MRI Expert Witness Stories

I have been extremely fortunate to have the opportunity to serve as an expert witness on MRI in a number of insurance claims and lawsuits. I say 'fortunate' because there is an awful lot to learn from the mistakes of others (mistakes that can lead to insurance claims or litigation). Applying the philosophy that 'forewarned is forearmed,' understanding how others get into trouble is a powerful way to inform the decisions that can help keep you out of trouble. I often use these 'vicarious lessons learned' in my consulting work with hospitals and imaging providers.

My particular areas of expertise (recognized by various state and federal courts) pertain to both the physical environment of MRI suites (the design & construction of these spaces), and the practices and standards which, if followed, are most likely to protect patients, caregivers, and visitors to MRI suites. I do get approached every once in a while with questions about specifically how a study was executed (specific pulse sequences), or whether the images from an MRI study were correctly interpreted, but legally these often require experts who either are MRI technologists, or physicians. My bailiwick is on MRI safety process (which, yes, directly involves the actions of both MRI technologists and physicians, but is rooted in standard-of-care safety practices, not so much in the frame of the delivery of clinical care).

Magnets Quenching or Quench-ploding

I've been involved in a handful of legal actions arising from MRI systems that quench and result in damage to the MRI scanner, itself, and sometimes -through an explosion- to the buildings in which they sit, and sometimes injuring people nearby.

A few of these have involved questions of inappropriate deinstallation methods. A couple revolve around inappropriate design of quench pipe systems (quench pipes that were designed using a different vendor's standard details, instead of the designs provided by the manufacturer of the MRI system being installed), and/or quench pipe designs that don't meet the (current) design requirements for protection against ingress of horizontally wind-driven rain.

There was a very interesting case where something almost went catastrophically wrong very shortly after a 3.0T MRI installation at a physician's office. The manufacturer's rep, who was there to do acceptance testing of the freshly-delivered system, actually triggered a quench (to avert the catastrophic event). The physician's office owner filed an insurance claim for the loss, and sued the MRI manufacturer. I got brought in by the attorneys for the insurance company (who were investigating before paying the claim). Turned out that the physical condition that created the gold-plated opportunity for catastrophe had been created by an errors or deviations in the building of the building (coordinated by the physician's office owner). Shortly thereafter the insurance company was dismissed from the litigation, and the attorney's for the MRI manufacturer asked if I could then be their expert on the same case!

There was another case where a janitor came into an MRI control room, after business hours, and a panel on the wall was squawking. In his effort to try and reset or disable the audio alarm, he hit one of the buttons on that panel that just so happened to be the quench button, initiating a quench which discharged hundreds of liters of ultra-pure liquid helium and caused the MRI scanner to de-energize... a process that often requires a minimum of $50,000 - $100,000 to undo.

Things Flying At MRI Magnets

As common as the pictures of objects flying at MRI scanners are, not much of these wind up in litigation because it's often pretty clear who is responsible. But I was involved as an expert in a case where a member of a specialty cleaning crew brought a floor polisher into the MRI scanner room, and was injured when it went flying. I believe most projectile accident injury claims are settled long before the lawyers would get experts involved.

MRI Burns

There a few cases that I've been involved in as an expert witness that have centered around patient injuries from burns. These are somewhat similar to the flying objects category insofar as -once it's determined that it's an MRI burn- it's pretty unequivocal that the responsibility lies with the MRI provider, or (in the case of malfunction) the MRI manufacturer, or a manufacturer of any products that were in place if they made any unsubstantiated claims about the MRI safety of their products.

Perhaps my most interesting expert role was in one of these cases. I was actually contacted by the attorney representing the hospital where the accident had occurred, and he laid out the facts (as he knew them) and the outcome. I essentially said, 'based on what you've shared, it seems pretty definite that your client is responsible for the injury.' Every other time I've said something similar to an attorney who contacted me, they've thanked me for my time, and I've never heard from them again. In this case, however, they still retained me to help them parse the arguments that were being made by the opposing side (and the opposing side's expert), and help them understand the strength of the various arguments. I think I was something of an 'MRI safety whisperer' to the attorneys and their client, the hospital. The hospital wound up settling with the injured patient not long after I was brought on. (I have no idea if those two things were related.)

MRI vs. Medical Implant Injuries

Earlier this year I concluded serving as expert for the plaintiff in a case where a patient was injured when pressurized CO2 tissue expander malfunctioned when next to the MRI scanner and released significant quantities of CO2 into the expanding envelope. Fortunately for MRI providers, everywhere, this particular implant is no longer sold (and had reports of a number of problems, including problems with MRI-caused malfunctions). At the center of the litigation was the claim that the imaging center did a substandard job in screening their MRI patients for contraindications (the imaging center's MRI patient screening form had 15 questions -all answered correctly by the patient- which can be compared to the nearly 70 questions on the 2024 ACR MRI safety screening form), and in overseeing MRI safety standards and practices, including their own documented policies, such as they were.

Attorneys for the plaintiff had made an early settlement offer, that was rejected by the defense. The matter was eventually settled at trial for an amount that was an order of magnitude larger than the early settlement offer.

Patient Movement Injuries In MRI

There are a handful of cases involving the movement of the patient into / out of the MRI bore. One of the most common forms of patient injury (apart from pinched fingers in table-tracks) is to breast MRI patients, whose torsos are elevated when laying face-down on the breast coil. When the table advances into the MRI bore, larger patients (or smaller-bore MRIs) can wind up pinching their back against the ceiling of the bore. In more than a few patients this has resulted in abrasions or even broken ribs.

I've also been involved in a few cases where the patients have claimed that their arms get torqued on the way into / out of the bore...

Questions of MRI Liability

While not every MRI technologist or radiologist may have a firm understanding of how MRI injuries occur, that's not because their causation is a mystery to the industry. By and large, we know the mechanics of causation for most MRI-specific injuries and -more importantly- we know what effective preventions are. This means that, almost by definition, nearly every MRI injury accident is known, with understood causation, and effective preventions. In light of these facts, it becomes an uphill battle to argue for absolution of the responsibility of the provider team (institution, radiologist, and radiographer).

How MRI Expert Witness Work Has Changed My Views

Not so very long ago I thought that Policies were wastes of both time and paper... 'they're just chaff in a 3-ring binder that nobody not looking for a cure for insomnia will ever look at.' But since then I've seen providers 'hoisted on their own petard,' vilified by their inability to even live up to the policies that they write for themselves. On the flip-side I've seen liabilities diminished when providers (who've experienced accidents) have well built policies that they actually follow, demonstrating an intentionality to follow best practices.

So I've gone from loathing policies, to loving them, and I encourage all my consulting clients to take a long, hard look at their policies. There are lots of practices that can reduce the risks of something bad happening, but no workable practices that make risks go to zero. A good set of best-practice-based policies that reflect how care is actually delivered at your site will both reduce the risk of things going sideways, and may even be a harm-reduction tool if the bad thing ever really does happen.

While it may be a poor business decision for my own future expert work, I strongly encourage all of my MRI safety teachers, coaches, managers, and consultants to seize on opportunities for expert witness work, if you get one. This work demystifies the litigation 'boogeyman' that many are terrified of, and will help redirect your attention into the often quiet and innocuous areas of MRI practice where grave risks may be looming... just waiting for their opportunity to pounce.