Contributory negligence is the legal term for when someone has contributed to his or her own injuries. In cases where contributory negligence exists, the jury will determine to what extent the plaintiff was responsible for his or her own injury. In some states, in cases where the plaintiff was responsible for more than a certain percentage of the injury, no damages will be awarded. In other states, the total damages will be reduced by the amount for which the plaintiff was responsible. In this case, Ms. V did not follow up with Dr. R after her endocrinologist told her to, and then she stopped taking one medication (although she told Dr. R of this) and decreased another medication (without telling him). By doing so, she contributed to her own kidney failure, and the jury recognized this by reducing the damages in this case.
There is a great deal of talk in the news about physicians ordering unnecessary tests to protect themselves from potential malpractice suits. This is an issue in terms of costs (some tests are quite expensive), and the effects on patients (some tests are invasive).
A urinalysis however, is neither invasive nor costly. Dr. R was aware that Ms. V had three of the required four criteria for a diagnosis of lupus. He also was aware that kidney involvement was another one of the criteria for lupus, and therefore something to watch for. The easiest and best way to monitor for that would have been to perform a urinalysis on Ms. V – at least once a year. Had he done so, she could have been diagnosed, and therefore treated, earlier.
If you are aware that a patient has many, but not all, of the criteria necessary to diagnose a serious condition, you are obligated to monitor that patient to determine if any new symptoms develop. A urinalysis in this case would have been a relatively simple way to do so.