ALLEGATION
The patient alleged that the physician’s failure to provide timely follow-up care to abnormal mammogram results delayed her breast cancer diagnosis and treatment for 14 months, causing the cancer to grow and spread.
CASE DETAILS
A 39 YOF was seen by her internal medicine physician for her yearly physical. At this annual exam, the physician ordered routine blood work and a breast cancer screening mammogram, which the patient promptly completed. The radiologist’s impression included two new focal asymmetries in the patient’s right breast, measuring 1.3 cm and 1.2 cm in size. These findings were suspicious for underlying masses, and further imaging and an ultrasound were recommended. While the results later became available through the patient portal, the radiologist’s office did not forward the report to the ordering physician or contact the patient with the results.
Two weeks later, the patient returned to her PCP for a telehealth follow-up visit to review test results. Blood work results were reviewed but the ordered mammogram was not discussed. In a second telehealth visit seven months later, only medication side effects were discussed.
One year after the initial mammogram order, the patient scheduled an appointment with her PCP after feeling two lumps in her left breast. The physician inquired whether the prior ordered mammogram had been completed and the patient responded that it was, but she had never been advised of the results. The physician’s office then obtained the mammogram results from the radiology office and, as had been originally recommended by the radiologist a year prior, ordered further imaging for the next day. This second mammogram noted two masses at 3.5 cm and 3.2 cm. Both masses had exponentially increased in size from the screening a year before with new onset of enlarged right axillary lymph nodes.
Biopsies revealed histologic grade III invasive ductal carcinoma of both right breast masses and additional images confirmed the findings. The patient was diagnosed with stage III triple-negative breast cancer (TNBC). The patient underwent 12 weeks of chemotherapy and a bilateral mastectomy, and she also developed thyroiditis resulting from medications.
EXPERT TESTIMONY
Due to the delay in addressing the abnormal mammogram report, experts could not support the physician’s lack of follow up to obtain, review, and share the findings with the patient to begin timely treatment. This shortcoming in care was exacerbated by the two intervening telehealth follow-up appointments. Each of these visits presented an opportunity for a review of outstanding tests and subsequent discussion as to the status of the mammogram, which would have led to obtaining and reviewing the abnormal results. Though it was opined that the five-year survival rate remained at or above 80%, even with the delayed care, experts concurred that the delay in care did result in both increased grading and staging of this aggressive cancer. While experts felt there was a plausible causation argument that the mastectomies would have occurred in any event, the challenges surrounding the standard of care made it imprudent to proceed to trial.
RESOLUTION
Due to the difficulty defending the delay of care, this case was settled pre-trial.
RISK REDUCTION STRATEGIES
- Establish a system for tracking consults and referrals that includes:
- Verification that all results are returned to the practice and appropriately reviewed and authenticated by a physician or APP
- Communication of results to the patient
- Patient notification and follow up when indicated with corresponding documentation in the medical record
- If no consultation report is received, follow up by the ordering physician or APP with the consulting physician is recommended.
- Ensure proper communication and documentation of pertinent patient information to the consulting or referring provider for coordination of care, which may help prevent miscommunications regarding patient care responsibilities and follow-up activities.
REFERENCES
If you have questions on this topic, please contact us at RiskAdvisor@ProAssurance.com or 844-223-9648.
