Med Mal Case: Herpes

[bbc586]

A patient goes to his PCP for an STD check. Just started a new relationship.

Calls in for results, told they're negative.

Girlfriend gets herpes.

Guy calls the office back, asks for clarification, doc says yeah sorry about that, someone told you wrong.

Girlfriend sues the doctor.

Great case that challenges the typical understanding of the physician/patient relationship.

More details: Expert Witness Case #19

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[InvestingDoc]

Interesting case. I can see why she got upset and sets an interesting precedent. What if this was HIV? I think it would be an easy way to understand how this suit could end this way.

 

[Crayola227]

Makes total sense.

 

[chessknt]

It actually doesnt make sense because the doctor didn't tell the patient the wrong information, a member of the staff did. That would be like getting sued if a nurse accidentally injected the wrong medication in a patient that you didnt even order.

Also what state was this in? Like MN (where the state supreme court argued that a hospitalist who never saw a patient but was talked to by an ED NP was somehow ultimately responsible for that patient), I would avoid whatever state this is because if this guy had gone out to have sex with a dozen people you would have a dozen lawsuits for people you arent responsible for, absolutely preposterous logic. Did the girlfriend get a copy of the results? Where was her duty to look after herself instead of taking someone's word for it?

EDIT--Found the supreme court case, it was in Connecticut. Their judgement was that disclosing medical information should not be delegated to members of staff that are not physicians since that shows negligence. Id quit the state for sure, absolutely ignorant of what a PCP's workflow looks like to think they can call every single patient with the result of every test and that this is somehow the standard of care. Unlike them, the PCP doesnt get to bill the patient $150 dollars every 15 minute increments for every point of contact.

Connecticut Supreme Court Holds Doctor Can Be Held Liable For STD Transmitted To Patient's Girlfriend - Medical Malpractice Lawyers

www.medicalmalpracticelawyers.com

 

[InvestingDoc]

It actually doesnt make sense because the doctor didn't tell the patient the wrong information, a member of the staff did. That would be like getting sued if a nurse accidentally injected the wrong medication in a patient that you didnt even order.

Also what state was this in? Like MN (where the state supreme court argued that a hospitalist who never saw a patient but was talked to by an ED NP was somehow ultimately responsible for that patient), I would avoid whatever state this is because if this guy had gone out to have sex with a dozen people you would have a dozen lawsuits for people you arent responsible for, absolutely preposterous logic. Did the girlfriend get a copy of the results? Where was her duty to look after herself instead of taking someone's word for it?

EDIT--Found the supreme court case, it was in Connecticut. Their judgement was that disclosing medical information should not be delegated to members of staff that are not physicians since that shows negligence. Id quit the state for sure, absolutely ignorant of what a PCP's workflow looks like to think they can call every single patient with the result of every test and that this is somehow the standard of care. Unlike them, the PCP doesnt get to bill the patient $150 dollars every 15 minute increments for every point of contact.

Connecticut Supreme Court Holds Doctor Can Be Held Liable For STD Transmitted To Patient's Girlfriend - Medical Malpractice Lawyers

www.medicalmalpracticelawyers.com

"Their judgement was that disclosing medical information should not be delegated to members of staff that are not physicians since that shows negligence." This is insane. No primary care doctor has time to call 99% of patients about their labs. It is the standard of care to have a nurse or MA call patients to let the know the results or they get a message on their portal.

 

[chessknt]

"Their judgement was that disclosing medical information should not be delegated to members of staff that are not physicians since that shows negligence." This is insane. No primary care doctor has time to call 99% of patients about their labs. It is the standard of care to have a nurse or MA call patients to let the know the results or they get a message on their portal.

Plus it sounds like a mistake I make all the time--he got std tested a month prior and they probably read those results. #****Connecticut

 

[Crayola227]

There's plenty of tests that physicians don't ever delegate to midlevels - STD/HIV tests being one of them. Also biopsies for cancer. This case shows exactly why delegating say, all normal lipid results to midlevels might not have the same level of liability (potential harm) than certain other tests, and that's why some test results are not reported by midlevels as a matter of protocol in some practices.

As the physician you review all tests. I've definitely seen workflows where you then delegate what can be communicated through an online portal or your midlevels can call on, and the ones that don't.

Sounds like this wasn't an accident like the midlevel made a call he doesn't routinely authorize. The example of a nurse randomly injecting something you didn't order isn't the same thing at all.

 

[chessknt]

There's plenty of tests that physicians don't ever delegate to midlevels - STD/HIV tests being one of them. Also biopsies for cancer. This case shows exactly why delegating say, all normal lipid results to midlevels might not have the same level of liability (potential harm) than certain other tests, and that's why some test results are not reported by midlevels as a matter of protocol in some practices.

As the physician you review all tests. I've definitely seen workflows where you then delegate what can be communicated through an online portal or your midlevels can call on, and the ones that don't.

Sounds like this wasn't an accident like the midlevel made a call he doesn't routinely authorize. The example of a nurse randomly injecting something you didn't order isn't the same thing at all.

So a +HSV2 test is the same risk/liability as having cancer and HIV? Where do you draw the line? Is a sodium of 134 serious enough to call? Triglycerides of 500? Plt 140? All of these could ultimately be tied to a life threatening diagnosis too.

The patient called the office to get the results because he wanted to **** his girlfriend bareback but she wouldn't let him until he had the results. The Dr was probably busy and the person who answered the phone (or a nurse or whoever since it doesn't say) looked at his results (probably the wrong ones from a month before) and said they were fine. The MD may have not even been aware this phone call took place, we dont know. I think that is pretty damn similar to an RN injecting something I didn't order on my patient and somehow I am held responsible--it is complete nonsense.

 

[tantacles]

So a +HSV2 test is the same risk/liability as having cancer and HIV? Where do you draw the line? Is a sodium of 134 serious enough to call? Triglycerides of 500? Plt 140? All of these could ultimately be tied to a life threatening diagnosis too.

The patient called the office to get the results because he wanted to **** his girlfriend bareback but she wouldn't let him until he had the results. The Dr was probably busy and the person who answered the phone (or a nurse or whoever since it doesn't say) looked at his results (probably the wrong ones from a month before) and said they were fine. The MD may have not even been aware this phone call took place, we dont know. I think that is pretty damn similar to an RN injecting something I didn't order on my patient and somehow I am held responsible--it is complete nonsense.

coming in hot

 

[Crayola227]

It's going to depend on what the standards are. If your office says it's OK for nurses to randomly inject stuff in patients and then something bad happens, that's on you. OTOH if you can show that you have a workflow where nurses receive orders in xyz ways and that's all that's ever been endorsed by you, then if they act outside that you have a defense.

I'm an MD, and couldn't get my urine culture results just looking for a UTI over the phone for 3 days because they had to directly get the OK from the MD who ordered it. Probably because of cases just like this one.

No, I don't think HSV and cancer are the same thing, my point is that you're wrong, plenty of docs have certain categories of labs that are NEVER handled by midlevels and are always handled by the MD. STD tests are often included in that. HSV antibody testing and its sensitivity and specificity make it a classic case example of the test that needs interpretation, as well. Couple that with the fact that the danger here is that your liability extends beyond the patient, in a way it does not with other examples (although if someone has a seizure/stroke and kills someone else in a car accident in the Na/plt examples....) and you can see why liability is not all the same for all tests, and docs deal accordingly.

In my previous outpatient practice, any labs really outside normal, one always put in a note about how it was communicated to the patient. That's good practice but also CYA. Sometimes it was a direct phone call from the MD personally, an automated print out, or was routed it to a midlevel with a note of what they wanted them to say. But it was all reviewed by the MD and the action taken recorded in the HR.

Also the risk to the patient/others is fundamentally different in mathematical terms with a positive HSV test vs the low Na. The chances that the misinformed patient passes on herpes which is pretty contagious vs has a seizure or whatever from their chronic hyponatremia doing something med-mal worthy... might just explain what I am explaining is some of the differential in how we see MDs address these tests with patients.

None of the part of this having to do with the trouble they got in for how they mishandled the results is really unusual except for the fact they were liable to a never-seen 3rd party.

You can't mishandle things in your workflow, have a 3rd party be hurt (get TB you didn't report to the health department, a sz that ends in MVA) and think you can't be held accountable for your workflow.

It is inappropriate for a midlevel to interpret and report the results of an HSV test in these circumstances. Period. That is what I was taught in med school and beyond, makes perfect sense to me, and I know personally of no clinic that allows midlevels (non-NPs/PAs) to make those reports without direct oversight. And if the midlevel acts outside of that, I've always seen it get the smackdown pretty quick. That's standard of care from what I've seen. This legal case just reinforces why.

 

[deleted480308]

I push my people to get electronic records then a sentence and a click is me notifying them of things. I personally call any std stuff that comes up positive. If it’s all negative i will type the result summary myself and someone else can call .....dr asked me to call and tell you (reads my statement verbatim) if you want to have a longer discussion about it i can schedule you an appt right now

no office should have random rns giving out lab results