review the report and act on its findings in a clinically appropriate timeframe.

The guidelines also address a specific and increasingly common problem: the delegation of echocardiogram interpretation to personnel who lack the qualifications to perform it. In academic and community hospital settings alike, economic pressures have at times led to informal arrangements in which technicians or non-cardiologist physicians read and report echo results. The consequences of this practice — when a significant finding is missed — can be catastrophic.

A Pattern the Courts Have Recognized

Several years ago, a New York hospital became the subject of investigation and litigation when it was revealed that thousands of echocardiograms performed in its cardiology department had been reviewed only by technicians — not cardiologists. The tests had been ordered for patients with suspected cardiac conditions. The results were not submitted to any physician for review. An independent investigation found that hundreds of patients may have suffered serious harm as a result.

This case drew national attention because of its scale, but it was not an isolated event. Across Pennsylvania and the country, similar failures occur on a smaller scale — individual physicians who order echocardiograms and never follow up on results, hospitals where report routing systems break down, practices where financial arrangements lead to echocardiograms being read by unqualified readers.

The legal principle in each case is the same: a patient who receives an echocardiogram is entitled to have that test interpreted by a qualified physician and to receive appropriate follow-up care based on the results.

Common Cardiology Malpractice Patterns We Investigate

At Lupetin & Unatin, we evaluate cardiac testing malpractice cases involving a range of failure patterns:

• Echocardiogram results that were never read by a cardiologist, or were read by a physician without appropriate echo training
• Significant findings — including valvular heart disease, reduced ejection fraction, intracardiac thrombus, or wall motion abnormalities suggesting prior heart attack — that were not communicated to the patient or ordering physician
• Failure to follow up on an echocardiogram showing findings that required further evaluation, such as exercise stress testing, cardiac catheterization, or cardiothoracic surgical consultation
• Delays in diagnosing heart failure because echo results showing reduced cardiac function were not acted upon
• Stroke caused by delayed identification of atrial fibrillation, intracardiac thrombus, or a patent foramen ovale that was visible on echocardiography
• Death from cardiac arrhythmia or structural heart disease that would have been identified and treated had the echo been properly interpreted and followed up

Ordering a Test Creates a Legal Obligation

One of the most important principles in medical malpractice law — and one that many patients are unaware of — is that when a physician orders a diagnostic test, that physician assumes responsibility for acting on the results. Ordering a test and then failing to review the results, or failing to follow up on abnormal findings, is itself a departure from the standard of care.

This principle applies with full force to echocardiography. A cardiologist who orders an echocardiogram cannot disclaim responsibility for the patient’s outcome simply because the test was performed and a report was generated. The duty to act on that report — and to ensure the patient receives appropriate care based on what it shows — rests with the physician.

The same principle applies to the ordering physician in other specialties who requests an echocardiogram as part of a cardiac evaluation. If the report comes back with a significant finding and the physician takes no action, that failure is actionable.

What to Do If You Believe Cardiac Testing Malpractice Harmed You

If you or a family member suffered a heart attack, stroke, cardiac arrest, or other serious cardiac event, and you have questions about whether diagnostic testing was performed, interpreted, or followed up correctly, here are the steps to take:

• Request all cardiology records, including the original echocardiogram report, any follow-up test results, and all physician notes documenting what was done in response to the findings.
• Request the actual echocardiogram images, not just the report. These can be reviewed by an independent cardiologist to assess what was visible and whether the interpretation was accurate and complete.
• Identify who interpreted the echo. The report should identify the interpreting physician by name and credentials. If it was not interpreted by a board-certified cardiologist with echo training, that is significant.
• Determine what follow-up, if any, was recommended and whether it occurred.

Pennsylvania’s statute of limitations for medical malpractice is generally two years from the date of injury or from when the injury was or should have been discovered. In cardiac cases, the discovery may occur at the time of a subsequent cardiac event — a heart attack or stroke — rather than at the time the echocardiogram was performed. Consult an attorney promptly to understand how the limitations period applies to your situation.

About Lupetin & Unatin, LLC

Lupetin & Unatin is a boutique medical malpractice and catastrophic injury firm based in Pittsburgh, Pennsylvania. We represent patients and families harmed by cardiac testing errors, misread diagnostic studies, and delayed diagnosis throughout Pennsylvania. Our attorneys are Fellows of the American College of Trial Lawyers and have been recognized by Super Lawyers and Best Lawyers in America. We handle all cases on a full contingency fee basis — no fee unless we win.