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Malpractice Risks at the Front Line of Cancer Detection

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Malpractice Risks at the Front Line of Cancer Detection

By Jock Hoffman, CRICO

Related to: Clinical Guidelines, Diagnosis, Primary Care, Other Specialties

Primary care clinicians who see patients ages 40–70 are at the front line of cancer detection and, thus, at risk of an allegation that they failed to make a timely cancer diagnosis. Practices that may help primary care providers reduce their risk of being sued include routinely updating family histories, recognizing cancer risks for younger patients with certain histories and symptoms,1 and coordinating care with other providers who share a patient’s diagnostic process.

The four most commonly diagnosed cancers for U.S. adults2 are:

  • Breast (269,000 annual diagnoses)
  • Lung (234,000)
  • Prostate (165,000)
  • Colon and Rectal (140,000)

Given the impact of such diagnoses on quality of life and life expectancy, it is no surprise that a failure to diagnose one of those cancers is among the most common allegations in medical professional liability (malpractice) claims and lawsuits. Analysis of more than 95,000 cases reported to CRICO’s national Comparative Benchmarking System (CBS) found 1,684 cases filed from 2007–2016 with an allegation of a missed diagnosis of one of those four cancer types. Over the same 10-year period, 1,892 cases involving those cancers were closed, with an average payment of $439,000.

Top Cancers in MedMal Cases

CANCER
CASES FILED
2007–2016
CASES CLOSED
2007–2016
  #CASES AVG
INCURRED LOSS3
#CASES CLOSED
W/PAYMENT
AVG PAYMENT4
Breast 598 $263K 658 38% $396K
Lung 524 $282K 569 38% $451K
Colorectal 384 $266K 452 37% $491K
Prostate 178 $273K 213 42% $431K
Total 1,684 $271K 1,892 38% $439K

 

Considering the national volume of cancer diagnoses, allegations of malpractice are extremely rare, but they are worth examining. Incidents that evolve into medical malpractice cases do, generally, represent a subset of similar adverse events. Clinicians who see patients in the key demographic segments most susceptible to these common cancers are at risk for a missed or delayed diagnosis, even if they have never been named in a malpractice case.

While routine screening can be a valuable tool for cancer detection, it is not infallible. Many cancers are undetected in their early stages despite diligent compliance with recommended screening regimens. The CBS case details indicate that allegations of malpractice related to missed cancers are often triggered by breakdowns in the broader diagnostic process. Systemic failures and cognitive errors throughout the assessment, testing, and follow-up phases are relatively common.

 

Breakdowns in the Diagnostic Process of Care

STEP CANCER CASES5,6
1. Patient notes problem and seeks care 1%
2. History/Physical 9%
3. Patient assessment/evaluation of symptoms 31%
4. Diagnostic processing 23%
5. Order of diagnostic/lab test 42%
6. Performance of tests 5%
7. Interpretation of tests 34%
8. Receipt/transmittal of test results (to MD) 6%
9. Physician follow up with patient 30%
10. Referral management 23%
11. Provider to provider communication 19%
12. Patient compliance with follow-up plan 20%

 

Clinicians—especially primary care providers—face an increasingly complex and imperfect set of processes for cancer screening and detection. Not every missed diagnosis is the result of clinician error but, too often, these cases reveal missed opportunities. By focusing on opportunities to employ decision support and effective communication techniques, clinicians who see patients for breast, lung, colorectal, or prostate health issues have a better chance of avoiding allegations that they were responsible for a missed or delayed cancer diagnosis.

Notes

  1. Of the 1,684 patients in this analysis, 35 percent were under age 50 (including 54% of patients with breast cancers).
  2. American Cancer Society: Cancer Facts and Figures 2018. Atlanta, Ga: American Cancer Society, 2018.
  3. Includes reserves for open cases, and expenses and payments for closed cases.
  4. Includes defense expenses.
  5. Cases alleging a missed diagnosis of lung, breast, colorectal, or prostate cancer.
  6. A single case may have breakdowns in multiple steps.

Additional Material

   

July 27, 2018
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