In the late fall of 2013, when nurse practitioner Ms R, aged 56 years, was notified about a lawsuit involving one of her patients, she was dismayed but not surprised. She had, in fact, been expecting it since that day this past March when she realized that she had neglected to tell the patient that he had tested positive for hepatitis B… in 2006.

Ms R had been working for a veterans’ medical center for more than 20 years. Her duties were varied and included seeing her own patients and going over medical results with patients. Because Ms R had been working at the medical center for so long, some of her patients had been with her for many years. One of these patients was Mr H, a 52-year-old veteran.

Mr H had been coming to the medical center since 2002, and he had been seeing Ms R since 2006, which was the first year that she was assigned to go over his test results with him. She did not remember much of that first meeting—after all, it was 7 years ago—but she had noted in the file that she told him his blood test results were normal.

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She saw the patient again in 2008, 2009, and 2010, but never looked back at the 2006 test results, which had indicated that the patient had tested positive for hepatitis B. This was not surprising. The medical center was busy and understaffed, and Ms R was responsible for many patients. She rarely had the time to look at old test results unless there was an obvious problem. However, in March 2013, when Mr H returned to the medical center and Ms R was looking through his records, she discovered that the 2006 lab results had information that she had neglected to convey to the patient. Ms R’s heart sank as she looked at the report. Had she noticed it 7 years earlier, she would have ordered follow-up tests and referred the patient to a specialist. Now, years had passed without treatment and without an appropriate explanation.

Mr H was sitting in the exam room, looking at the clinician expectantly.

“Everything okay?” he asked.

Ms R took a deep breath and tried to collect her thoughts. “I’m afraid I owe you an apology,” she began. “I realize that you tested positive for hepatitis B in 2006 and that information wasn’t conveyed to you… I should have recommended further testing at that point. I honestly don’t know why I didn’t see this in 2006… It was a terrible oversight, and I am so very sorry about it.”

The patient looked concerned. “What does this mean?” he asked. “What happens now?”

Ms R informed Mr H that she would order more tests and provide a referral to a specialist for further treatment, as she should have in 2006 when he first tested positive.

Unfortunately, lab tests and scans performed in March and April showed that Mr H had a mass in his liver. Further testing revealed the mass to be hepatocellular cancer, which had spread to the patient’s lungs. Mr H was admitted to the hospital and given radiation therapy, but he succumbed to the disease by the summer.

By late fall, Mr H’s widow had consulted with a plaintiff’s attorney and had instituted a lawsuit against the medical center, based on Ms R’s treatment of Mr H. When Ms R was notified about the lawsuit, she was unhappy but not surprised. She knew she had made a mistake.

The defense attorney representing the medical center spoke to Ms R to get the facts. Ms R was hoping that the case would settle so she could avoid having to testify, but the defense attorney had ideas about challenging the case legally. “I’m going to make a motion asking the court for summary judgment,” the attorney told Ms R. “That means I am asking the court to dismiss the case before it ever goes to trial, because the plaintiff has not introduced any evidence that the liver cancer was caused by the failure to treat the hepatitis B. I am also asking the court to exclude the proposed testimony from their nurse practitioner expert because she has never practiced in this state.”

The defense attorney filed the summary judgment motion and challenged the expert witness who was going to testify that Ms R had breached the standard of care by not conveying her patient’s lab results to him. The court considered the motions and ruled that the summary judgment motion was not appropriate and that the expert, despite never practicing in that particular state, would be allowed to testify as to what Ms R’s standard of care should have been. The case was sent back to the lower court and is pending trial.