Tracking Pathology Slides

Failure to diagnose and misdiagnosis of pathology slides are common allegations in medical malpractice litigation.  Unlike medical records and radiographs, it's not possible to duplicate pathology slides exactly.  The fact that some pathology slides are irreplaceable creates challenges for legal nurse consultants in the case.  Tracking the slides helps LNCs overcome those challenges.

When the case involves misdiagnosis or failure to diagnose pathology slides, both the plaintiff and the defense will hire pathology experts to review the slides in question.  Some pathology labs scan slides but digital pathology is not the standard of care yet.

As a legal nurse consultant, you'll encounter two types of pathology slides.  Histology (also called histopathology) slides contain tissues obtained via a biopsy or surgery.  The tissue may be in the form of an aspirate, as seen in fine needle aspirations of a thyroid gland, or in the form of a mass, as seen in surgery for tumors.

Cytology (also called cytopathology) slides contain free cells or tissue fragments.  Physicians obtain the material in two ways.  The first way is by scraping, as seen in a Pap smear.  The second way to obtain material is by specimens from body fluids - pleural, cerebrospinal, peritoneal, urine, or sputum.

The pathologist must slice tissue samples (the kind for histology slides) into very thin sections, place the slices on slides, and stain the slices with dye before using a microscope to examine them.  To make the tissue firm enough to slice, it is either frozen or processed with a fixative and then placed into paraffin wax.  Surgeons use frozen sections in surgery as a guide during the operation.  A "block" is the term for tissue saved in paraffin wax.  The block preserves the tissue indefinitely. There is no block with cytology samples.

One challenge for legal nurse consultants is that pathology laboratories don't like to release their original slides.  When possible, the labs will send recuts.  Recuts are new specimens sliced from the block.  Pathologists consider recuts to be duplicates, although technically they're not.  Pathology labs can send recuts to each law firm that requests slides, as long as there is enough tissue in the block.

Sometimes the only set of slides is the original set.  For example, pathologists can't recut cytology slides because there is no block.  In that case, the pathology lab will release the original set of slides to a law firm for its pathology expert to review.  Because both the plaintiff and defense experts need to examine the slides, the law firms forward the slides from one firm to another.  Since the case may involve more than one defendant, the originals can be shuttled to many different law firms and many different pathology experts.

This movement of the original slides from law firm to law firm creates another challenge for legal nurse consultants - misplacement or loss of the slides.  The term chain of custody, in which there is chronological documentation of evidence, doesn't apply to medical malpractice cases because they aren't criminal cases.  However, if you're responsible for a firm's pathology slides, it's helpful to track their movement in and out of the firm by establishing a paper trail. 

If you have original pathology slides and need to send them to a local law firm or expert, draft a letter that identifies the date of transfer, a description of the slides, and the name and address of the receiving party.  This letter becomes the start of your paper trail.Later, if you can't find the slides, your paper trail will help you locate them. 

After drafting your letter, send the slides to a local law firm or expert via a courier with instructions for the courier to obtain the printed name and signature of the receiver and the date of delivery.  The courier will need to return that information to you.   If sending the slides to an out-of-town expert or law firm, use a mail service that allows you to track the slides.  Require a signature upon delivery of the slides.  Keep all tracking information either in the case file or in the location where you physically store pathology slides.

After your firm's pathology expert has reviewed the slides, reverse the process.  Don't count on the expert to return the slides to you automatically.  Whether the expert is local or out-of-town, arrange for the pick-up and delivery of slides to you.  Don't let the expert send the slides to another law firm or another pathologist.  If you do so, you'll lose track of the slides.

By developing a tracking system for pathology slides, they'll no longer be so challenging.

...Katy Jones