Benefits can accrue when physicians talk directly with their patients about laboratory results. Just don’t let your system for having that discussion get in the way of communication.
A severely overweight young lady visited Dr. B, a bariatric surgeon, for weight reduction. She weighed 325 pounds and reported to Dr. B that she had been morbidly obese her entire life and that she had failed all diets. Dr. B considered the patient a good candidate for bariatric surgery and recommended she undergo a laparoscopic Roux-en-Y gastric bypass surgery. The patient agreed and attended a bypass nutrition education class.
During that class, the patient learned about her post- surgery diet, the importance of protein, vitamin, and mineral supplementation, fluid requirements, physical activity, and common problems.
In her written consent for surgery, the patient signed a “nutrition agreement” stating she understood the need to take lifetime vitamin and iron supplements to avoid protein malnutrition and anemia.
The patient underwent the procedure successfully and saw Dr. B two weeks after surgery. She reported that she was taking her vitamins, calcium, and iron. The patient made follow-up appointments with Dr. B and his office staff over the next year, by which time her weight had dropped to 194 pounds. At approximately 13 months post-op, Dr. B instructed the patient to follow up in a year.
At 24 months post-op, Dr. B sent the patient a letter instructing her to get lab work completed and to contact the office to schedule her follow-up appointment.
The patient had her lab tests drawn six weeks later and on the same day, went to the urgent care center with complaints of a cold. Her weight was 181 pounds. On that visit, the plaintiff did not include iron in her list of current medications. She was instructed to follow up with her primary care physician but did not do so.
Dr. B received the lab results the next week and initialed each page. The labs showed the patient had low hemoglobin (7.4 on a range of 11.7-15.5) and hematocrit (23.8 on a range of 35-45). The patient also had low levels of vitamins A and B1, and low total iron and iron binding levels.
Some six weeks after the lab tests, the patient passed out in the shower and fell. After recovering, she crawled to make a telephone call to paramedics. At the ER, the patient’s labs showed her hemoglobin at 6.7 and a hematocrit of 22.4. X-rays showed a right ankle fracture and displacement.
The ER physician believed that the patient experienced a syncopal episode secondary to anemia. She was admitted for an orthopedic consultation and a transfusion of packed red blood cells.
The patient underwent an open reduction and internal fixation of her ankle. After her discharge from the hospital, she called Dr. B and told him about the fall and her injury. Dr. B noted from that conversation that the patient had not taken her iron pills in more than a year and had not scheduled her appointment as instructed.
The patient sued Dr. B for not advising her of her medical condition before the fall and injury.
At trial, Dr. B testified that at his office, general surgery labs were reviewed and discussed with the patient right away as they tended to be more acute. Follow-up bariatric labs, however, would wait until the patient came in for his or her visit. Because of the patient’s failure to schedule her follow- up visit, Dr. B did not discuss the results with her.
Though Dr. B testified that he believed he met the standard of care, a gastroenterologist testifying for the plaintiff said that Dr. B was negligent in failing to notify his patient of her anemic laboratory values. Much of the trial focused on patient compliance and Dr. B prevailed at trial when the jury found him not negligent.
The defense verdict for Dr. B notwithstanding, a strong tickler system to address unreported results could make similar legal ordeals avoidable.
Author Gordon Ownby is General Counsel for the Cooperative of American Physicians, Inc.(CAP).
If you have questions about this article, please contact us. This information should not be considered legal advice applicable to a specific situation. Legal guidance for individual matters should be obtained from a retained attorney.