Getting sued for a "missed" diagnosis

[yaah]

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http://www.sj-r.com/News/stories/21289.asp

Excerpts:

Holley said Bell, a physician based at St. John's Hospital, should be found negligent even though Bell's error was triggered by a mistake made by a St. John's medical technician.

Both sides agree that the technician — called a cytology assistant — mistakenly included a biopsy sample from another patient among the nine samples that Bell thought were all from Robinson.

That other patient's sample, which showed an aggressive form of cancer, led to Bell making a diagnosis that prompted Robinson's Springfield doctors to give him useless radiation treatment.

Holley argued that Bell failed to notice several discrepancies that should have tipped him off to catch the mistake of former St. John's cytology assistant Sherry Sullivan.

For example, Holley said that only one of the nine tissue samples from the area around Robinson's spine was positive for cancer.

And even though the sample from the other patient was incorrectly labeled with Robinson's name, Holley said Bell could have taken two seconds to look on the other side of that slide. Another patient's name was written on the back.

OK, I can see this too, but what was it mixed up with? "The area around the spine" - what is that, exactly? I am presuming this was an FNA, and not a CSF, because they radiated the area. So something was biopsied and called cancer. As I said, I can see how someone would fault the pathologist on this, but shouldn't one fault the clinician too? And I wish they would give more of the history - this is classic lawyer behavior, providing only enough information to make things seem bad and not providing enough information to make a full and informed decision.

I mean, if I was a clinician and got a diagnosis of cancer on an FNA of the spine region, I would do a diligent search for a primary (since it's probably a met) and if I didn't find anything, would probably wonder if the biopsy was a false positive or something. To me, it sounds like this patient is a classic setup for an infection anyway, getting a diagnosis of "cancer" (whatever that means in this case) would raise red flags in many different ways.

How many people here "take two seconds" to look at the back of the slide? We can look at the back of the slide to try to see through the frosted glass and see what is written under the label, but in order to really tell you have to peel back the label and look at what is written there. Maybe their procedure is different.

I'm glad the lawyer is there to tell us that it's odd to see cancer in only one of 9 presumably FNA samples. Gee, that never happens! 🙄 Typical case: Passes 1-5: blood. Pass 6: diagnostic tissue. Passes 7-9: Blood and debris.

"There are no ‘red flags' here for a pathologist," Laudeman said, adding that the St. John's assistant made a mistake "and Dr. Bell got ‘kneecapped' in the process. A reasonable pathologist would have done just what Dr. Bell did."

Sullivan, 45, of Petersburg, testified that she regretted the mistake, which she said "could have happened so easily" in other cases be cause of the process used at St. John's in handling multiple pathology samples from different patients.

Robinson, 54, a former Springfield resident now living in Quincy, sued Bell in 2000 along with several other Springfield doctors and St. John's. He is seeking payment for medical bills and unspecified damages for pain and suffering.

St. John's paid an undisclosed amount to settle its part of the case in 2004, and all the doctors were dropped from the case except Bell.

Hard to put too much blame on the pathologist for this, but as I said, of course we don't know the whole story. Did the pathologist design these procedures? Did the pathologist design different procedures that weren't properly followed? What was it confused with? Did the mistaken sample have something that doesn't make sense in the spine? Carcinoma? Sarcoma? I hate stories like this because they don't tell you anything! And as I said, the patient sounds like a diabetic with back pain and a spinal mass. Probably, radiology said it could be infectious or a neoplasm, but clinically since there are no other cancers it probably was most clinically consistent with infection. I wonder what the clinical history on the path rec was? I would wager one of three possibilities: 1) Nothing. 2) 50 year old male. 3) 50 year old male with spinal mass. CLINICAL HISTORY HELPS!

The pathologist is in a tough situation. For the lawyer to say "there are no red flags" is not really honest. Of course, that also depends on the information that they are not providing.

 

[LADoc00]

I think this is a risk in any large medical center, which why I vastly perfer to practice in a smaller sub 220 bed hospitals with a small staff I know very well and can pick up the phone if I got a case like this and say, Hey I only got 1 slide with material, what is the situation? I would ask them to repeat the procedure or at least check my own people for a possible screw up.

The problem is arising because pathology has been more and more consolidated. You have locums provider who dont know anyone and are afraid to ask questions. You have rotating staff so no one knows each other etc.

This is my summed up thoughts: almost never will I make a first diagnosis of malignancy from an FNA and certainly not from a single slide, I dont give a crap who would, I wont. I would ask for a core which is easy to get and I would do stains to determine lineage/organ of origin. The whole thing smacks of shenanigans.

PS-Saw Joel Greenson yesterday, somewhat funny, although the political anti-Bush stuff was a little 'meh' after the first 10 or so slides. Made a few references to messing with fellows so I would watch yourself yaah. I definitely think UMich is creating a dynastic legacy in GI Path.