When Dr P was notified about the lawsuit, he was shocked. He felt bad about the patient’s outcome, but he couldn’t imagine what he had done wrong. He looked at the patient’s file – yes, there had been one instance of hematuria, but he had done a follow-up urinalysis that was fine. He contacted his malpractice insurance company and set up a meeting with a defense attorney.

When the attorney mentioned settling to avoid a trial, Dr P was adamant that he did not want to settle and that he hadn’t done anything wrong.

The attorney had a medical expert review everything, and the expert said “it can really go either way. The patient had hematuria and Dr P followed up as appropriate. There was no hematuria at the follow up, so nothing to inform the patient about or conduct more testing. But the other side will probably argue that hematuria can come and go with cancer like this and that the patient should have been told and sent to a specialist.”

The attorney looked at Dr P. “It’s all going to depend on the jury,” he said. “They will hear conflicting testimony from the medical experts about what should have happened, and they will have to decide who they believe. Are you sure you want to go to trial?”

“Yes,” said Dr P.

Legal Background

At trial, Mr N’s family testified heart wrenchingly about what a wonderful person he was and how his life had been cut so short. His widow testified that Dr P never told her husband that there was blood in his urine or that he should see a specialist. The plaintiff introduced an expert who said that with this sort of cancer, hematuria can be intermittent, and that Dr P should have sent the patient to a specialist, conducted more urinalyses, or at least informed the patient. Had the cancer been discovered when Dr P was treating Mr N, said the expert, there would have been a much greater likelihood of Mr N’s surviving. By the time Mr N’s cancer was finally diagnosed by the new doctor, argued the plaintiff, it was too advanced tor treatment to be successful.

Dr P’s expert testified that there was nothing to treat or to tell the patient about. “Mr N had one urinalysis showing hematuria,” said the expert. “Dr P did the right thing by not panicking anyone, and simply redoing the urinalysis. The second urinalysis was fine, so there was no reason to refer the patient to a specialist or to tell him anything.” The expert went on to say that Mr N’s smoking and obesity were also major factors in his demise, and that Dr P clearly had tried to help Mr N control these things.

The jury deliberated for 4 hours and returned with a verdict for Mr N’s family. The jury found that negligence played a substantial contributing factor in Mr N’s death and they awarded his family $4.2 million.

Protecting Yourself

This was a tough case, that probably could have gone either way. It demonstrates the unpredictability of jury trials. Unfortunately, cases such as this often lead to unnecessary testing and referrals to specialists as physicians try to cover every base to protect themselves legally. The best advice, is always the same: take good notes, keep your patient as informed as possible about their own condition so that they can have a hand in making decisions, and refer your patient to a specialist when necessary. The question of when it is necessary, however, may be determined more on a legal basis (as in the fear of lawsuit) rather than a medical basis.

Dr P’s best bet here would have been to explain to the patient what hematuria was when it first showed up and explain the importance of follow up urinalysis. If the patient had that information, he would have been less surprised at his diagnosis, and he might have been less likely to sue.

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