You went to your doctor. You had blood work, an imaging scan, a biopsy, or another test. You waited for the results, and no one called. Weeks or even months later, you learned that the test had shown an abnormal finding that was never properly followed up.
Finding that out can raise immediate questions: Who received the result? Should someone have contacted you? Was additional testing or treatment needed? Most importantly, did the delay affect your health?
An abnormal result does not always signal a serious medical problem, and a missed notification does not automatically amount to medical malpractice. Some findings, however, call for additional evaluation, repeat testing, referral, treatment, or another clinical response. When that follow-up does not occur, diagnosis or treatment can be delayed.
The Agency for Healthcare Research and Quality has identified problems with test-result communication and follow-up as persistent patient-safety concerns.
If an abnormal result in your medical record was not properly followed up, determining whether malpractice occurred generally requires looking at what the result showed, what follow-up was reasonably required, who was responsible for taking action, and whether the delay caused additional harm.
Failure to Follow Up on Abnormal Test Results: When Does It Cross the Line Into Malpractice in NJ?
A bad medical outcome does not automatically mean medical malpractice occurred. The key question is whether a healthcare provider failed to provide the level of care that was reasonably expected under the circumstances and whether that failure caused harm.
A failure to follow up can occur when a provider does not take appropriate action on a result that reasonably required further attention.
In New Jersey, a missed follow-up malpractice claim generally requires four things to be established:
- Duty: The provider or healthcare entity had a legal duty to provide appropriate care under the circumstances.
- Breach: The provider failed to meet the standard of care, for example, by not acting on an abnormal result or not notifying you of a finding that required attention.
- Causation: There must be a legally sufficient connection between the failure to follow up and the patient's injury. Depending on the circumstances, that can involve showing that the delay caused additional harm or increased the risk posed by an existing condition and was a substantial factor in producing the actual injury.
- Damages: You suffered a real, demonstrable injury, such as progression of a disease, a worsened prognosis, the need for more extensive treatment, greater disability, or another measurable loss associated with the delayed diagnosis or treatment.
Not every missed notification supports a malpractice claim. If a result did not require further action or the delay had no effect on diagnosis, treatment, prognosis, or another measurable outcome, the communication failure may be real without causing compensable harm.
A delayed cancer diagnosis that allowed the disease to progress or reduced treatment options, for example, can raise significant causation issues. Depending on the circumstances, the medical evidence may address whether the delay increased the risk of harm from the disease and whether that increased risk was a substantial factor in the patient's ultimate injury. A minor abnormality that caused no resulting harm presents a very different situation.
Common Situations Where a Missed Follow-Up May Support an NJ Malpractice Claim
Certain clinical scenarios come up repeatedly in missed follow-up cases. Some of the most common include:
- Cancer screening results, including breast, colon, lung, cervical, or prostate findings, that were never communicated to the patient or appropriately acted upon.
- Abnormal laboratory findings that called for additional testing or clinical evaluation but were never discussed with the patient or appropriately followed up.
- A radiologist's finding on an MRI, CT scan, or X-ray that was documented in a report but was not appropriately communicated or acted upon.
- A biopsy result that was lost in a records system or routed incorrectly, resulting in necessary follow-up not being completed.
- A cervical screening result showing abnormalities without the repeat testing, additional evaluation, or referral appropriate for that patient's result and risk level.
Missed follow-up can involve more than one provider or system. Laboratories, radiology practices, specialists, and primary care offices may use different workflows or communication channels, creating opportunities for a result to be routed, documented, or acted on incorrectly.
Medical offices may lack a reliable process for tracking outstanding results. Electronic health record systems can route reports through different inboxes or workflows, and responsibility for follow-up may not always be clear. In some cases, one provider assumes another has already notified the patient, and no one does.
A systemic communication gap does not by itself determine liability. Depending on the facts, responsibility may involve an individual physician, hospital, radiology practice, laboratory, medical group, or more than one provider or entity.
If you received care through a large health system in Camden, Burlington, or Gloucester County, several providers or departments may have handled the same result. A review should identify who received it, who was responsible for follow-up, and where the communication process broke down.
What Filing Rules Matter in a Missed Follow-Up Malpractice Claim?
Medical-malpractice claims in New Jersey are generally subject to a two-year statute of limitations, but determining when that period begins is not always as simple as looking at the date the original test was performed.
In some cases, New Jersey's discovery rule affects when a claim accrues. The rule can postpone accrual until the patient knew, or through reasonable diligence should have known, that an injury occurred and that another person's fault may have been involved. That issue can become especially important when an abnormal test result remained undisclosed, and the patient did not discover the missed follow-up until much later.
Exactly when the limitations period begins depends on the facts. Additional and much shorter notice requirements can also apply when a public entity or public employee is involved.
Learning that a medical condition exists is not necessarily the same as having reason to know that negligent care contributed to it. Patients therefore should not rely on a general online calculation to determine how much time remains to investigate or file a claim.
A medical malpractice action in New Jersey also generally requires an Affidavit of Merit. An appropriately qualified licensed person generally must state that there is a reasonable probability the care at issue fell outside acceptable professional or occupational standards or treatment practices. The affidavit generally must be provided within 60 days after the defendant files an answer. A court can grant one additional period of up to 60 days for good cause, and specific qualification requirements apply to the person providing the affidavit.
These procedural requirements are another reason the timeline, potential defendants, and medical records should be reviewed carefully when an abnormal test result was never followed up.
What Evidence Matters Most in a Missed Follow-Up Malpractice Case
If you believe a missed follow-up caused you harm, there are steps you can take now to preserve the information needed to understand what happened.
- Start by requesting your complete medical records from every provider involved, including the ordering physician, any specialist, and any lab or imaging facility.
- Preserve communications related to the test, including patient-portal messages, emails, letters, voicemail records, appointment notices, and other communications you received from the provider's office. Make a note if you do not recall receiving any communication about the abnormal result.
- Write down the timeline as you remember it: when the test was ordered, when it was performed, whether and when you were contacted, and when you first learned that something had been missed.
This documentation can help establish the timeline of the test, the missed follow-up, and what happened afterward.
An appropriately qualified medical professional typically reviews the records to assess what the applicable standard of care required and whether the failure to act caused additional harm or affected the patient's medical outcome.
Electronic health records, lab-routing logs, radiology reports, and internal communication records can help show when a result was received, where it was sent, and whether anyone acted on it. Some of those materials may not be available directly to the patient but can become relevant during litigation.
What Should You Do if You Learned an Abnormal Test Result Was Missed?
Learning that an abnormal test result was sitting in your medical record without appropriate follow-up can leave you wondering whether an earlier response would have changed what happened. Answering that question usually requires more than looking at the result alone. The timing of the test, the recommended follow-up, the providers who received the finding, what happened afterward, and the effect of the delay all matter.
At Andres, Berger & Tran, our team represents patients in medical-malpractice matters throughout New Jersey, including Camden, Burlington, and Gloucester Counties, as well as in Philadelphia.
If you believe a doctor or other healthcare provider failed to follow up on an abnormal test result and the delay caused serious harm, contact Andres, Berger & Tran. Our attorneys can review the medical records and circumstances surrounding the missed result and discuss your legal options during a free consultation.
Disclaimer: Results may vary depending on your particular facts and legal circumstances. The articles on this blog are for informational purposes only and are no substitute for legal advice or an attorney-client relationship. If you are seeking legal advice, please contact our law firm directly.