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Even if they’re not at fault, pathologists and laboratory professionals may encounter legal challenges — including being named as a defendant in a lawsuit — at some point in their careers.  

Although not every legal dispute can be prevented, pathologists and laboratory professionals can take practical steps in their daily work to reduce their risk of being sued and strengthen their position if a claim does arise. Understanding those best practices, along with how to respond if facing litigation, can help pathologists and laboratory professionals approach these uncomfortable situations with confidence and clarity.  

Common reasons for being sued  

“Lawsuits are a reality of medical care in the United States today,” says ASCP Past President Robert Goulart, MD, MASCP, professor of pathology, director of quality and patient safety, and associate chief of anatomic pathology at University of Massachusetts Memorial Health. Dr. Goulart emphasizes that while he is not an attorney, he routinely gives lectures on pathology medical malpractice topics.  

“Pathologists and laboratory professionals have become an integral part of the medical team,” he says. “This has, however, likely led to increased ‘exposure’ and medicolegal risk.”  

Misdiagnoses make up some of the biggest sources of lawsuits for pathologists, says Jon Ritter, MD, professor of pathology and immunology at Washington University School of Medicine.  

“We tend to have fewer lawsuits, but I think they're bigger when we do get named because it's usually something like a misdiagnosis of cancer one way or the other,” Dr. Ritter says.   

Many pathology lawsuits tend to involve simpler cases a pathologist “didn’t see coming,” Dr. Ritter says. This is because complex cases are usually sent out for a second opinion.   

“If you look at errors in pathology, 90 percent of them are because you missed something,” Dr. Ritter says. “There were 10 pieces in the biopsy and nine of them were benign, but you missed a little bit of metastatic cancer in a lymph node.”  

But getting named in a lawsuit doesn’t necessarily mean you made an error. A pathologist might also be included simply because they were part of a patient’s care team.   

“I’ve had a number of cases where they just name everybody whose name they can find on the chart,” Dr. Ritter says. “It may be that your diagnosis was perfectly acceptable.”  

Honesty and transparency can lessen your risk  

Being quick to admit errors and changes in diagnoses can help decrease the number of lawsuits a pathologist is likely to be named in.  

“Say an outside report came back that somehow changes your diagnosis. Not making timely communications to people caring for the patient can get us in trouble,” Dr. Ritter says. “When you cover things up or aren’t forthright about a mistake, that’s way worse than saying, ‘I’m really sorry we got this wrong.’”  

In addition, don’t assume that a change in diagnosis will automatically be communicated to all the relevant parties. Instead, take the time to ensure all critical parties get the update so they can change treatment approaches if necessary. In some cases, this might mean making a personal phone call to the attending clinician.  

Dr. Goulart advises reviewing and following your subspecialty’s official best practices for contacting clinical teams. The Association of Directors of Anatomic and Surgical (Subspecialty) Pathology, for example, has defined a list of urgent diagnoses that require immediate notification.  

“These relatively uncommon situations need to be reported to the treating clinical team by the pathologist in a timely manner, with this communication documented in the pathology report,” Dr. Goulart says.  

One tool that Dr. Ritter likes to use when contacting clinicians and care teams is the secure chat feature in Epic.   

“I can go into Epic and use that chat function and pick out the patient's entire care team and notify all of them,” he says. “If it’s not documented anywhere, it essentially didn’t happen,” Dr. Ritter says.   

Pathology reports should be clear and informative  

How laboratory professionals write their pathology reports is another vital facet for clear communication.  

“For complicated or difficult cases, it's important to write the report so I can understand what you (the pathologist) were thinking and why you did what you did,” Dr. Ritter says.  

Imagine you did a panel of five immunostains and three pointed to one diagnosis, but two suggested a different one. Explain in your report what led you to your conclusion and why.  

“I tell people, you’re not necessarily writing the report on those kinds of cases for the clinician, you’re writing it for the next pathologist who looks at the case,” Dr. Ritter says.   

And although there’s no way to make a pathology report entirely “bullet proof,” a clearly written one is the best way to reduce legal risk, Dr. Goulart says.   

“A well-written, clear, concise surgical pathology report and, when needed, direct pathologist to clinical/surgeon communication are the two best ways to reduce medicolegal risk,” he says. “Communication is key. As a quality pathology report is the pathologist’s best defense, details should be carefully documented at the time of sign-out.”   

Follow best practices for addenda vs amendments in reports  

Make sure you use addenda and amendments correctly in your pathology reports.   

“As reviewed by ASCP through survey data, follow recommended revised reporting practices, including when and how to appropriately issue addenda and amendments, and the distinctions between the two,” Dr. Goulart says. “Addenda and amendments are used in very different circumstances and confusing this distinction can lead to significant patient risk.”   

An addendum “adds additional information, typically providing results of ancillary tests such as molecular studies, but the facts in the original report remain correct,” he says.   

In contrast, an amendment is “necessary when the facts stated in the original report are no longer correct.”   

Following this protocol is vital.   

“I cannot emphasize enough that carefully adhering to this practice is essential to ensure diagnostic accuracy and the correct patient management,” Dr. Goulart says. “Do not mask what needs to be an amendment as an addendum.”  

If the amendment is significant, communicate this quickly. Some examples include “frozen section discrepancies, molecular test results which significantly alter clinical management/treatment, and extradepartmental consultations (whether personal or institutional) which differ significantly from the original diagnosis,” he says.   

If you’re named in a lawsuit, don’t panic  

If a pathologist finds themselves named in a lawsuit, don’t panic.  

First, contact the appropriate team members. This could be your risk management or legal team if your employer has one, Dr. Ritter advises. You should also alert your malpractice insurance carrier, Dr. Goulart says.  

“Failure to contact your malpractice carrier may jeopardize the insurer’s obligations to the pathologist in the lawsuit,” he says.  

Both Dr. Ritter and Dr. Goulart agree that the next thing you should do is preserve all relevant records.  

“Make sure the slides and all the information get sequestered somewhere,” Dr. Ritter says. “Because if stuff gets lost, you’re in real trouble.”  

“Work with your administrative office to place all slides and blocks in safekeeping,” Dr. Goulart says.  

And keep your emotions in check.   

“It’s a long haul,” Dr. Ritter says. “Don’t start emailing people inflammatory things, because those can all be subpoenaed. Don’t send an email saying, ‘This stupid patient is suing me.’  Remain calm.”  

In fact, it’s better to just not talk to anyone but your lawyer and insurer.  

“Discuss the claim only with the insurer and the attorney provided by the insurer,” Dr. Goulart says. “Follow the instructions of your assigned defense attorney. They are the experts in legal matters; you are not.”  

And don’t take it personally.   

“We do thousands of cases a year. It’s impossible that you never get one of them wrong,” Dr. Ritter says. “But, you may not have done anything wrong in this case.”   

Knowing what ‘not’ to do is also important