Dr. Z’s office was crowded, but this was nothing new. The 61-year old urologist had built a thriving practice, primarily from referrals from his network of general practitioners. It didn’t hurt that he was active in the local country club and regularly played golf with other physicians. The urologist’s genial personality engendered good will from his colleagues and he garnered many referrals this way.

His business was booming to the extent that he eventually decided to hire an additional urologist, as well as several nurses and office staff to help manage the caseload.

Elevated PSA

One of Dr. Z’s patients, Mr. R, 56, was a referral from a family practitioner with whom Dr. Z occasionally played golf. The family practitioner’s notes indicated that the patient, a married father of three, had a PSA of 4.1 ng/mL. Repeat PSA testing confirmed the elevated results. The patient’s physician referred him to Dr. Z to determine whether the elevated PSA indicated cancer.

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Dr. Z spoke to the anxious patient about his PSA level and its implications, and then scheduled a transrectal ultrasound and biopsy for the following week. The procedure went normally and the physician told the patient that the results would be conveyed to his regular doctor.

Lab results are in

The following week, during an exceptionally busy afternoon, Dr. Z received a faxed report from the laboratory indicating that Mr. R had prostate cancer. Dr. Z then proceeded to leave the patient’s file, along with several others, on his office manager’s desk with a Post-it note attached, telling her to fax the lab results to Mr. R’s family physician.

In the flurry of patients and paperwork, however, the note came off and the lab results were never sent to the family practitioner or to Mr. R. The patient’s folder (with the lab results) was filed away, and Dr. Z didn’t give it another thought—until a year later.

The following year, Mr. R returned to his regular doctor for his annual physical. Mr. R’s PSA had spiked—this time to a 6.4—and he was referred, again, to Dr. Z for consult.

When Dr. Z opened the patient’s file for review, he became agitated. He shuffled anxiously through the papers, trying to find a note from his office staff indicating that the lab results had been sent to the Mr. R’s primary physician.

“Did your regular doctor inform you about the lab findings from last year?” he asked the patient.

“No,” said Mr. R, alarmed. “Was there a problem?”

A devastating diagnosis

At this point, Dr. Z was forced to convey the bad news to Mr. R. The patient, shocked and furious, immediately called his primary care physician to see if that office had ever received the lab results. It had not. Mr. R quickly found another urologist. He was subsequently diagnosed with adenocarcinoma of the prostate with extracapsular extension and a Gleason score of 7 and underwent a radical prostatectomy. Prognosis for survival was poor.

Initially shocked, Mr. R became depressed and then angry. Both he and his wife blamed Dr. Z for the failure to convey the information a year earlier, when it might have helped. Mr. R’s wife was a homemaker and two of his children were still in college (one had not started yet), and he worried about the financial ramifications that the disease—and his eventual death—would have on the family. Mr. R decided to consult a personal injury attorney.

The attorney reviewed the records, and told Mr. R that it was clear that the urologist had never sent the lab results to Mr. R’s family physician.

“There are no notes in the medical record indicating that Dr. Z forwarded your lab results. In fact, there’s no mention about a follow-up call or that you had been advised to check back regarding results.”

“I was told that Dr. Z would send the results to my doctor,” said Mr. R. “I assumed that since my doctor never said anything, or contacted me, that everything was okay.”

The attorney then had an expert physician review the records. Had Mr. R been diagnosed a year earlier, in the expert’s opinion, his prognosis would have been far different—with a possible chance of survival. The plaintiff’s attorney then filed a malpractice lawsuit against Dr. Z.

Upon being notified about the lawsuit, Dr. Z consulted with his attorney. “I did leave instructions for my office staff to fax over the results,” insisted Dr. Z. “Somehow, it just didn’t happen.”

After much questioning and discussion, Dr. Z admitted that the patient’s chances would have been better had his diagnosis come earlier. His defense attorney suggested settlement negotiations, and the case was eventually settled for the policy limits of Dr. Z’s malpractice insurance—$750,000.

Legal background

Trials are expensive, and the results are impossible to predict. Settlement is often a more viable option, as it allows for negotiation and can be beneficial for both parties. Had Dr. Z gone to trial, he might have tried to shift blame to the family practitioner for not following up or even the patient himself for not calling about the results. But Dr. Z knew that because he’d advised Mr. R that the results would go to the family practitioner, and had not mentioned anything else about follow-up, such a line of defense would be weak. Although Mr. R initially was looking for a higher settlement, he was willing to settle for Dr. Z’s malpractice policy maximum, since that money was guaranteed. Mr. R also sued his family practitioner, but that case has yet to be decided.

Protecting yourself

Physicians are busy—there is no denying that. And these days with insurance paying only negotiated amounts, physicians have to see more patients every day in order to make ends meet. However, there is no excuse for not following up appropriately, especially when lab results have immediate consequences. In this case, there was a clear breach of standard of care.

Dr. Z should have called Mr. R’s family physician himself and informed him of the results and then had his office staff fax over the paperwork. Dr. Z should not have left anything to chance where the patient’s immediate well being was concerned. Subsequently, Dr. Z should have followed-up to make sure that the patient received the test results and was being treated thereafter. To let a year go by, during which Mr. R’s condition deteriorated substantially, was negligent.