Malpractice Case: Being Passive About Referral Treatment Can Create Legal Risk

Gordon T. Ownby

Disclosures

October 05, 2020

When the patient was a no-show at Dr FP's office 2 months later, the office contacted the patient and charted that he had "already seen the dermatologist and will just follow up with them."

Nearly 6 months later, the patient applied for benefits with a faith-based organization for sharing medical expenses. In the application, the patient noted that he had a melanoma skin mole removed and that he had a complete recovery.

When the patient next returned to Dr FP (approximately 1 year following the no-show), the record shows that the patient requested a dermatologist referral because his previous dermatologist told him to follow up in 1 year. Dr FP had not received a report from the telehealth dermatologist but noted "per patient everything was fine."

Dr FP completed a referral request form to a dermatologist for melanoma history and multiple nevi. Two weeks later, Dr FP's office sent a 1-page referral by fax to a new dermatologist that listed "cyst melanoma history." Though that dermatologist initially consulted with the patient without apparent knowledge of the melanoma history, he made an addendum a week later noting the patient's history of "melanoma 1.4 mm to right shin."

After another no-show, the patient returned to Dr FP 5 months after the second dermatology consult with a complaint of a torn muscle in his right thigh. Dr FP discussed with the patient the possibility of lymph node involvement from the melanoma, to which the patient responded that neither dermatologist mentioned lymph pathologies. Dr FP ordered an ultrasound of the groin, which revealed a solid mass. After an MRI, Dr FP sent the patient to a surgeon, whose excision biopsy revealed metastatic melanoma with extensive necrosis and BRAF mutations.

In the course of his cancer treatment (during which he told his doctors that the original lesion had been removed), the patient declined BRAF and MEK inhibitors in favor of a naturopathy course. The patient died several months later, 2 years after his first consultation with Dr FP. His family sued Dr FP and other providers. Dr FP and the family resolved the legal matter informally.

In situations of life-threatening illnesses, jurors will expect to see detailed documentation of the patient education process and a referring physician's hands-on coordination with the patient's other physicians. A record showing less than a physician who is actively involved in the at-risk patient's follow-up will suffer under litigation's withering review.

This case comes from the "Case of the Month" column featured in the member newsletter published by the Cooperative of American Physicians, Inc. The article was originally titled "The Active Role of the Referring Physician."

Correction, October 28, 2020: Due to an inadvertent error by the author, a condition referenced in this column was incorrectly stated. The correct condition is "metastatic melanoma." We apologize for any confusion.

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