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Stallworth v. Boren8/20/2002
the intracranial angiogram in a pediatric patient, there have only been several times in your career when you've seen anything like that; isn't that true?
[Dr. Holmes]: You mean a fistula?
[Dr. Boren's attorney]: Like the one in this case.
[Dr. Holmes]: Yes. After I saw the arteriogram, I mean, based on the arteriogram it would be a fistula, and fistula are uncommon, arteriovenous malformations are much more common and AV fistula is a subtype, if you will. o the arteriograms, as far as I'm concerned, allowed us to subcategorize it as a little more uncommon abnormality. However, apparently at surgery they found an AVM so they found more than we could see on the film.
In their case, the Boren Defendants called two expert witnesses to address the applicable standard of care.
First, the Boren Defendants called Dr. John Cieply (Dr. Cieply), the only general diagnostic radiologist among the four principal expert witnesses who testified at trial. Dr. Cieply explained that radiologists "are, in a sense, consultants to the other physicians[,]" because what they do is "take x-rays, interpret x-rays to give findings to the physicians."He further explained that radiology is not pure science, but "sort of a combination of science and an art. The science part is the generation of the x-ray. The art part comes in interpreting it." Dr. Cieply analogized the general diagnostic radiologist to the "old fashion [general practitioner,]" in that they are "consultants to everybody across the board." The practice of general diagnostic radiology, he explained, concerns the entire body, as opposed to the various radiology sub-specialties, such as neuroradiology.
Dr. Cieply described how radiologists work:
[Dr. Boren's attorney]: What is it that you do in general in making your -- how do radiologists such as yourself go about their work?
[Dr. Cieply]: In a way, it's a little harder to describe. But effectively, you start off in radiology in your residency, and you start looking at films. Essentially, you look at films for years. And that's where the three-year or the four-year residency would encompass. And you look at films in every different section.
You rotate from gastroenterology -- that's the stomach and the colon -- to chest radiology, we've talked about, to neuroradiology. And you just keep looking at films and looking at films with professors with you. And you build up a font of knowledge. And I sort of think of it as sort of a template in your brain that this is a normal. And that's where we're learning. We're learning the abnormal because we're going to spend our life looking for the abnormal. So what you do is you set a whole series. You get a library in your head of normal templates of each thing. And we're talking about hands and fingers and feet and knees and chest and the brain. And then we're talking about the brain in children and the brain in adults and the heart and the chest of a young person, an old person.
So anyway, your mind has all these templates. And each time we look at a film, we throw one of these templates on there. And the things that are abnormal stand out to us. And then once they stand out to us, then we know it's abnormal and then we have to make our decisions of is this abnormal bad or is this abnormal not too bad or is this an abnormal meaning there's a disease or is this an abnormal. . . . So that's basically how we operate each and every time we see a film.
We're always comparing what we've seen in the past to what we have now. Because if you don't have any basis to compare, you wouldn't have any idea what's normal or abnormal.
[Dr. Bore
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