Doctors bungle lab order, causing brain injury at birth
Stay safe with five tips to prevent lab work from falling through the cracks at your doctor's office
I spent the last two Friday afternoons deposing four OB/GYN doctors who practice together in a Houston-area clinic. These doctors took care of my client during her pregnancy with her now two-year-old boy who was born with a brain injury. Sadly, his brain injury would have been avoided if the doctors had not made a simple mistake over and over again during the prenatal care.
By the way, depositions are an out-of-court opportunity where a lawyer for one side gets to ask a witness questions under oath. A court reporter types every word that is said and then prints a transcript, which can be read to the judge and jury in court.
The answers that the OB/GYN doctors gave to my questions at these four depositions surprised me.
The risk of Rh-negative blood
This whole birth injury case revolves the mother having Rh-negative blood that reacted with her baby’s Rh-positive blood, while she was still pregnant with him.
If a pregnancy mom has Rh-negative blood, early in her pregnancy the standard of care requires the OB/GYN to order a blood test that measures maternal antibody levels. The results of this simple blood test show the doctor if the mother’s body is waging an immune response to the baby’s red blood cells.
If the antibody test comes back positive and the titer levels are high enough, the OB/GYN has to bring in a specialist to help with the pregnancy. The specialist has advanced training and is called a maternal fetal medicine doctor, or perinatologist.
What did the doctors do wrong?
It is easy to understand why an OB/GYN would want to know if the mom’s immune system is trying to kill her baby’s red blood cells. And it is important for the safety of the baby that the doctor gets those results as soon as possible.
The OB/GYN clinic where my client received her prenatal care bounced her around like a ping pong ball. Instead of having one doctor manage her care, the clinic chose to have each of the four doctors see her multiple times during her pregnancy.
All four of the doctors admitted to knowing that she was Rh-negative and that the baby was at risk for Rh incompatibility. Rh incompatibility can cause a baby to have hemolytic anemia and a brain injury.
So, how is it that this conscientious mom never ended up having this important antibody test ever done during her pregnancy? This is where the case gets scary, because it is easy to see how a careless doctor could make the same mistake.
The OB/GYN clinic’s electronic medical records say that a doctor ordered an OB blood panel test, which included the important antibody screen.
During their depositions, the doctors explained how, when they make an order for lab work, it is automatically electronically transmitted next door to the Quest lab. The OB/GYNs explained that all their patients need to do is go to the lab and check-in, because the lab already knows what tests are needed because they had received the lab orders, or requisitions, electronically.
Well, that is how is should work. But, unfortunately for my client, her doctors were too dependent on an electronic system that failed, and they did not know it. Let me explain how.
By carefully questioning one of the doctors at deposition, I learned that the OB/GYN clinic’s electronic medical records system has a computer-accessible tab called labs. If you click the labs tab, the computer pulls up a list of each lab that was ordered, the date of the order, who ordered it, whether the order was electronically transmitted, and whether the order was received by the lab.
Before the deposition, the doctor had looked at the labs tab for the OB blood panel test and antibody screen. Do you care to guess what it showed? I will give you a hint: The lab never got the order. The labs tab showed that the order was never received by the lab.
The mom testified in her deposition that she had all the blood work done that was requested early in her pregnancy. She went to the Quest lab next to her doctors’ office and had blood work done. The lab records are clear on that. The problem was the lab did not run the OB panel and antibody test, because it never received the order from the doctors’ office.
My client had around a dozen prenatal visits during her pregnancy. The medical records show that a doctor tried to order the antibody screen blood work on her first visit. For the next 11 or so visits, there is nothing in the record that reflects that anyone ever checked on the missing lab work or even knew it was missing.
When I asked one of the doctors if their electronic system provided any automatic warning to them about missing labs, I was told “no” and that it was up to each doctor to go back and check manually.
Six tips that you can use to prevent injury from missing labs
This case re-emphasized for me that we cannot be too reliant on electronic medical records and orders that float around in the air somewhere. Here are some tips to prevent things falling from the cracks when it comes to lab work.
First, any time your doctor mentions that you need some lab work, ask for a printed copy of the order for the lab work that you need to have done. Ask your doctor to give a general explanation of the purpose for each lab test.
Second, go to the lab and have the testing done as soon as you can, and certainly well before your next follow-up appointment with your doctor.
Third, when you go to the lab to have blood drawn, bring the paper copy of your doctor’s lab order with you. Ask the lab staff to make sure that their electronic record of the order, or requisition, matches your paper copy of your doctor’s order. In other words, make sure that the two lists completely match. If not, contact your doctor immediately and get it fixed.
Fourth, get a receipt from the lab that shows which tests they are running.
Fifth, bring your lab receipt and the paper copy of your doctor’s order to your next appointment with your doctor. Ask your doctor if the results for each lab are in, and to explain the results. If the doctor’s office does not have the lab results, show them the lab receipt, which may help them get the results back from the lab more quickly. Keep following up with your doctor until they share and explain the results to you.
Missing labs can be dangerous and deadly
As a Houston medical malpractice lawyers, I have seen cases, like this, where a missing lab goes unnoticed and it can cause a birth injury and brain injury. In other cases, it can cause an infection to be treated with the wrong medicine and progress into sepsis, or could cause organ damage.
If you or someone you care for has been injured from a doctors’ mismanagement of lab work, call 281-580-8800 for a complimentary consultation with the Texas medical malpractice lawyers at Painter Law Firm.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
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This article was originally published in the September/October 2017 edition of "The Houston Lawyer" magazine [...]read more
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This article was originally published in the September/October 2017 edition of "The Houston Lawyer" magazine
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