Suit alleged failure to follow up on result

These types of cases are 'extremely difficult to defend'

After a hospitalized patient was discharged, an abnormal lab result was sent to her primary care provider. That provider apparently filed the lab result in the patient's chart without recognizing the abnormality. The patient later died from a condition related to the abnormal lab result, and the family sued for malpractice.

"The case went to trial with a laundry list of defendants, including treating physicians, the hospital, and the lab which ran the results. The lab won summary judgment, and two physicians had awards against them," reports W. Ann Maggiore, JD, an attorney at Butt Thornton & Baehr in Albuquerque, NM.

In another malpractice case, a diagnosis of a coagulopathy required two tests, the first of which was ordered by a fellow working in the practice who left when he finished his rotation. The patient received the first test, but when she received the second lab slip in the mail, she thought it was for the test she already had obtained. The practice didn't follow up, and the patient never got the second test.

"The coagulopathy wasn't discovered until much later," says Maggiore. "A lawsuit resulted, and the jury returned a verdict against the doctor who owned the practice, even though she had never even seen the patient. The primary care doctor was also found liable." The physician had written a letter to the patient's primary care physician saying her office would follow up as needed, but no follow-up occurred, she explains.

Cases alleging a failure to follow up on an abnormal test result are "extremely difficult to defend," says Maggiore. "Patients seen by multiple providers are at high risk for having a test result fall through the cracks due to poor communication between providers." To reduce risks, Maggiore recommends these practices:

• Avoid telling patients, "We will only call you if something is abnormal."
• Instead, physicians should tell patients that if they don't receive a call, they should call the office to obtain the test result.
• Have a system in place for tracking ordered tests and incoming test results to ensure these are acted on, and that patients are informed.
• This system can be as simple as a notebook in which the doctor writes the date, patient's name, and tests ordered, with a place to document when the test result comes in.
• Make referrals in writing and request copies of all test results.
• "Doctors who appear clueless about the care their patients are receiving from other providers don't fare well in depositions," she says.