TODDLER DIES OF SEDATION OVERDOSE BECAUSE X-RAY
TECHNOLOGISTS WERE WORKING OUTSIDE THE SCOPE OF PRACTICE
Following is a tragic incident that highlights both the importance of having patience
with young patients and the criticality of working within the scope of practice, i. e.,
doing only those procedures and examinations for which you have been trained.
Raymond and Mary Portlock filed suit against the Duncanville Diagnostic Center, a
radiologist and two radiographers for the negligent death of their 4 1/2-year-old, who
died as a result of acute chloral hydrate Intoxication. Brought to the clinic for a
routine cystourethrogram and an intravenous pyelogram, little Erica was having
difficulty settling down for the exam. So, the two x-ray technologists Involved
inquired if the radiologist could give Erica something to calm her nerves. The
physician told the x-ray technologists to give Erica chloral hydrate, which, as would
be expected, made her unconscious. After the examination was completed, the x-
ray technologists sent the still unconscious Erica and her parent's home. Erica never
regained consciousness. She died later that day.
The x-ray technologists allegedly failed to ascertain the proper dosage from the
physician, they failed to measure the medication, and failed to document the
administration of the narcotics. But, by the very act of administering narcotics, the x-
ray technologists were performing outside the scope of practice. Donna Hardin,
program administrator of the Texas Department of Health's Medical Radiologic
Technology program, indicated that no reprisals could be taken against the x-ray
technologists because the administration of narcotics does not tail under the
jurisdiction of that agency. She went on to say, "Under the Medical Practice Act, [x-
ray technologists] are permitted to take orders from a physician, even if the orders
don't fall under their scope of practice."18 Thus, as the regulation now stands, x-ray
technologists may perform duties for which they have no training, e.g., administering
narcotics, if the physician so delegates.
As a result of this loophole in the regulation, the two defendant x-ray technologists
are still licensed and practicing in Texas. Further, their names are likely to be
deleted from the suit. Even If they had insurance it wouldn't cover the case because
they had been working outside the scope of practice.
As a result of this case, the rules of professional conduct are being revised so that
the radiographer's liability will encompass not only "radiologic" but "medical"
procedures as well, As part of the defendant radiologist's out-of-court settlement, he
has been ordered to write a paper outlining the procedures and treatments that a
physician can legitimately delegate to an x-ray technologist. Says Hardin, "I hope the
paper will help encourage technologists to refuse orders if they are not trained to
carry them out" 19