Cases of missed, delayed or incorrect diagnosis are unfortunately very common in the medical field, with a recent study published in The Journal of the American Medical Association estimating they occur in 10 to 20 percent of all diagnoses given. In clinical laboratory, radiology and pathology fields, the error rate is between 2 and 5 percent.
Contrary to what one might think, errors in diagnoses don’t happen only in cases of rare disease or unusual conditions, but occur even with commonplace conditions, like asthma or anemia. The effects of these errors are staggering. Our Miami medical malpractice attorneys understand that by some estimates, between 40,000 and 80,000 U.S. deaths every year can be attributed to diagnostic error, with the injury count being far higher. The JAMA study noted a recent survey of 6,000 physicians that concluded more than 95 percent of all diagnostic errors are preventable.
There are many ways doctors and hospitals can work to reduce these errors, often the result of faulty communication, lack of informed consent, system failures, documentation errors and issues with clinical judgment and technical skills.
The Physician Insurers Association of America reports that obstetrics is the main medical specialty against which claims are made. Others include internal medicine, orthopedic surgery and general surgery.
One recent case, Adams v. Laboratory Corp. of America, reviewed by the U.S. Court of Appeals for the Eleventh Circuit, appears to have been the result of problems relating to technical skill by laboratory technicians contracted with an obstetrics care provider. The appellate court partially reversed the lower court’s finding that the plaintiff’s expert witness failed to meet reliability standards, which means the lawsuit will continue to work its way toward trial.
Litigation here stems from alleged error by laboratory cytotechnologists in detecting abnormalities in the patient’s Pap smear samples. As a result, the plaintiff alleged, she suffered a delay in her cancer diagnosis, which forced her to seek more aggressive treatment and negatively impacted her prognosis.
According to court records, the patient underwent a series of five Pap smears over the course of nearly three years. Each time, the doctor put the scrapings from the patient’s cervix on a slide and then sent those samples to the defendant lab for review.
It was up to the laboratory technicians to determine whether abnormalities existed. The lab workers never gave any indication of a problem. The patient’s last Pap smear was in September 2008.
In August 2009, she sought treatment from her gynecologist for vaginal bleeding. It was at that time she was diagnosed with cervical cancer. By then, the cancer had spread to her lymph nodes. This meant the cancer was in the advanced stages, requiring radical surgery and grueling bouts of chemotherapy.
The patient and her husband filed suit against the lab, alleging staffers who viewed slides between 2006 and 2008 breached the standard of care by failing to properly identify abnormal cells that would have indicated she had cancer. This caused her to suffer a delay in diagnosis of as long as several years. Had she received a proper diagnosis earlier, the cancer could have been treated much sooner.
The plaintiff’s expert witness was a professor of pathology for more than 15 years, had more than four decades of training cytotechs, and served on a task force that helped develop the system used by pathologists and cytotechnologists – including those working at the defendant lab – to report Pap smear results.
This witness traveled to the defendant laboratory, reviewed the patient’s slides for 90 minutes using the same model of microscope and then formed the opinion that the cytotechnologists breached the applicable standard of care by failing to identify abnormal cells that they should have red-flagged.
One of the central issues in the case was whether the methodology used by this expert witness was “tainted by unreliable methodology,” as the defense alleged. Specifically, she had not mixed the slides with others for a comparison, and she viewed the slides already knowing the patient was later diagnosed with cancer.
The district court sided with the defense, indicating she should have used a “blinded review,” without knowing the identity of the patient or her clinical outcome. The appellate panel reversed, finding this analysis “manifestly erroneous” because the witness’s opinion was based on methodology that is widely accepted and grounded in the available physical evidence.
The appellate court’s reversal means this case will continue to trial, where the plaintiff will be given the opportunity to present these facts to a jury.
Preventing a wrongful, delayed or missed diagnosis is an increasing priority in the health care field, and one about which industry leaders have expressed increasing concern. Although there is a growing understanding of how diagnostic mistakes arise, there is far less available information about how they may be prevented.
A recent article in Medical Economics provides some insight into how physicians, hospitals and other health care providers can avoid malpractice litigation.
One of the best ways is to improve communication between doctors and patients. While a bad outcome in one’s medical condition is not always synonymous with malpractice, poor communication prior to the outcome is one of the primary factors a family considers when deciding whether to file a lawsuit. Physicians need to communicate effectively with patients and families regarding all potential outcomes. It’s one of the best ways doctors can mitigate their own risk. Special consideration of this issue should be given when there are language barriers or when patients are elderly or non-compliant.
Another part of good communication means obtaining a patient’s informed consent. Doctors must make sure, wherever possible, that patients consent to the procedure and have a full understanding of possible risks.
Doctors and health care providers should also take care to be apprised of new developments in their specialties and practice areas. One of the primary issues in medical malpractice cases is whether the doctor followed current acceptable standards of practice. It’s not uncommon for a busy physician or health care provider to fall behind on keeping up with the latest developments in their fileds. One of the biggest changes in recent years – and one that can significantly reduce the risk of a malpractice claim – is transitioning to electronic patient records.
Clinicians can also curtail liability issues by making sure to follow up with diagnostic tests and the outcomes of specialist referrals. When reports or test results are not received in a timely manner, or when the results are suspect, the physician or provider should follow up to ensure nothing was missed, overlooked or forgotten.
Additionally, hospital risk managers need to ensure there is a clear, uniform policies and standards for staff and physicians. When this doesn’t happen, there is the potential for several competing standards that can vary from doctor to doctor or among staffers. This makes an organization vulnerable to errors and/or omissions.
With specific regard to laboratory testing errors, the researchers noted the increasing reliance of physicians on laboratories, because doctors tend to have less patient interaction than they did even a few decades ago. The researchers suggested better communication between doctors and lab technicians was critical. Also proper training of technicians and more stringent supervision of lab workers were also deemed important factors in preventing diagnostic errors.
If you have been injured due to medical malpractice in Miami, contact the Law Offices of Jose M. Francisco.
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