Dr. B, Ms. W’s direct supervisor, was Mrs. K’s primary physician. Ms. W had an excellent working relationship with Dr. B. They operated in a collegial manner, and Dr. B, the older physician, often used their interactions as teaching points for Ms. W. The practice was quite busy, but the staff always attempted to accommodate patients who needed to be seen immediately.

One afternoon in September 2011, Mrs. K, 45, showed up at the practice and was seen by Ms. W. The clinician was very familiar with the patient. During the past year alone, Ms. W had probably seen the patient a half dozen times for various minor complaints in addition to her regular check-up. 

Today, the patient complained of breast tenderness and pain. After ensuring that it was not related to the patient’s menstrual cycle, Ms. W excused herself to speak to Dr. B. After hearing the facts, Dr. B asked Ms. W what she thought was the right thing to do in the situation.

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“I think we should refer her for mammography,” replied Ms. W.

“I agree,” said the physician, as he filled out the referral slip.

Ms. W did not perform a physical exam on the patient at this time. She gave the patient the referral for the radiologist and advised her to have a mammogram performed within the next few days.

The patient went to the radiologist 3 days later for mammography. In her report, the radiologist interpreted the results as “indeterminate microcalcifications in the left breast, probably benign” and recommended a follow-up study in 3 to 6 months. The radiologist’s report was sent to Dr. B and Ms. W’s practice and was filed away, but neither clinician contacted the patient to tell her about the results.

During the next year and a half, Mrs. K returned to the practice numerous times for various minor ailments-colds, coughs, a pulled muscle, a migraine-but neither Ms. W nor Dr. B mentioned the radiology report, and the patient did not ask.

About a year and a half later, in early 2013, Mrs. K self-referred herself to a breast specialist. The specialist performed an in-office biopsy that revealed high-grade ductal carcinoma in situ. The following month, Mrs. K had a mastectomy and a left sentinel node biopsy. The biopsy showed that the cancer had spread to the lymph nodes leading to a diagnosis of multifocal Stage IIIC invasive ductal carcinoma. Mrs. K then went through both chemotherapy and radiation, but her prognosis was poor. Her oncologist estimated that she had a 50% chance of living for another 5 years.

Mrs. K and her husband sought the counsel of a plaintiff’s attorney and asked why, if she had been sent for a mammogram in 2011, had she not been notified that there was a problem. The attorney subpoenaed her medical records, which revealed the presence of the original radiology report, advising that she get retested in 3 to 6 months. 

“Did your physician or nurse practitioner tell you about this?” asked the attorney.

“No” replied the patient.

“Did anyone-the radiologist, your doctor’s office-send you a copy of this report? Did you ever see it before?”

“Absolutely not,” said Mrs. K. “If I had, I would have done something much earlier.”

“I’ll take the case,” said the attorney. The attorney proceeded to have an expert look at the radiology report and the patient’s chart and prepare an expert’s report, which was required in this state to file a medical malpractice lawsuit.