Doctor, nurse practitioner ignore MRI results for two years, woman dies of cancer
Physicians and mid-level providers (physician assistants and nurse practitioners) must timely inform patients of radiology test results
As a Houston, Texas medical malpractice lawyer, many of the lawsuits that I handle for patients and family members involve a failure of communication. This type of medical error usually occurs when there is a hand-off from one healthcare provider to another.
Think about it. The provision of modern health care involves a lot of different players including, doctors, specialists, nurses, laboratory techs, radiologists, and pathologists. When one healthcare provider refers an order or consultation to another provider, poor systems allow results to get lost in the shuffle.
It could happen at a hospital nursing shift change, where one nurse receives a physician order, does not have time to complete it before going off duty, and fails to tell the next nurse coming on duty.
This medical error also frequently takes place with lab results or diagnostic radiology reports. A doctor orders a study, a nurse enters the order, the lab or radiology departments handle the test and generate a report into the electronic medical records system, and then no one notices the report.
An example of a real Texas medical malpractice case shows how dangerous this can be.
A woman in her 50s went to see a pain management physician for help with chronic back pain. In August, the pain management doctor ordered an MRI of her thoracic spine. In addition to some spinal abnormalities, the radiologist noted a “possible 9 mm right lung nodule.” The radiologist recommended a CT scan if clinically warranted.
This is a good point to stop and discuss two important things about the radiology report.
First, almost every radiologist includes in reports that the doctor who requested the study may want to order additional radiological studies if clinically indicated or warranted. If you see language like that in a radiology report, it means that the radiologist is in a dark room somewhere looking at the CT or MRI images, but has never seen or evaluated the patient. The radiologist saw some type of abnormality in the study, but is leaving it up to the doctor who ordered the study, a clinician, to decide whether further workup is needed.
Second, in the CT scan report we have briefly discussed, the radiologist had an incidental finding of a possible lung nodule in a study that was ordered to evaluate back pain. The American College of Radiology defines incidental findings as findings that are unrelated to the clinical indication for the imaging examination performed. In other words, a lung nodule is an incidental finding in this case because it has nothing to do with back pain.
MRI report ignored for two years
In October, at the patient’s next appointment, the pain management doctor did not mention anything to her about the possible pulmonary nodule. He also did not order a CT scan, which the radiologist recommended should be considered.
At the patient’s next two appointments that same year, the pain management physician and his advanced practice registered nurse (APRN) never mentioned the pulmonary nodule. The same is true for the 14 office visits the patient had the following year.
Seven months into the next year—almost two years from the date of the MRI—the APRN noticed the old MRI report. She informed the patient about the potential pulmonary nodule and recommended that she discuss the MRI results with her primary care physician. The APRN then faxed the two-year-old MRI report to the primary care doctor’s office.
It was not long before the primary care doctor saw the patient and ordered a CT scan. A radiologist looked at the scan and identified a right paratracheal mass, in the throat area. The doctor ordered a biopsy, which led to dreaded news—cancer. The diagnosis was small cell carcinoma, and she started treatment with chemotherapy and radiation. The patient ultimately passed away.
Even though the lung nodule was an incidental finding on the MRI, the standard of care required the pain management doctor to inform the patient about it immediately, send the results to the patient’s primary care doctor, and order a CT scan, as had been recommended by the radiologist.
At poorly-organized offices, these types of study results can fall through the cracks. That is why the standard of care requires physician offices to develop a tracking system for all lab work, radiology and diagnostic studies, and referrals. These systems help ensure that doctors review reports and tests results before they are filed and potentially ignored.
Doctors’ offices should also document in the medical records follow-up actions on abnormal results. This includes things like speaking with or attempting to reach the patient, sending a copy of test results to a primary care doctor, or referring the patient to a specialist.
What you can do
Any time that a doctor orders lab work or a radiology study, I recommend that you request a copy of the report for your own review. Laboratory reports typically include normal reference ranges and will flag any abnormalities. Radiology reports normally end with the radiologist’s impressions, which list any abnormalities that the radiologist observed on the MRI, CT, x-ray, or other study.
In addition, for any radiology study, request a copy of the actual images on a CD. That way, if you have to see another doctor about the same condition, you can provide the reports and CD for review and comparison purposes.
We are here to help
If you or a loved one has been seriously injured by a medical error, call Painter Law Firm, in Houston, Texas, at 281-580-8800, for a free consultation about your potential case.
Robert Painter is an attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, doctors, surgeons, pharmacists, and other healthcare providers. In 2017, H Texas magazine recognized him as one of Houston’s top lawyers.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
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Published in the July/August 2018 edition of "The Houston Lawyer" magazine