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An error with a question.


Mark A. Hurt MD

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I have a question. What is the legal status of the following error?

The patient had a series of three biopsies under a single case number. Parts “B” and “C” were small, of similar size, and with the differential of “rule out basal cell carcinoma.” Part “B” contained a basal cell carcinoma in the initial section; part “C” was a cell-poor lichenoid infiltrate. Recuts to deplete block “C” were ordered. When received, there was a basal cell carcinoma, and the diagnosis was rendered as such.

In a month, there was an excision submitted from the site of the prior part “C,” it containing only post surgical scar. Re-review of the original material revealed that the recuts to deplete were actually obtained on part “B” of the prior (not on part “C” as was thought originally), which contained basal cell carcinoma in the initial section. Part “C” of the prior was then recut to deplete, and it revealed no basal cell carcinoma. Looking back at the original paperwork, recuts were inadvertently ordered on part “B” instead of part “C.”

Confused?

In summary, in the initial evaluation, there was a mix-up not by the histotechnologist but by the dermatopathologist. The dermatopathologist incorrectly interpreted recuts on part “B” as if they were taken from part “C,” then reported the diagnosis on part “C” that really was the diagnosis for part “B.” This resulted in an unneeded excision.

The error was explained to the surgeon, the report was corrected, and all charges for the histopathologic examination were written off.

I ask again, what is the legal status? I'm curious to know your points of view.
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3 Comments


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Robledo F. Rocha

Posted

[size=4]Two preanalytical errors, namely, the incautious order to recut part B instead of part C and the imprudent examination of part B recuts if it were from part C, have compromised the correct diagnosis of the part C, hence the unnecessary re-excision. Ultimately, however, and depending on the circumstances, like aesthetic outcome, the dermatopathologist’s charge can be dismissed as insignificant.[/size]
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Dr. Mona Abdel-Halim

Posted

It is in the hands of the patient, I guess, if he or she has suffered from the surgical outcome, it might be legally significant, if not, then I think like Robledo that it can be considered insignificant.
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Mark A. Hurt MD

Posted

Thanks to you both for your comments. If I understand the issue of negligence properly, I think the analysis of this case was below the standard of care, but it did not result in harm (that's not to say a lawsuit will be prevented). Do you have any clarifications on this interpretation?
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