Don’t Let Late-Returning Tests “Boomerang” on You

In today’s complicated health care delivery system, physicians rely on many other professionals to get their patients proper medical care. But while physicians need to feel comfortable in “letting go” of some components of their care, they also need to make sure that some things “come back.”

Dr. O is an otolaryngologist who had been treating his female patient for chronic sinusitis. In recommending surgery, Dr. O advised the patient of the usual risks and complications of the procedure. When Dr. O asked during the surgical work-up whether the patient might be pregnant, she responded that she was on birth control pills. Nevertheless, it was Dr. O’s practice to order a pregnancy test forhis surgical patients who are in their child-bearing years.

Normally, such blood work goes to the lab at the hospital next door. In this case, however, the patient’s health plan insisted that the lab work go to another facility.

In reviewing the patient’s chart prior to surgery, Dr. O did not notice that the results on the pregnancy test that he had ordered had not yet been returned by the distant lab.

The surgery, which was performed under general anesthesia, went forward without complication. Sometime after the procedure, however, the patient called Dr. O to say that a home pregnancy test was positive. Dr. O then checked the chart, which by that time contained the blood work results, indicating that the patient was pregnant at time of surgery.

Upon learning of her pregnancy, the patient worked with her obstetrician to undergo several special diagnostic tests for birth defects associated with anesthesia and the medications used during the nasal surgery. The fetal development appeared normal and the patient eventually delivered a healthy baby. The patient and her husband did not sue Dr. O, but did request that he reimburse them for the test expenses that were not covered by insurance.

Fortunately, there was no adverse medical result in Dr. O not having the opportunity to review and evaluate the test that he had ordered.

However, the case does serve as a warning not to let “what’s in the chart” serve as a checklist for non-delegable responsibilities. In other words, if it is a physician’s practice to order a test, it will be his or her own responsibility to ensure that it comes back in time to act on it.

Gordon Ownby is CAP-MPT’s general counsel. Comments on Case of the Month may be directed to gownby@cap-mpt.com.