Legal Pearls: Failure to Refer A Patient to Needed Specialist

The Legal Case

The PCP was sued for the wrongful death of this patient.. An autopsy showed that the patient had undiagnosed left anterior descending artery atherosclerotic stenosis. When the PCP met with the defense attorney provided by his insurance company, the attorney already had a copy of the patient’s medical records and they had been reviewed by the attorney’s medical expert.

“Why didn’t you just refer him to a cardiologist when he first came in with the chest pain complaint?” asked the attorney, bluntly.

“He had a history of hypochondria,” said the physician. “I believed this was the same situation.”

The attorney pointed out that he had come in 6 times in a 9-month period with similar complaints. He noted that the medical expert had concluded that the physician should have known, based on the patient’s symptoms and history, that he was at substantial risk for coronary heart disease.

“In all honesty,” said the attorney, “if you had failed to refer him to the cardiologist just once, we could have defended that. Maybe even twice. But he came in 6 times with the same or similar complaints, and a jury will not understand why you didn’t just refer him to a cardiologist.”

The case settled prior to trial for an amount within the physician’s malpractice coverage.

The Takeaway

Knowing what you don’t know is as important as knowing what you do. No general practitioner can be a specialist in everything–hence referrals. This type of malpractice case is common with primary care physicians. If a specialist were being sued, lawyers would argue that failure to order appropriate diagnostic tests was the failure in the standard of care. With a general practitioner, the charge is that the doctor should have known enough to know that the patient was at risk and needed treatment from a specialist. After 6 visits with the same complaints—all of which were indicative of a blockage—the PCP should have known enough to send the patient to a cardiologist, who would have ordered an angiography which would have revealed the problem. He could have been treated with bypass surgery or a stent/angioplasty, but not if he was never referred to a cardiologist.

Bottom Line—Understand what you don’t know, and don’t be afraid to refer a patient or to ask for a specialist’s help.

Ann W. Latner, JD, is a freelance writer and attorney based in New York. She was formerly the director of periodicals at the American Pharmacists Association and editor of Pharmacy Times.