Failure to report abnormal PSA leads to Gleason 9 PCa

January 30, 2015

A patient with an abnormal PSA level transferred to another physician's care and was never told of his result. Two and a half years later, a biopsy revealed Gleason 9 prostate cancer.

Dawn Collins, JDA Florida man went to a pulmonology and internal medicine group in 2006 for primary and pulmonary care. At the first appointment, blood work was ordered that included a PSA test. The PSA result was an abnormal level of 4.1 ng/mL. The physician who ordered the test circled the value on the lab report and underneath it wrote, “Discuss next visit.”  

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The patient never came back to that physician but switched to another physician in the group, whom he saw over the next 2½ years. The patient was never informed of the abnormal PSA result.

In 2008, the patient went to a medical center with complaints of back pain. A magnetic resonance imaging scan showed cancer had spread to his spine, shoulder blades, pelvis, and ribs. A PSA ordered at that time was 100.0 ng/mL. Two days later, a prostate biopsy was performed and revealed prostate cancer with a Gleason score of 9.

The man sued the physicians in the pulmonology/internal medicine group and claimed that in addition to failing to inform him of his abnormal PSA test result, they had also failed to perform digital rectal examinations that would most likely have found a mass and led to an earlier biopsy and diagnosis.

The physicians denied any negligence and maintained that earlier diagnosis and treatment would not have made a difference in the patient’s outcome. A jury found the second physician in the group who followed him for the 2+ years completely at fault and returned a verdict for $934,000.

Next: Ms. Collins' legal perspective

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LEGAL PERSPECTIVE: Of course it is below the standard of care not to inform patients of abnormal lab values, and in this case the defense did not deny that, but put forth the argument that the earlier diagnosis would not have made a difference, which the jury did not buy. This points to the importance of not only reviewing patient records at each visit, and especially when the patient has switched doctors even in the same practice, but also having a standard system for the reporting of all results to the patient upon receiving them.

A letter in the mail, a phone call, or electronic notification could be employed at the time the results come in as a standard procedure to notify patients without taking the chance the patient does not come back for that next visit. Documentation that the procedure was followed should be included in the medical record.

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