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Legal Issues
The Legal Issues Center
Malpractice Litigation and Sonography
Articles by Roger C. Sanders, MD
Ultrasound-related Legal Cases
Vascular Technologist sues physicians for falsely billing for interpretation of venous imaging studies. Decision is favorable to physicians. Case appealed to Michigan Supreme Court. The following links provide more information about this case
Q&A with Dr. Sanders
Missing arms

Q: (Jan. 2008) I am a physician currently being sued for not reporting the missing upper limbs of 24 Week fetus. The technologist did not image the upper extremities and did not notice that upper limbs were missing. as a general rule we do not require imaging of upper extremities on routine examination. It is our policy to have technologist only visualize arms, without recording the images. Please let me know you feelings on this case. Is it standard not to have images of upper extremities?

A: Your case is not unique. I know of three other suits related to absent arms or a leg. The AIUM/ACR guidelines do not stipulate that you have to document the presence of all limbs and it can be very difficult to see the down arm when the fetus is lying on its side. The case is defensible if there is no indication for a higher level sonogram such as advanced maternal age, family history of a congenital abnormality or ingestion of a medication that might cause fetal abnormalities. The problem with a visible deformity such as this is that juries are easily swayed by a view of the deformity or (other similar deformities like cleft lip) and jump to the conclusion that the absence of the arms would be obvious in utero and so insurance companies are loathe to let such cases go to trial. Of course most cases do not go to trial and for the most part malpractice suits are settled out of court or dropped. My practice is to require documentation of all limbs even on basic level sonograms. I actually try to get a view that rules out club foot and views that show some of the hands but I don’t spend any time on this if they are very inaccessible and I do not try to count fingers in basic level sonograms. Roger Sanders
A Message from Dr. Roger Sanders
Comments on this series of articles on the legal aspect of ultrasound are welcomed. Comments can be sent to

I am still collecting cases for the ultrasound litigation series. The series only includes cases in which an allegation of poorly or negligently performed ultrasound is the main issue or is one of the litigation targets. It does not include cases in which ultrasound is an important part of the evidence but in which there are no accusations that the ultrasound was performed poorly. If you are involved in or have information about a relevant case, please send me a summary that includes the following:

  1. reason for the suit
  2. a crude location e.g. Florida
  3. the defendants specialty e.g. obstetrics
  4. what is happening in the case, e.g. whether depositions have been taken, settlement talks are occurring or whether the case is going to trial
If you would like to suggest a link that should be added to the list of links to ultrasound-related legal cases, please forward the URL to me at the address given above.