Dr. N, 62, was a pediatric nephrologist who was the head of the kidney transplant program in a major hospital. Over the past several years, he’d occasionally been asked to serve as an expert in medical malpractice cases.

In one such case, Dr. N was contacted by the attorney for a young man, Mr. K, who wanted to file a lawsuit against the clinicians who treated him in his local emergency department (ED). The attorney called Dr. N and asked him to look at the medical records and assess whether the clinicians had been negligent in their care of Mr. K.

Dr. N carefully reviewed the records which laid out the story. Mr. K was 15 years old when he first came to the ED with his mother. He complained of blood in his urine, and a urinalysis verified gross hematuria as well as protein in the urine.

The attending urologist, Dr. U, diagnosed Mr. K as having a urinary tract infection, prescribed antibiotics and sent the young man home. Six weeks later, Mr. K returned to the same ED complaining of continuing blood in his urine as well as new symptoms of a sore throat, fever and right flank pain. Mr. K was examined by Ms. A, a urology physician assistant. Ms. A called Dr. U to discuss the examination, evaluation and treatment plan, but neither Dr. U, nor any other physician, actually examined Mr. K. Again, Mr. K was given antibiotics, was told he had a urinary tract infection, and was sent home. 

Almost two years later, Mr. K, now 17, returned to the same ED complaining that he was spitting up blood. Tests revealed that the teenager’s kidneys were no longer functioning. A renal biopsy indicated that he had late-stage IgA nephropathy, which would require him to be on hemodialysis three times a week for the rest of his life. It was determined that the kidney disease had progressed too long without treatment and the kidney failure was irreversible.

After receiving this devastating news, Mr. K and his family hired the plaintiff’s attorney who had contacted Dr. N to review the records and give an opinion. In the state in which this took place, a certificate from a qualified expert needed to be filed to begin the lawsuit. After reviewing the records, Dr. N concluded that the clinicians had breached the standard of care by failing to include nephritis in the differential diagnosis when Mr. K presented to the ED on both occasions. He reported his findings to the plaintiff’s attorney, and filled out the required certification necessary to begin the malpractice suit. The lawsuit was filed against Dr. U (the urologist) and Ms. A (the physician assistant) alleging negligent care in the treatment of Mr. K.

Dr. U and Ms. A consulted with their malpractice attorney who told them “I think we may be able to get this whole case dismissed. The expert they used was a nephrologist, not a urologist, and therefore is not a ‘qualified expert’ under the statute. Without a certification from a qualified expert, they can’t proceed with their case.” The attorney filed a motion to dismiss the case. The court agreed that Dr. N was not a qualified expert in the case, and the case was dismissed, much to the distress of the plaintiffs.

The plaintiff’s attorney immediately appealed, and argued that Dr. N was, in fact, a qualified expert. The attorney pointed out that the statute said that the expert “shall have had clinical experience, provided consultation relating to clinical practice, or taught medicine in the defendant’s specialty or a related field of health care.”

The case went to the state appeals court, which had to decide whether nephrology was a related field of health care to urology, specifically in the context of developing a differential diagnosis for a patient who presents to the ED with blood and protein in the urine. The court ruled that under the circumstances, urology and nephrology are related fields, and that Dr. N’s certification of the case was valid.