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Failure to Act on Abnormal Test Results

Deborah Lavender
The Cochran Firm, Metairie, LLC
Assisted by Megan Shaffer, Ph.D.

I.    Defining “abnormal”:  Interpretation of test results can be subjective based on the individual reading the test report or film, even in light of lab reports giving a range of normal values.
A.    Often x-rays include a “list of possibilities” as to why the film may be abnormal, and may erroneously cause such visible aberrations as “within normal limits”.
B.    There is no standard requiring physicians to report abnormal findings to patients. General rule of thumb is to report findings considered to be significant in light of the patient’s history and symptoms.

II.    “Abnormal” results as indicated by laboratory values far outside the norm require follow up.  Cases as clear as these generally settle prior to trial.

III.    “Abnormal” as indicated by observation of a mass or suspicious shadow on radiology requires follow up. 
A.    American College of Radiologists developed the BIRADS system was developed to classify “level of suspicion” for breast cancer (Breast Imaging Reporting and Data System).  Any result of 3 or higher requires follow up.
        0    Incomplete diagnostic study
        1    Nothing to comment on, routine screening recommended
        2    Follow up mammogram is definitely benign
3    Findings are most probably benign (>98%), six-month follow up recommended
4    Findings not consistent with breast cancer, but possibly malignant, consider biopsy
        5    Lesion highly probable for cancer, take appropriate action
        6    Lesions proven malignant, assure treatment is completed

B.    Failure to diagnose kidney cancer based on a mass seen on x-ray film, settled prior to panel ruling.  For example:
       
On or about July 2, 2003, Dr. S ordered x-rays of decedent=s lumbar spine, a renal ultrasound, and a renal artery ultrasound to investigate complaints of back pain.  The results of those studies were abnormal, including a lesion in the superior portion of the patient=s right kidney, representing a Amass@ approximately 3 cm. in diameter.  In addition, Mr. A appeared at the hospital on or about 7/9/03, also with complaints of back pain.  An MRI was ordered which revealed a heterogeneous mass approximately 3 cm. X 2 cm in size.”

By 7/10/03 Dr. S was in possession of both studies, but his office chart reflected erroneously that the studies were normal. His notes indicate that he intended to order a CT of the kidney, but this test was never ordered.  On or about June 2005 Mr. A discovered his kidney cancer, and although he submitted to treatment, it was too late. He died on November 15, 2007.
   
    C.    Blood work values
A.    Tests including PTT, PT and INR are sometimes used to determine bleeding tendencies, but numerous studies have shown they are not useful predictors
i.    PTT (partial thromboplastin time) can be used to measure the effectiveness of heparin treatment in the prevention and treatment of thromboemboli.
ii.    PT (prothrombin time) can be used also to determine if coumadin is used at a therapeutic level.  Hemophiliacs will have a normal PT time, but PTT will be elevated.
iii.    INR (international normalized ratio) can be used to measure treatment with Coumadin or warfarin.  This is a standardized number that allows for comparison of clotting values between different hospitals.
        B.    None will measure the activity of Plavix.