Screening Without Follow Up Is a Broken Promise, by Fransiscus Nanga Roka

Cancer screening provides a promise; it will find the problem in time to make a difference. When results that are not normal continually do not lead to a proper reaction, the promise becomes a cruel deception.

On April 9th, 2026, a five-week long medical malpractice trial concluded in a Connecticut Superior Court in Stamford when a jury decided to award $49 million to Jennifer Anderson, her gynecologist Dr. Dzwinka Carroll and Westmed Medical Group. The award consisted of $39 million to Ms. Anderson and $10 million to her husband for his loss of consortium. This award is a result of a jury decision, not a settlement or proof that all payments have been made and that the appellate process is complete.

Her attorneys state that Anderson went to yearly checkups from as early as 2013 through 2019, testing positive for high-risk HPV each time, including HPV16. Her attorneys also say that Carroll did not perform the colposcopy required by the applicable standards of care. After experiencing some bleeding irregularities in September 2019, Anderson was diagnosed with invasive cervical cancer.

The main deficiency of the program, then, wasn’t just that it couldn’t find cases of disease. The problem was that it did receive a signal (or alarm), but was unable to act on this signal (or alarm) in a timely manner to investigate the possible infection.

The significance of this distinction extends beyond the scope of a single trial. Health systems are celebrating screening rates, electronic health records, and preventative appointments. However, a completed screening is an unfinished obligation if it results in the need for additional medical treatment. Tracking tests but failing to track follow-up care provides recognition of activities, however, it does not provide evidence as to whether patients received the preventative care they required.

Precision in medicine is critical. Most positive HPV results do not indicate cancer, nor do the majority of abnormal cervical screenings. Follow up will depend upon the genotype, what was found today, what has been found in the past, and on the individual’s characteristics. The type of follow-up could include retesting, colposcopy, biopsy, or treatment. Risk-based care is necessary for prevention instead of an indiscriminant approach to care.

The complexity of the system supports the argument that we need reliable systems. However, this does not support having important results lost while waiting for another appointment, referral, or electronically transmitted results.

The litigation also included claims that records were destroyed when Westmed was transitioning to its new electronic system and that staff training on using the new system was insufficient. These claims need to be separated from other established facts. However, these claims raise a significant question about governance – who verifies that a software migration retains all the data necessary to provide patient protection?

Medical practices should implement five reforms.

Assigning responsibility to a specific clinician for all abnormal laboratory results is the first step in managing abnormal results. The assigned clinician will be responsible for following up on the abnormal results until either the recommended course of action has been taken, or an alternative course of action has been agreed upon by both parties.

Secondly, make registries of overdue follow-up, and then escalate those according to the clinical risk. Alerts that are unassigned are only “electronic noise”.

Third, provide patients with understandable results, clear timelines for receiving care, and direct support to help arrange for care. Portals should facilitate communication, not pass off institutional responsibility to patients who are fearful.

Fourth, there should be an independent review prior to closing out legacy record keeping systems. The records of previous outcomes, referrals, and unresolved issues must continue to be available to those who need them. All modifications to the records must have an auditable trail.

Fifth, have boards evaluate their failures in follow-up along with screening coverage. Regulators and insurance companies can encourage successful completion of preventative care pathways and at the same time allow for proper use of professional judgment in clinical practice, as well as prevent the occurrence of unnecessary procedures.

A large verdict can help hold someone responsible for their actions. It cannot restore the time that a person could have been treated if the treatment had been started sooner.

The bigger picture here is about the way that we’ve made prevention into a bunch of paperwork. In order for us to be able to say that we have a preventative healthcare system, then that system needs to take action based on what is being said by the warning. If not, then we will only have recorded the danger, but then left the patient to deal with it.

Fransiscus Nanga Roka

Faculty of Law University 17 August 1945 Surabaya and Managing partner Law Firm Victorious Indonesia