A note at 19 weeks by the wife's perinatologist describes the patient as a cystic fibrosis carrier while the husband was not. When an ultrasound revealed an echogenic bowel, the perinatologist recommended amniocentesis, which the wife declined. The perinatologist documented that his patient "may consider genetic counseling and fetal testing." That same day, the genetics center documented the declined amniocentesis and also the offer and declination of cystic fibrosis DNA testing for the husband. Nevertheless, subsequent medical records indicate that both parents learned at about this time that they were both carriers for cystic fibrosis. The parents nevertheless did not undertake in utero testing.
Three weeks prior to delivery, an ultrasound revealed an echogenic bowel fetal abnormality, excessive fetal growth, and fetal myocardial hypertrophy. The newborn's diagnosis of cystic fibrosis was made through the newborn screening health program.
| Medscape Editor's Key Notes: • Be cautious when a patient requests services outside your specialty, and strongly consider referring the patient to a specialist for said care. • Document any referrals made to the patient in the record and detail discussions about the stated limitations of services and/or testing. • If services or tests are ordered, ensure understanding of prescription order terms and be clear about the test results' qualifications. |
In a lawsuit for wrongful life and negligent infliction of emotional distress, the family sued Dr NS, claiming that he was negligent in performing prenatal genetic testing on the husband, resulting in being erroneously told that he was not a cystic fibrosis carrier and leading to the baby's ultimate condition. The plaintiffs claimed that Dr NS ordered the wrong test and that the husband did not receive a copy of that initial report. Further, the parents denied that Dr NS made any referral and claimed that his report to the husband on the negative test was stated definitively.
At his deposition, Dr NS testified that he agreed to the add-on testing for his patient out of professional courtesy to a hospital colleague, even though he did not recall actually knowing his patient's wife. Dr NS testified that he did not know how "CFTR" appeared on his prescription order, as he said he left the specific test to be performed up to the lab. Also at his deposition, Dr NS said he did not recall reading the narrative on the report stating the test results' qualifications.
The family and Dr NS resolved the litigation informally.
While Dr NS's ordering a cystic fibrosis test in such circumstances could itself be defensible, the absence of any documented referral or even a discussion on the stated limitations of that test created a significant burden for the neurosurgeon.
Physicians put in similar situations should think hard about whether the best "favor" they can give their patients is to tell them they need to see a different doctor.
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 "When the Patient Seeks a 'Favor.'"
© 2020 Cooperative of American Physicians, Inc.
This case comes from Medicine on Trial, originally published by Cooperative of American Physicians, Inc., to provide risk management lessons from litigated case histories.
Comments