A 41-year-old patient, Mr. E, visited Dr. L, a family physician, for an influenza shot. While in the office, he asked the doctor for a referral to a dermatologist. “My wife wants me to get my skin checked,” Mr. E. said. “I’ve got a couple of spots on my back.” The doctor issued the referral.

A week later, Mr. E visited a dermatologist, who documented a mole on Mr. E’s back measuring 6 mm in diameter. “I’ll get in touch with your physician about this,” the dermatologist said. After the patient left, the dermatologist sent a letter to Dr. L recommending that the mole be removed. The letter was opened by the office manager and placed in Mr. E’s file, but Dr. L never looked directly at the letter.

Suspicious mole

Six years later, Mr. E returned to the dermatologist for a skin check. The original dermatologist had retired and his partner was now running the practice. The new dermatologist examined Mr. E’s back and documented the mole that had been noticed six years earlier. However, since over five years had passed from the original appointment, Mr. E’s original file had been warehoused, and the dermatologist did not realize that the diameter of the mole more than doubled. He recommended to Mr. E that it be monitored. A few months later, Mr. E’s wife noticed that the mole had changed color.

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He returned to the dermatologist’s office to have it excised and was diagnosed with malignant melanoma soon after. The cancer had already metastasized to other areas of his body, including his brain. Over the next year, Mr. E tried radiation, surgery, and experimental chemotherapy, but to no avail. He died a year after the cancer was discovered, leaving a wife and two young children.

Issue of negligence

His wife consulted a plaintiff’s attorney who agreed that there was an issue of negligence. “The original dermatologist should have removed the mole or contacted Dr. L and told him—not by letter—that it needed to be removed,” the attorney said. “Dr. L, who wrote the referral, should have checked up afterwards. He saw this patient for another six years and never bothered to ask about the dermatologist, or look at the mole himself. He never even looked in the file to see the letter.”

When Dr. L heard that his patient had succumbed to skin cancer, he reviewed the patient’s file, where he found the letter from the original dermatologist advising removal of the mole. Dr. L felt a combination of guilt and panic as he realized that his carelessness might have contributed to the patient’s death. When he was notified that he was being sued for malpractice, he was not surprised. The dermatologists were also sued.

Dr. L met with his defense attorney, and the discovery process began. Before the case went to trial, however, the case was settled out of court for $2.8 million.