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Public Health Reporting and Testing

Case Compliments of Versuslaw

Establishing clinical laboratory negligence/public health malpractice - Anderson v. Alabama Reference Laboratories, 2000 WL 1174214, No. 1982182 (Ala. 08/18/2000)

This case has two parallel legal themes, only one of which was the focus of the litigation.  The plaintiff sued the laboratory for negligently handling his sputum sample, resulting in his being misdiagnosed with tuberculosis.  His damages were the emotional suffering from being diagnosed with a loathsome disease.  These damages were complicated by his physician's negligence in managing the diagnosis of tuberculosis.  Rather than reporting the patient to the health department and letting their tuberculosis control program handle the contact tracing and evaluation of risk to others, the physician did not report the patient.  Instead, he told the patient to report himself and to tell his friends and other close contacts that he was infected and that they should get tested:

"Dr. Fuller told Anderson, in the presence of Anderson's wife, who was then seven-months pregnant with the couple's first child, that persons with tuberculosis may also be infected with the human immunodeficiency virus (HIV), and he recommended that Anderson submit to an HIV test. Dr. Fuller instructed Anderson that, because tuberculosis is a highly communicable disease, he should tell any persons with whom he had close, daily contact that they should be tested for tuberculosis."

The misdiagnosis was discovered when the state health department used sub-typing to try to identify the molecular epidemiology of the case.  Their analysis determined that his sample had been contaminated by another patient's sample at the laboratory and that plaintiff was free of tuberculosis.  In the time between the diagnosis and its correction, plaintiff took antituberculosis medication and suffered significant side-effects, leading to this claim:

"After his meeting with Dr. Fuller, Anderson reported to the local county health department, where he was required to sign a form promising to take the drugs for treatment of tuberculosis for one year. Anderson began taking the drugs. As a result of taking the drugs for tuberculosis, he suffered several side effects, including a rash, dizziness, fatigue, nausea, and repeated vomiting. . . . On October 7, 1997, Anderson and his wife filed this action against ARL in the Russell Circuit Court. They alleged that ARL had negligently, wantonly, or recklessly performed the tuberculosis testing on Anderson's sputum specimen and that it had committed "legal fraud" in reporting the results of the testing and had thereby caused him to suffer severe emotional distress and economic losses and had thereby caused his wife to suffer, among other harm, a loss of consortium."

Defendant moved to dismiss, based on failure of plaintiff to comply with the expert testimony requirements of the Alabama tort reform laws on medical negligence cases.  In specific, that plaintiff's expert was not properly qualified because she was not personally familiar with the testing procedures and was not in the same specialty as the experts for the laboratory.  The key legal issues was whether a clinical laboratory was covered by the statute.  It was not a listed provider (doctor, dentist, etc.), but there was a catch all category of "other provider."  The court found that the laboratory was covered by the "other provider" clause and thus plaintiff's expert had to meet the standards of the law.  While plaintiff's expert was a medical school professor trained in microbiology, she had no personal experience in clinical reference laboratories.  More troublingly, she admitted that she was not familiar with the standards and methods for tuberculosis testing, nor was she familiar with the CDC guidelines.  (It would seem that she would not meet the general standards for expert testimony.)  The court upheld the summary judgment for defendant, based on failure of plaintiff to rebut the testimony of defendant's expert.

Not mentioned in the case is the physician's negligence in failing to report the patient and in improperly telling the patient to warn his friends.  Had this been handled by the health department professionals, they could have done it without identifying plaintiff.  In this way, the case is very much like the classic syphilis misdiagnosis case, Molien v. Kaiser Foundation Hospitals, 27 Cal. 3d 916, 616 P.2d 813, 167 Cal. Rptr. 831 (Cal. 1980).  In the instant case, had plaintiff been infected, not reported himself and not told his friends, the physician might have been liable for any spread of the disease among plaintiffs' contacts.

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