A medical mistake: what should I do?

To be succinct: I had pain in my left side and went to dr. at local clinic here in our small rural town. He happens to be a nephrologist. He gave me an ultrasound, diagnosed a large cyst on my left kidney, and referred me to a city hospital for an aspiration. I go. Go through drinking all that contrast, intravenous dye, CAT scan; get into operating room (by the way it must be done with only a local anesthetic as I have no one to drive me the 125 miles home); radiologist asks about the pain in my right side. Whoops. Turns out the cyst is on my right kidney, doesn’t need to be aspirated and my left kidney is totally normal and the pain could not be referred. Dr. says plain and simple my dr. made a mistake, which the written record they have had faxed to them substantiates. He says something about my time and his being wasted. I ask about my former pain (which mostly vanished two days after I saw my doc originally) and he says blood tests and CT are normal and “maybe it will just go away”, with a smile. Beside the angst due to the anticipation of having a very long needle stuck in my kidney and the associated risks, with only a local; the risk of having to drink a contrast when I am allergic to so many things already; having to sit in the public waiting room with a hospital gown on (just kidding), etc. I am going to get a great big bill from the hospital and the Cat scan people. I don’t think I should have to pay for this; I’m not going to pay for it. But I’m not sure what to do. Going to the doc in person would probably be best, but he doesn’t have a private practice and the clinic would probably be on the hook. I just don’t know what angle to approach this from. If I go to him he could pay it personally and no one would know; but, would I be violating some law? I am presuming the hospital is going to bill me by the way. I won’t go into a few other small things, but lets just say I’m not going back to this doc for my next hangnail. Can I have some opinions?

Ah, poor suezeekay, the sage continues I see. :frowning:
I’d say go find a lawyer who specializes in medical malpractice and see what exactly your rights are, and how to get the best deal out of the situation. Doctors make mistakes, after all they are only human, but not knowing your left from your right is a bit much I think. I don’t think you should end up paying for this goose egg either.
But look on the bright side, the cyst you DO have doesn’t need to be worked on.

Sanscour

There is no legal recourse in this case. In the legal definition of malpractice, it specifically states that physical harm must come to the patient. No harm has come to you in the case.

Inconvenience? Yes. Mental anguish? Maybe. But no harm.

I’m sorry that all of this has happened to you, but as Sanscour stated, doctors are people too and he made a mistake. In nursing practice I make mistakes also, thankfully none of which have caused harm.

Unfortunately, this physician holds no responsibility towards your bills for what has happened. He acted in good faith within the scope of his practice and referred you for care when he thought that you needed help he couldn’t provide.

If anything, I would be more concerned about the second doctor, the interventional radiologist hoping the pain would just go away. If harm comes to you from inaction to treat, then the radiologist could in fact be held responsible. Make sure you have copies of your medical records from both visits.

I was having my tubes tied and was told (whilst being wheeled into the O.R.) that I was in acute renal failure and would have to undergo major surgery and blah, blah, blah. I had to drink the evil stuff and was inconvenienced AND thought I was giong to die.

Turns out it was a lab mistake. Them’s the breaks. No harm, no foul. There are entirely too many people taking doctors to court over incidents like yours. It makes medical care costs skyrocket and makes great medical minds choose other fields. People make mistakes. Medicine is not an exact science. Please consider that you have your health while others are dying horrible deaths.

I’m not giving my qualific ations here, but a half-hearted search would prove I have enough background to comment intelligently on this topic. None of this should be construed as legal advise however, I am not licensed in Maine. But as a person I feel compelled to state the following…

ER NURSE while I don’t know what state you’re from or even if you’re from the US, kindly stop throwing around what you think is your legal knowledge. Although I don’t know where you’re from, and though I’m not familiar w/ many state’s particular laws (and I know there’s been some tort reform) I know of NO state that has the type of law you proffer to be accurate. If I’m worng please prove me so.

Generally a medical malpractice case is based on negligence. Negligence generally consists of:

  1. duty
  2. breach of that duty (breach of standard of care)
  3. causation (did that breach cause…)
  4. damages

Damages can include economic loss as well as the things you mentioned.

However, that said, Sue unless you don’t have insurance or have some huge copay/deductible, you may want to let it go. Yours does not appear to be a huge case and lawyers frown upon cases where they can’t make a lot of money–you may want to just ask your doctor to help you with your deductible, get your medical records from your doctor and subsequent treatment. Many doctors really are decent human beings and will want to make things right, but don’t go overboard in your demands.

As mentioned, the above is just what I would do from a personal perspective, it is not meant to constitute legal advise. I am not licensed to practice in your state.

Call the doctor, tell him he screwed up. Chances are he’ll waive the bill. Doctors these days are like garter snakes: they’re more afraid of you than you are of them. It can’t hurt to politely ask.

I guess I didn’t really make it clear: I don’t want to sue, I just don’t want to pay for the CT, the radiologist, and the hospital bill. He is a Nephrologist for god’s sake; he should be able to tell the right from the left on an ultra-sound and I shouldn’t have to pay for it if he makes a mistake. I’m willing to forgive 3 weeks of worrying about the procedure, driving 250 miles, going though the tests, etc. but I’m not going to pay our money for his mistake.

Except that the interventional radiologist didn’t make a mistake.

There was an order for further evaluation and treatment that was made in good faith. The nephro didn’t just send you there for grins n’ giggles, he sent you there because he thought you had a problem, and that an interventional radiologist would be better able to take care of that problem. The reason the IR had you go through the CT scan and further lab testing is to double check for a problem before he stuck a large needle into your side. That this all came back normal is a Good Thing, because it serves as a second opinion. There was nothing wrong in the opinion of the IR, so nothing was done. You’re still responsible for the cost of the CT and related services.

One thing to keep in mind is that a primary caregiver (such as your nephrologist) is not a radiologist. A radiologist has additional training in reading of diagnostic imaging studies (4 years for that, IIRC), and a specialist (and I’m sure the IR probably specializes in kidney diseases) has additional training over and above that. Moreover, no IR (or at least none that I’m familiar with, and I’ve worked for large practices) is ever going to treat a patient based on old studies, mainly because things can change. Studies can be faulty, cysts and stones may go away or move, or whatever.

Sorry, but you’re responsible here.
Robin

I’m with you on the end result MsRobyn but if the nephologist did an ultrasound and read it himself (which is usual) he should have known what side it was on…

It’s possible that the nephro did the scan himself, but it’s also possible that a tech or nurse did the scan and mislabeled the images. Not that that excuses the nephro from questioning why the sides were mislabeled when the symptoms didn’t match the images.

Robin

Thanks for your comments Robin, but you are making the mistake of thinking that I actually live in an urban area. I live on a freeking island in northern Maine. And we only have a nephroloogist because he’s paying off his student loans. We are talking here about a small rural clinic.

A technician did the ultra-sound. My doctor was in the room at least part of the time and commented that my kidneys were functioning normally and joked with me a little. When I went into his office perhaps 5 minutes later he told me I had a large cyst on my left kidney and he said it had to be aspirated due to the pain it was causing.

So, I was referred to the city hospital due to an error by my doctor here at home in reading the ultra-sound and his consequent mis-diagnosis of my pain. To paraphrase the radiologist, I should never have been referred.

And the CT was done because obviously the radiologist wants current information before he sticks a needle in my left side and finds out there is no cyst there. There was no other reason, because my doctor did not refer me for further evaluation or because he thought the radiologist would be better able to take care of it. He was very sure of his diagnosis. He told me that if he had had the necessary equipment in the clinic he would have done the aspiration right then and there, that day, because he had done it numerous times when he worked in a large hospital.

He sent me to the hospital because we are in a rural area and he couldn’t do it here. He was sending me for an aspiration for a cyst which he had already diagnosed as benign and in need of aspiration because it was causing pain. He didn’t feel it needed any further evaluation.

Unfortunately, something else was obviously causing the pain on the left side because the radiologist at the hospital said that in no way was the cyst on my right side causing pain in my left side.

The radiologist said to me: Your doctor made a mistake. This was a waste of your time and mine (quote). Plus he and the nurses apologized several times for my having to spend the better part of the day there and etc. ( having to drink the contrast, having an IV put in for further chemicals to go into my body; going through the CT, and for having to endure 3 weeks of waiting and worrying about having this done with no anesthesia because I have no one to drive me home, plus having to drive 250 miles). Yada, yada.

Of course I can forgive my doctor for being fallible, but I’m not paying for it. My doctor is paying for it because all that followed from that error is not my responsiblity. If he had indeed wanted further confirmation of a benign cyst I could understand that, but he was willing, but not able, to do the aspiration himself that day. I was referred strictly for the mechanics of the aspiration. and for a medical problem that did not in fact exist.

Then don’t pay the nephrologist, but you’re still responsible for the hospital expenses.

The radiologist’s statement is based on hindsight. Yes, your nephro made a mistake, which is unfortunate. But it’s not the IR’s fault. The nephro made a decision to refer you for follow-up care. It doesn’t matter what his intentions or reasons were. He wanted you to have a procedure done that he couldn’t do himself. Period. Doesn’t matter that he’s done a zillion of them, but is out of needles this week.

Look. Think of it this way. Women have mammograms done all the time. Some of them go on to have further evaluation because the original study showed “something”. It’s not uncommon for the second, more thorough study to show nothing, because what the radiologist saw was a shadow or a film defect. I’ve had patients insist that they were not going to pay the bill based on the fact that nothing came up on the second study, even though something did on the first.

Now, I’m not a doctor, nor have I seen the ultrasound. For all I know, what the nephro thought was a cyst might’ve been a shadow or a stone that passed. Both of these are possible. And as I said, no IR is going to insert a long needle into your kidney without proof that a) there is a problem, and b) that it’s the same problem.

Basically, the only problem I see here is that the IR was an asshole.

Robin

Write to your local physician and state the facts in a time line in a very unemotional way. Explain both your financial loss and emotional anxiety (not too detailed here but do say that you were under duress or some such). Then claim that you feel that the physician was in error and propose a means for him to rectify matters. Maybe you propose that he waive his bill and then have him negotiate with the hospital for you for payment reduction or elimination. Most hospitals have reduction programs and he may be able to tap into that for you.

I would just send the letter to the physican and the clinic management. You don’t know if this is a unique error or one of many this person has produced. I would avoid an attorney right now, but I would also research Maine medical disciplinary procedures. That info may be online. And you may need to trigger those processes in the future.

I had a friend in a similar rural environment undergo an analogous situation–turned out that the physician had wronged several people and he is now facing a loss of license from the state board and is not seeing patients.

I don’t understand your reasoning. What does a doctor referring a patient for further evaluation have to do with this case? It has nothing to do with me. I wasn’t referred for further evaluation.

My doctor FOUND a cyst on the left and sent me to the hospital to have it aspirated. But, there was no cyst on the left. It was on the right. That required no treatment. He read the ultra-sound wrong. He read it wrong, put 2 and 2 together (pain in left side; cyst in left kidney) and came up with 5. The correct diagnosis sould have been, pain in left side, cyst in right kidney, no relation. These cysts are so common, 50% of people over 50 have them, very, very rarely cause trouble.

To speculate that I actually had a shadow or stone on the left AND a cyst on the right, which he missed, is, well, pretty far-fetched.

Maybe I portrayed the IR unfairly. It’s an extremely busy hospital because it services all of northern Maine. The day I was there people were coming in to Imaging constantly. Also, it services people of all incomes. If you are single and have income under 17,500 all the services are free. They were efficient but very organized to handle all those people. It takes a lot of time to set up the surgery, and for the nurses to prepare, much less the doctor. I can absolutely see why he was miffed (I won’t go as far as to say irritated) about the waste of his time. He was very straight-forward. And I appreciate that because that’s much more helpful than lying about why he decided not to do the procedure. He could have just not told me I had no cyst rather than saying the doctor read to ultra-sound wrong and that it was actually a run-of-the mill cyst on the right which required no treatment.

Nobody is talking about not paying anyone. I’m talking about WHO is going to pay. I already paid the Nephrologist because I went to him for an office visit and had an ultra-sound (which by the way was $400.00). I paid for that because I made the appointment and he used it as a diagnostic tool; if he had found nothing I would have still been responsible for it. That is a no-brainer.

Last year I went to see an opthalmologist because I developed a very large opaque circle in the center of my vision; he thought he saw something but wasn’t sure about it and referred me to a retinologist. She gave me some tests and couldn’t find anything and eventually it diappeared. I paid for all of that, which was extemely expensive, because it was diagnostic.

But it’s a huge leap for you to compare that kind of scenario to one where the doctor makes an obvious mistake, not in judgement, but in telling the left from the right, and from that mistake follows thousands of dollars spent for unnecessary tests and procedures.

I think you are confusing a mis-diagnosis or a uncertainty in diagnosis or some kind of maybe he didn’t read the ultra-sound correctly or maybe he wanted further confirmation of his diagnosis scenario, with mistaking the right and left. Remember the man who had his left leg amputated by mistake? See how mistaking the left from the right can lead to awful mistakes? Too bad, unlike me, they didn’t catch it in the operating room.

What if the dr told you one of your children had a cyst and sent you off on a trip of 250 miles after 3 weeks of the child being prepared to have a long needle inserted in his kidney, having to have an IV put in, and go into surgery, only to find out, what the heck, no cyst after all. Your Doc made a mistake and read the wrong side of the screen. That’s okay. Pay the $3,000 and be glad. You are nicer than I am.

Well, being the new guy around, I didn’t realize that we had wordsmiths around ready to tear things apart. How about a quote from a legal document then? Sorry I don’t have more time to look up the remaining, but it can probably be found in the Uniform Disciplinary Code for Medical Professionals" for each state.

"Revised Code of Washington (RCW) 7.70.040

Necessary elements of proof that injury resulted from failure to follow accepted standard of care.

The following shall be necessary elements of proof that injury resulted from the failure of the health care provider to follow the accepted standard of care:

(1) The health care provider failed to exercise that degree of care, skill, and learning expected of a reasonably prudent health care provider at that time in the profession or class to which he belongs, in the state of Washington, acting in the same or similar circumstances;

 (2) Such failure was a proximate cause of injury."

In any case, there is no negligence, as in neglegince the defining factor is a failure to act, hence the term. (I can look that up for you at some other time if needed, BBJ.) Malpractice is error through commission and negligence is error through omission. In either case, harm needs to come to the patient.

Financial harm would only be reimbursed should negligence or malpractice be established. This can only be done if it is established that either provider acted in a manner inconsistent with the judgement of a prudent practitioner. In the information conveyed in the OP, it doesn’t appear that this is the case.

First of all, as I said, this happens all the time. Local guy misreads or misinterprets an imaging study or lab test. Local guy sends patient to Big-City Hospital for further evaluation and treatment. Big-City guy can’t find anything. No treatment takes place.

I also didn’t say that your local doctor completely misread the study; I only raised that as a possibility based on my own experiences working in radiology and reading diagnostic imaging reports. It’s entirely possible that between the time you had the ultrasound and the time you saw the interventional radiologist, the cyst ruptured on its own, and the IR saw no reason to do anything. In my training and experience, this isn’t malpractice of any kind; if anything, the local nephrologist did too much.

And, as Geoduck posted, you can always ask for the nephrologist’s help in negotiating a reduced hospital bill. But I can tell you that there’s at best an outside chance that’ll happen. As far as the hospital and IR are concerned, you had a legitimate order, work was performed, and they are entitled to be compensated at their full billing rate.

Robin

Psst ER Nurse over here please.

You are wrong and your legal ‘opinions’ are dangerous.

Not being a lawyer, I would like to comment on bottledblond’s post. My son went for an operation when he was young, and the doctor let him leave with my wife. When we got home, we found that there was something done wrong, and with a ton of blood everywhere, my wife took him to the hospital. While there, the doctor had to stick something that wasn’t done the first time (she was told in a small % of the time it happens) but because my son was a bit swollen, they couldn’t use anesthetic. You should have heard him scream. Now he has scars from the stitches, but you can’t see them. We phoned a lawyer and were told that unless he has an injury that is a lasting one, we have no claim. He has until a little while after his 18th birthday (I believe) (and he’s 4 now) to pursue or prove any long term damage. So I’d like to sue for mental anguish, scars, pretty much anything I could, but I can’t. So then I just think I’m thankful he’s ok, no permanent damage, and I get over it. And yes, I’ve talked to many lawyers as well as doctors, and it was the fault of the doctor, but no malpractice occurred.

oops, not stick, stitch

At this point, others comments and following up on definitions of malpractice, I’ve come to the conclusion that this is not malpractice. I guess the bottom line is that, even when I posted originally, I was thinking more of the moral and ethical responsibility of the doctor to pay the bill, rather than malpractice. I still haven’t decided what to do. I just can’t get it though my head than because he read the x-ray wrong I have to pay a monetary penalty.