Intradepartmental consult question

[kwyjibo]

What are the medicolegal implications when a case that has been reviewed in intradepartmental consultation/overread actually goes to litigation?

I've heard that by obtaining and documenting review by a second pathologist, it is very difficult to prove negligence and provides significant medicolegal protection. However, I have also heard opposite opinions stating that the overread is strictly a means to improve diagnostic accuracy but provides no actual legal protection.

Just wondering what other people's opinions are on the matter.

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[AZpath]

Helpful overall to case defense. Does not make you immune to negligence. Very much depends on the circumstances of the case.

 

[deleted314957]

What are the medicolegal implications when a case that has been reviewed in intradepartmental consultation/overread actually goes to litigation?

I've heard that by obtaining and documenting review by a second pathologist, it is very difficult to prove negligence and provides significant medicolegal protection. However, I have also heard opposite opinions stating that the overread is strictly a means to improve diagnostic accuracy but provides no actual legal protection.

Just wondering what other people's opinions are on the matter.

An erroneous diagnosis is NOT, in and of itself, malpractice.
It must be demonstrated that you did not follow the standard of care as an expert witness will explain to the jury. Your expert will give the jury their version of the standard of care. If there is a lawsuit, all pathologists mentioned in the report as intradepartmental consults will be named as co-defendants also. It can’t hurt you and MAY help but multiplication of the same erroneous dx helps no one. It all depends on what the jury believes is the standard of care as explained to them by (generally) opposing expert witnesses.

 

[coroner]

An erroneous diagnosis is NOT, in and of itself, malpractice.

Correct. But if patient harm resulted as a result of that erroneous dx., it is. Hence why you also said "in and of itself", which I get. The problem is patient harm is something lawyers can circumvent e.g. emotional stress, which anybody can claim and would be hard to defend against.

If there is a lawsuit, all pathologists mentioned in the report as intradepartmental consults will be named as co-defendants also. It can’t hurt you and MAY help but multiplication of the same erroneous dx helps no one.

This is why some groups choose to put a generic comment, "This case was was seen in intradepartmental consultation and the diagnosis was reached in consensus", without naming names in order to limit liability

However, other institutions I have been to, including residency/fellowship did list individual physician names because some of them were experts in their field; plus, some clinicians liked that a more seasoned pathologist they knew also looked at that particular case (even though another pathologist was signing it out).

 

[deleted314957]

Even if you and your whole dept were wrong AND it harmed the patient the jury must be convinced by a preponderance of the evidence that you violated the standard of care. That standard is typically presented by opposing expert witnesses. There cannot be a judgement of malpractice unless the jury believes that. That is why it is so important to have a likable , believable, avuncular expert on your side. In a trial, it is the experts who establish the standard of care. Because it is a civil case it is just preponderance of evidence that rules the day.

 

[Dave CX]

What are the medicolegal implications when a case that has been reviewed in intradepartmental consultation/overread actually goes to litigation?

I've heard that by obtaining and documenting review by a second pathologist, it is very difficult to prove negligence and provides significant medicolegal protection. However, I have also heard opposite opinions stating that the overread is strictly a means to improve diagnostic accuracy but provides no actual legal protection.

Just wondering what other people's opinions are on the matter.

I once testified against a pathologist who had an atrocious miss (uterine leiomyosarcoma). He and his partner missed it TWICE!!! Woman died. Settled for a bit below the state cap. Even an expert consult wont always help. Someone in Philly lost a lawsuit over a melanoma, even though the case was reviewed at initial diagnosis by Bernie A as a consult who agreed with a benign diagnosis.

 

[deleted314957]

It all comes down to the experts, how they come across to the jury and who they believe. You and I may know about Bernie. They don’t. All they get is a recitation of his CV, other than his testimony. Perhaps the jury thinks he is a stuffed shirt, etc. Dr. Andy of Mayberry who hits it off with the jury will win them over.