Prostate cancer

Legal Pearls: Failure to Follow Up After a Referral

  • A man aged 56 years came in reporting abnormal urination and back pain. The primary care physician (PCP) ordered a prostate-specific antigen (PSA) test, the results of which were 10.96 ng/mL. Based on the results, the physician referred the patient to a urologist.

    The patient underwent a biopsy soon after. “The biopsy was benign," the urologist told the patient. "However, it’s really important that we test your PSA level regularly. I’d like you to come back in 3 months for a follow-up PSA test.” The patient agreed and left, but he never returned to the urologist.

    The urologist sent a letter to the PCP reporting difficulty contacting the patient and the need for continued PSA testing. Over the next several years, the patient continued to see the PCP routinely. Blood work was often done, but the patient’s PSA level was never tested.

    Three years later, the patient came to see the PCP with left flank pain and hematuria. He was admitted to the hospital, where a PSA test was performed, the results of which were 2400 ng/mL. The patient was diagnosed with advanced prostate cancer that had metastasized to his bones and kidneys.

    The patient died a little over a year later.

    Was the PCP at fault?

    (Discussion on next page)

    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.

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