Multiple urinalyses revealed hematuria in a 49-year-old woman, but her urologist failed to run any blood tests

As a urologist with nearly 30 years’ experience, Dr. T, 58, was accustomed to having patients referred to him by other doctors. But he never expected to be sued for not making a referral himself.

The patient, Ms. Y, 49, had been referred by her general practitioner, Dr. A. According to the re-ferral note, a urinalysis taken as part of a routine checkup had found blood and protein in Ms. Y’s urine. A follow-up test two months later showed the same abnormal results, prompting the referral.

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A urinalysis performed during her first visit to Dr. T revealed hematuria. Over the next two months, the urologist saw Ms. Y three more times. Urinalysis at each visit detected hematuria. Despite these findings, Dr. T did not run any blood tests. He assumed that Dr. A had run them already and would have notified him of abnormalities. The urologist believed watchful waiting was appropriate under the circumstances and did not order any kidney function tests.

Frequent urinalyses ordered Ms. Y diligently returned for follow-up every two to three weeks, but after the fourth visit she was fed up with what she perceived as Dr. T’s failure to do anything but check her urine. Three days after that visit, she returned to Dr. A, complaining of nausea and weight loss. He ordered blood and kidney function tests, which revealed anemia, high blood urea nitrogen (BUN), and abnormal creatinine levels.

As soon as he got the test results, Dr. A checked Ms. Y into the hospital, but she went into renal failure and was put on dialysis. Diagnosed with glomerulonephritis, she underwent kidney transplantation within a year.