Dr P, 60, was a primary care physician who had a small practice with three partners. He had never been party to a lawsuit, and he prided himself on the fact that his practice had cared for thousands of patients in the past two decades since it was formed.

One of his newer patients was Mr N, 48. Mr N was a large, outgoing man with a booming voice who loved to fish and be outdoors. Dr P had only been seeing the patient for a year, and Mr N was now in the office because Dr P was monitoring his borderline hypertension.

“Are you still smoking?” the physician asked.

“Yeah,” said Mr N, “but I’m down to just a pack a day now.”

Dr P spent a few minutes advising the patient to quit smoking and explaining the health ramifications of continuing to smoke.

“How is the healthier eating going?” asked the physician, while noting that the patient was officially obese.

“Not bad,” said Mr N. “Still haven’t dropped any weight though.”

The physician spent another few minutes talking to the patient about not taxing his body by making it carry around so much excess weight, and about how he might be able to lower his blood pressure by reducing his body weight.

As part of his workup, he ordered a urinalysis, which indicated hematuria. Dr P noted it in the file but didn’t mention it to the patient, and instead scheduled a follow up appointment for a month later.

The following month, another urinalysis was performed and was negative for hematuria. The physician noted this in the chart, and then forgot about it.

The patient was eventually put on medication to lower his blood pressure. A year later he moved and began seeing a new medical practice in his new home town. At his first appointment with the new doctor, (two years after the urinalysis from Dr P revealed hematuria) a urinalysis was performed which revealed the presence of blood in the urine.

“Have you ever been told that you had blood in your urine before?” asked the new physician.

“No,” said the patient, “I’m sure I would have remembered that.”

The new physician sent the patient to a urologist. A full workup and imaging revealed that Mr N had advanced kidney cancer. Due to the advanced nature of the disease, treatments were limited, and Mr N died 3 years after diagnosis, leaving a wife and 2 children.

Prior to his death, he and his wife had requested the records from his original doctor and had been shocked to find that hematuria was noted but hadn’t been mentioned to him. Before he died, Mr N asked his wife to sue Dr P. “If he had told me, and I had gotten treatment sooner, maybe I would have lived to see my grandchildren,” he said. Following his demise, Mrs N hired an attorney and sued Dr P for negligence.