The case went to a jury trial. The plaintiff argued that the original urine sample taken by Dr A showing hematuria required a referral to a urologist, which would have resulted in Mr N having a proper workup that would have revealed the cancer at an earlier stage when it was still survivable.
The plaintiff’s experts testified that cancer of this sort can bleed intermittently, and that blood in the urine must always be taken seriously.
The defense introduced its own experts who testified that less than 3 red blood cells is not considered an abnormal hematuria and does not require further evaluation. Dr A complied with the standard of care “because in the absence of hematuria, a hematuria workup is not recommended,” testified the defense expert.
The plaintiffs countered by arguing that any blood in the urine is abnormal and needs to be worked up, as evidenced by the fact that the subsequent primary care physician and urologist both ordered such further evaluation with results that were also less than 3 red blood cells per high powered field.
After deliberations, the jury found Dr A to have been negligent in not following up on the first instance of hematuria and found that the negligence played a ‘substantial contributing factor’ in Mr N’s death. The jury awarded $4.2 million to Mr N’s family.
This case might have gone either way. Two experts testified that Dr A had complied with the standard of care in Mr N’s treatment and that there was insufficient evidence to warrant accusations of negligence.
Yet the jury found Dr A liable, even though the original abnormal result was barely out of the reference range. But it was out of the reference range. And thus, it should have been followed up on, or at least discussed with the patient so that he would be aware.
Dr A made 2 mistakes – the first was not to mention to the patient that he had an abnormal result – even if it was slightly abnormal. By not telling the patient, he was depriving the patient of knowledge and the power to do something about it, for example, to get another consultation or ask for follow up tests. Dr A’s second mistake was to assume that because it was only 1 blood cell off of the reference range, that it was not worth following up on.
Knowledge is power. Depriving patients of information prevents them from taking any action. Patients are entitled to be informed about the results of their tests, and to have those results acted upon.