Pathology Liability Insurance and The Doctors' Company Risk Management Advice.

September 09, 2013

Insuring Pathology Laboratories is a very specific task;

The liability that rises to (or attaches to the Lab) is very different than the liability that follows the physician.There are occasions where the lab is insured along with the entity of the Pathology Group (which is to say, the “City” Pathology Medical Group, Inc. always has a separate limit covering IT separate from the M.D.’s, and there are requests to include the Lab liability (with all of the Techs and specific licensed employees in that Lab in the one limit.

So, for example, there are five M.D.’s in the group performing the professional component services for the Lab and/or the Path group, the group is incorporated (i.e. like the ‘City Path Group, Inc”) referenced above, and, they have a Licensed CLIA approved Lab with employees and contracts to read specimens submitted from outside and within the state.

Separate and Distinct Limit covering the Lab.

It is my opinion and the opinion of The Doctors’ Company that the Lab should have a separate policy all to itself. Not just one limit covering the entity and the technicians and the employees. The Doctors’ Insurance Agency will work hard to find you the best offer for your separate Lab.

We will work with the leading provider of medical malpractice liability insurance for Diagnostics Laboratories, we have worked with :

  • Pathology Laboratories
  • Clinical Microbiology Laboratories
  • Genetic Laboratories
  • Clinical Biochemistry Laboratories
  • Hematology Laboratories
  • Drug Screening Laboratories

Purchasing the appropriate insurance will cost a bit more in premium and will save the Corporation from unnecessary drag on its one limit (which should separately respond to professional component liability claims) and will bring the right resources to defend your group when it is named.

Having a separate limit of liability is essential to a proper and strong defense.

Managing the claims and managing the risks is what The Doctors’ Insurance Agency works hard to accomplish by partnering with The Doctors’ Company. The Doctors’ Company WebSite is a valuable resource, which we assume everyone uses.

Recently, one of our Pathology groups asked about requests for Pathology Records; David Troxel, M.D. Medical Director, Board of Governors, TDC wrote an article about what to do when you receive a request for Pathology Specimen:

Some important information from that article which is on The Doctors’ Company Website ( is as follows:

Requests for Pathology Specimens

When you receive requests for pathology specimens—original tissue slides, blocks, or cytology smears—remember that these are irreplaceable materials that may become evidence in a malpractice claim, and follow the steps outlined in this article.

These materials are the property of the laboratory to which they are submitted. Pathologists are obliged to use such materials for patient benefit and have an added responsibility to maintain them in a safe and secure environment.

You will periodically receive requests from attorneys for slides, fixed tissue, or blocks. Knowing how to respond will help safeguard these specimens and minimize your liability. All requests require the written authorization of the patient.

It is necessary to separate requests into medical and legal categories. Medical requests may be urgently generated for continuity of care issues or be necessary for follow-up of medical conditions. Patients often relocate, and the new doctor may want (or need) to learn previous medical history details. Specialty referrals to another medical center constitute yet another of the need-to-know scenarios.

Medically Motivated Requests

If only histopathology slides are requested, prepare recuts, and label them as such to avoid any confusion with the original slides in the event of a claim or lawsuit. Examine the slides for comparability. If they are comparable, send only the recuts and a copy of your report. Retain the original slides.

If your review of the original slides or recuts reveals an error by you or a colleague, you should prepare an amended report. That report should be sent to the original treating physician and to the requesting doctor, along with a letter of explanation. Do not be defensive; merely state the facts. A personal phone call to the original doctor and to the requester is recommended, and such calls should be documented and dated—preferably in the amended report. Notify your regional Claims office of the possibility of a potential claim when an amended report is issued.

If original slides must be sent because recuts are not comparable, or if irreplaceable items such as cytology smears are requested, you have no choice in purely medical situations but to comply. When responding to medically motivated requests, always follow the procedures described below:

  • Include a cover letter indicating what has been sent. Your letter may include a generic check-off list of the various materials that are apt to be requested. Leave a space at the bottom for special instructions or comments. (Please see the attached PDF for sample letters.)
  • Request the return of all original or irreplaceable items.
  • State whether the requester may keep the recuts or if he or she should return them.
  • Request a copy of any reports issued by the reviewing pathologist. If there is a serious disagreement between you and the reviewing pathologist, immediately inform your regional Claims office, and consider sending the case to an expert consultant for another opinion.

Place a copy of your cover letter in a tickler file, and devise a follow-up system to ensure that any materials you want back are in fact returned. Maintaining such a system is well worth the effort if a claim should arise.

Legally Motivated Requests

Requests for specimens for legal purposes may be a simple letter or a letter accompanied by a subpoena. Both of these will require the proper authorization to release:

If possible, physicians are advised to send the non-original slides again. And, if the laboratory specimen cannot be released by recutting, then Dr. Troxel recommends that only under a court order should original specimens be released; whether you or a clinician is named in a claim or lawsuit, do not send any materials without The Doctors Company’s concurrence. We (or your assigned attorney, if you are named) will ascertain whether recuts of blocks will suffice. If so—and if the plaintiff’s attorney agrees—recuts can be prepared and sent as outlined earlier.

“If The Doctors Company or your attorney cannot accommodate a plaintiff’s attorney who insists on original slides, or if only the original slides are available (as, for example, with cytology slides), The Doctors Company or your attorney will file a motion in court to limit discovery and will argue for an examination of slides or other materials by the plaintiff’s expert on your premises and under your supervision.”

Dr.Troxel goes on to discuss the possible scenarios if only the original slides are available or requested)… There is legal protection under the spoliation of evidence by the court, so if you are required to send the original specimen you cannot be held liability for damage to that slide.

This information is provided by The Doctors’ Company as part of the ongoing effort to understand the practice of medicine in each specialty, The Doctors’ Company regularly studies the reasons plaintiffs name our physicians in law suits and what we can do to best defend and prevent unnecessary large settlements.