Radiologist’s Limited Duty on Follow-Up Testing: No General Obligation to Recommend a Biopsy Absent an Assumed Duty

1. Introduction

Rashada v Ahmed arises from an alleged failure to timely diagnose synovial sarcoma in the plaintiff’s left hand. The plaintiff treated for years with rheumatology providers—Sadia N. Ahmed, M.D. and Ahmed & Ahmed Physicians, P.C. (d/b/a Suburban Rheumatology) (the “Ahmed defendants”)—for chronic pain and swelling. An MRI obtained in 2018 was interpreted by radiologist Eric L. Snitzer, M.D. (“Snitzer”), whose report identified a mass but did not indicate cancer. A second MRI in 2021 (read by a nonparty radiologist) recommended biopsy; biopsy revealed cancer, leading to amputation.

The key issues on appeal were procedural and duty-based:

• Whether the plaintiff established entitlement to summary judgment on malpractice liability.
• Whether the Ahmed defendants and Snitzer established entitlement to summary judgment dismissing the claims against them.
• Whether Snitzer, as a radiologist, could be liable for failing to recommend a biopsy (as distinct from misinterpreting imaging).

2. Summary of the Opinion

The Appellate Division unanimously modified the Supreme Court’s order. It:

• Affirmed denial of the plaintiff’s motion for summary judgment because the plaintiff failed to meet the initial burden on deviation from the standard of care.
• Affirmed denial of the Ahmed defendants’ cross-motion for summary judgment because, although they made a prima facie showing, the plaintiff raised triable issues of fact through expert affirmations on deviation and proximate cause.
• Affirmed in part denial of Snitzer’s cross-motion on claims tied to interpretation/causation because the parties’ experts created issues of fact.
• Reversed in part as to one discrete theory: it granted Snitzer partial summary judgment and dismissed the claim that he was negligent for failing to recommend a biopsy of the hand mass.

3. Analysis

A. Precedents Cited (and how they shaped the decision)

1) Plaintiff’s summary judgment burden (malpractice elements + initial burden)

• James v Wormuth — Supplies the core malpractice summary-judgment formulation: plaintiff must show a deviation from accepted practice and that the deviation proximately caused injury. The Fourth Department uses James as the controlling framework for assessing the plaintiff’s motion.
• Clune v Moore and Salter v Deaconess Family Medicine Ctr. [appeal No. 2] — Cited “see generally” alongside James to reinforce the same two-element structure (deviation + proximate cause) for malpractice liability.
• Giancarlo v Kurek and Reading v Fabiano — Used to support the proposition that the plaintiff’s own submissions (here, deposition testimony of the defendant physicians) can raise triable issues of fact on deviation, defeating the plaintiff’s attempt to obtain summary judgment.
• Alvarez v Prospect Hosp. — A foundational New York summary-judgment case, cited for the rule that if the movant fails to meet the initial burden, the motion must be denied “without consideration” of the opponent’s papers.
• Gumkowski v Schwaab and Sawyer v Kaleida Health — Fourth Department applications of Alvarez, reinforcing the mechanical burden rule applied to deny the plaintiff’s motion once deviation was not established as a matter of law.

2) Defendants’ summary judgment burden (prima facie showing; detailed, claim-by-claim expert proof)

• Webb v Scanlon — States defendants’ prima facie burden: submit factual proof (often affidavits, deposition, records) establishing compliance with standard of care or lack of causation. The court uses this as the baseline for both the Ahmed defendants’ and Snitzer’s cross-motions.
• Isensee v Upstate Orthopedics, LLP and Occhino v Fan — Reinforce the quality requirements for defense expert affidavits and the need to rebut specific malpractice theories.
• Groff v Kaleida Health — Confirms a defendant physician may rely on their own affidavit/affirmation to meet the prima facie burden, and provides a formulation for the burden shifting to plaintiff once defendant meets that burden.
• Wulbrecht v Jehle — Emphasizes the expert affidavit must address each claim of negligence in the bill of particulars, preventing “partial” rebuttals from earning full dismissal.
• Bubar v Brodman — Supplies an important limitation on burden shifting: the burden shifts only on elements the defendant established prima facie. The court later uses Bubar also when discussing Snitzer’s causation showing.
• Stradtman v Cavaretta [appeal No. 2.] and Lewis v Sulaiman — Cited to validate that Ahmed’s affirmation was “detailed, specific and factual,” and claim-responsive, satisfying the prima facie standard.
• Allman v Roswell Park Cancer Inst. Corp., Leberman v Glick, and Cooke v Corning Hosp. — Illustrate how plaintiffs can defeat defense summary judgment by presenting competent expert opinions that create triable issues on deviation and causation. These cases ground the court’s conclusion that plaintiff’s rheumatologist and plastic surgeon affirmations sufficed against the Ahmed defendants.

3) Expert qualifications, preservation, and “battle of the experts”

• White v Bajwa and Ciesinski v Town of Aurora — Used for appellate preservation: arguments (here, about an expert’s qualifications) raised for the first time on appeal are not properly considered. This defeats the Ahmed defendants’ new appellate challenge to plaintiff’s expert qualifications.
• Finnegan v Kasowitz and Leberman v Glick — Support the proposition that competing expert opinions can create triable issues on causation in delayed-diagnosis settings, including “decreased chance” / loss of opportunity for better outcome (here, limb salvage).
• Payne v Buffalo Gen. Hosp. and Fay v Satterly — Provide the standard for whether an expert has the “requisite skill, training, education, knowledge or experience” to offer a reliable opinion. Applied here to reject Snitzer’s contention that plaintiff’s plastic surgeon was unqualified.
• Moon Ok Kwon v Martin, Borawski v Huang, and Corcino v Filstein — Establish the broad admissibility rule: a physician need not be a specialist in the precise field to testify; gaps go to weight, not admissibility. This line directly supports considering the plastic surgeon’s opinion against radiology/oncology opinions.
• Fargnoli v Warfel — Supports that an expert affirmation is properly considered when it is grounded in the record and not vague, conclusory, or speculative.
• Nowelle B. v Hamilton Med., Inc. and Mason v Adhikary — Stand for the “classic battle of the experts” principle: when experts squarely conflict on material issues, summary judgment is inappropriate and the jury resolves credibility/weight. This underpins denial of summary judgment on key portions of Snitzer’s motion (e.g., causation tied to interpretation).

4) Radiologist duty limits regarding further testing (the decisive precedent for the modification)

• Martingano v Hall — The controlling duty principle the Fourth Department applies: a radiologist does not “assume a general duty of care to schedule or urge further testing, or [to] diagnose [or treat]” the underlying condition. This case is the direct basis for dismissing the “failure to recommend a biopsy” theory against Snitzer.
• Neyman v Doshi Diagnostic Imaging Servs., P.C. — A Second Department authority consistent with Martingano, supporting the same limited-duty concept for diagnostic imaging providers.
• Mann v Okere — Cited “see generally” as additional support for the proposition that, absent special circumstances, the imaging specialist’s duty is not a general duty to manage follow-up care.

B. Legal Reasoning

1) Plaintiff’s motion: why summary judgment on liability failed

The court applied the strict sequence mandated by Alvarez v Prospect Hosp.: the movant must first establish entitlement to judgment as a matter of law. Even though the plaintiff sought summary judgment on the complaint, the plaintiff’s proof—especially deposition testimony from Ahmed and Snitzer—raised factual disputes about whether defendants deviated from the standard of care. Under James v Wormuth and its Fourth Department applications (Giancarlo v Kurek; Reading v Fabiano), any genuine dispute on deviation is fatal to plaintiff’s effort to win liability as a matter of law.

2) Ahmed defendants’ cross-motion: prima facie showing met, but triable issues existed

The Ahmed defendants satisfied their initial burden through Ahmed’s detailed, claim-specific affirmation addressing the bill of particulars (consistent with Webb v Scanlon, Isensee v Upstate Orthopedics, LLP, Wulbrecht v Jehle, and Stradtman v Cavaretta [appeal No. 2.]). Once that showing was made, the burden shifted (per Groff v Kaleida Health) to the plaintiff to present competent expert proof of deviation and causation.

The plaintiff met that responsive burden by submitting expert affirmations from a rheumatologist and a plastic surgeon, which the court held raised triable issues on both elements (citing Allman v Roswell Park Cancer Inst. Corp., Leberman v Glick, and Cooke v Corning Hosp.). The Ahmed defendants’ appellate argument attacking an expert’s qualifications was rejected as unpreserved (White v Bajwa; Ciesinski v Town of Aurora).

3) Snitzer’s cross-motion: split outcome (causation disputed; duty-to-recommend-biopsy dismissed)

On causation, Snitzer made a prima facie showing through an expert orthopedic surgical oncologist’s opinion that the cancer likely existed years before 2018 and that limb salvage was unrealistic even then. That was sufficient to shift the burden on causation (consistent with Bubar v Brodman). The plaintiff, however, raised a triable issue through a plastic surgeon’s opinion that an improper 2018 interpretation delayed diagnosis and decreased the chance of limb salvage (citing Finnegan v Kasowitz and Leberman v Glick), creating a “battle of the experts” that cannot be resolved on summary judgment (Nowelle B. v Hamilton Med., Inc.; Mason v Adhikary).

Snitzer also attacked the admissibility/competence of the plaintiff’s plastic-surgeon expert. The court rejected that challenge: qualification does not require matching subspecialty, and any gaps go to weight (Moon Ok Kwon v Martin; Borawski v Huang; Corcino v Filstein), while the affirmation was not speculative and did not misstate the record (Fargnoli v Warfel).

The critical doctrinal pivot is the court’s treatment of the standalone theory that Snitzer was negligent for not recommending a biopsy. Relying on Martingano v Hall (and consistent authorities Neyman v Doshi Diagnostic Imaging Servs., P.C. and Mann v Okere), the court held that a radiologist does not, by default, undertake a general duty to urge additional testing or to manage diagnostic follow-up. Because the plaintiff’s bill of particulars included a negligence theory framed as “failure to recommend a biopsy,” and because the radiologist’s role did not encompass such a generalized follow-up obligation in the circumstances described, that specific claim was dismissed as a matter of law.

C. Impact

• Sharper pleading and proof boundaries for radiology defendants: Plaintiffs may still pursue radiologists for interpretation/reporting negligence and causation from delayed diagnosis, but this decision reinforces that a separately pleaded theory—failure to recommend biopsy/further testing—is vulnerable unless the plaintiff can show the radiologist assumed such a duty or the standard of care specifically imposed it in a way consistent with New York’s duty doctrine.
• Case management and motion practice: Defendants can target discrete theories in bills of particulars for partial summary judgment, narrowing the case even when broader malpractice claims survive. The Fourth Department’s approach demonstrates that courts can excise duty-barred theories while leaving fact-bound standard-of-care and causation disputes for trial.
• Expert “fit” remains flexible: The opinion continues the trend that cross-specialty experts (e.g., plastic surgery opining on delayed limb salvage) can be sufficient at summary judgment. Challenges to qualifications should be timely raised in the trial court or risk waiver on appeal.
• Delayed diagnosis causation framed as “loss of chance”: The court’s acceptance of an expert opinion that delay “decreased a chance of limb salvage surgery” underscores that diminution-of-opportunity theories can defeat summary judgment where grounded in facts and not speculation.

4. Complex Concepts Simplified

• Summary judgment / prima facie burden: Summary judgment is granted only when no material facts are disputed and the moving party is entitled to win as a matter of law. “Prima facie” means the moving party has submitted enough evidence to require the other side to respond with evidence of its own.
• Deviation from accepted medical practice: Whether the provider’s actions fell below what a reasonably competent provider would do under similar circumstances.
• Proximate cause: A legally sufficient connection between the alleged mistake and the injury. In delayed diagnosis cases, causation can include proof that earlier diagnosis would have improved the outcome (e.g., increased chance of limb salvage).
• Bill of particulars: A document that specifies the detailed acts/omissions alleged as negligence. Expert affidavits on summary judgment are expected to address these specific allegations claim-by-claim.
• “Battle of the experts”: When qualified experts disagree on key medical questions (standard of care or causation), courts generally do not choose who is right on summary judgment; a jury decides.
• No “general duty” to urge further testing: For radiologists, New York law (as applied here) distinguishes between the duty to competently interpret and report imaging versus a broader duty to manage follow-up testing and treatment decisions—unless the radiologist assumed that broader role.

5. Conclusion

Rashada v Ahmed is a dual-message decision. Procedurally, it reiterates New York’s strict summary-judgment burdens in malpractice cases: plaintiffs must establish deviation and causation to win outright, and defendants must submit detailed, bill-of-particulars-responsive expert proof to obtain dismissal—after which plaintiffs can often defeat dismissal through competent counter-experts.

Substantively, the most consequential point is the Fourth Department’s targeted dismissal of the radiologist “failure to recommend a biopsy” claim. By applying Martingano v Hall and aligned authorities, the court reinforced a limiting principle on radiology liability: absent an assumed duty, a radiologist generally is not legally responsible for urging additional testing such as biopsy. Future litigants in delayed-diagnosis cases should expect closer scrutiny of how negligence theories against imaging specialists are framed—separating alleged interpretive error (often fact-bound) from duty-barred follow-up-management theories (often resolvable as a matter of law).