POLICY FOR HANDLING SURGICAL PATHOLOGY SLIDES/BLOCKS FOR
MEDICOLEGAL REQUESTS AND RETURNING SUBMITTED CASE MATERIAL

The Laboratory of Pathology receives various requests for NIH surgical materials (e.g. slides, blocks, tissue, and reports) for patients, healthcare providers or law firms for therapeutic or litigation procedures.  Requests on patients with an NIH Medical Record Number must first be made through the Medicolegal Section of the Medical Records Department, which then forwards approved requests to the Pathology Service detailing the materials requested.  If the request is for submitted material (e.g. SS, SJ, SM cases) from a patient without an NIH Medical Record Number, the request is handled internally within LP using parallel procedures and forms.  Forms are located in the appendices of the Privacy Policy located on the main Surgical Pathology policy manual page.

A Medicolegal Request contains the following information:

1. Patient’s name
2. Patient’s NIH Admission Number
3. Name and Address of Requester
4. Date of the Request
5. Department to which Request has been Referred
6. Dates for the Material Requested (if available)
7. Written Authorization for Release of material from the Patient and/or Law Firm (often times in the form of an affidavit) or Medical Institution

• • If patient is deceased, the written authorization may be from the estate of the deceased and the law firm or medical institution

• • In addition, a certificate of death may accompany the authorization

• • If a subpoena is received, please refer the request to the Chief, Surgical Pathology

• • If a request is received without having first been reviewed by the Medicolegal Department, please forward the request to the Medicolegal Department, 10/1N216

Medicolegal Requests For Pathology Slides/Blocks

Step #1

The medicolegal request should be entered into the excel spreadsheet located in the medicolegal folder in the LP Share Drive first.

Determine if the Pathology Service has surgical biopsy material on the patient (SI/SB slides/blocks are kept indefinitely):

1. SoftPath LIS –Surgical specimens from 1954 to PRESENT
2. Patient Reports –located in the North Corridor (pre-Softpath 1999)
3. If the request is for another Section (e.g., Hematopathology, Cytopathology), refer the request to the appropriate section.  Requests from multiple sections should be handled in concert to avoid confusion of the requestor).

Step #2

Access the requested surgical pathology slide(s).

1. Determine the original surgical pathology report(s) and slides to be retrieved by using the information collected from step #1 above and the information specified on the Medicolegal request.  Blocks from in-house surgeries are not to be released.  Recuts and existing duplicate stained slides are to be sent.  No exceptions.
2. Print or make 2 copies of the report(s).
3. The staff pathologist who signed out the case will select the slides and reports to be sent.
4. Have senior staff who signed out the case review the surgical pathology slides and report(s).  Senior staff is to order recuts.
5. Obtain recuts for H&E and/or immunohistochemistry/special staining if necessary (using the Recuts option in Softpath).  Make a copy of the stain request form.

Step #3

Prepare materials for shipping.

1. Complete and print card(s) for office files indicating the material being sent out.  The card(s) should include:
   1. Patient’s name
   2. Date of shipping
   3. Surgical Pathology accession number (SS/SI/SB/SM#)
   4. Number of slides being sent (include stain ID if known)
   5. Name and address of law firm and/or medical institution to which material is being sent
   6. Name of senior staff who approved the release of the material (staff who signed out the case)
2. Make one copy of the card(s).  Place the original in the file box labeled “Medicolegal cases –Slides/Blocks Mailed Out”.  The copy of the Medico-legal request and letter should be filed with the main report in 10/2S235.
3. The top copy of the Fed Ex slip is to be in 10/2S262.
4. Produce a legal letter indicating the following (see Appendix B).
   1. Current date
   2. Name and address to who material is being forwarded
   3. Patient’s name
   4. Surgical Pathology (SI/SB/SM/SS#)
   5. Number of slides being returned

5.  Place slides in slide cases and ship them in accordance with the procedures for shipping diagnostic material.

6.   Complete a Federal Express Airbill and remove the top copy.  The top copy of the Fed Ex slip is to be filed in 10/2S262.

7.   Your outgoing package should include the following:

1. 1. Legal letter for the release of the material
   2. A copy of the surgical pathology report(s) requested
   3. Accompanying stained slides and/or re-cut slides (special/immunohistochemistry stained or unstained) for the surgical pathology report(s).
   4. Federal Express Airbill attached to front package

NOTE:  The medicolegal spreadsheet listed in the L Drive must be updated with the material sent, date, and tracking number before the material is to be shipped.

Medicolegal Requests For Blocks

Medicolegal requests for blocks are processed in the same manner as tissue slides except for a few exceptions and inclusions.

Step #1

Determine if our department has material on the patient.

1. Access the card file on the CRIS and the hard copy card files to find any additional information on the patient and make a copy of each card.

Step #2

Access requested material.

1. Determine the original report(s) and material to be retrieved by using the information collected from the card files and the information specified on the Medicolegal request.
   1. Highlight the surgical numbers of all In-house cases on the printed card files.
   2. Retrieve the reports you have highlighted and make 2 copies of each.
2. Do not complete a Request for Re-Cuts form.

Contact the General Surgical Pathology staff and ask them to retrieve the block for you.  They will only need the Surgical Pathology Number of the block (i.e., S97-0000).

If the block cannot be found, do the following:

1. 1. Immediately contact the Medicolegal Section of the Medical Records Department at 496-3331 and inform them that blocks are not available for this particular patient and surgical number so that they may document it in their files.
   2. Produce a letter of Certification of No Pathology Material and obtain the signature of the approving Attending Pathologist. 
   3. Create a file for the patient to include:

• • • Request from the Medicolegal Section
    • A copy of the report(s) pertaining to the request
    • A copy of the signed letter of Certification of No Pathology

Step #3

Prepare materials for shipping.

1. Complete and print card(s) for office files indicating the material being sent out.
2. Make one copy of the card(s).  Place the original card in the file box labeled “Blocks & Slides Mailed Out”.  The copy will be placed in the patient’s file folder.
3. Obtain the Pathologist’s signature on the legal letter for release of blocks.
4. Make 1 copy of the signed legal letter.
5. Wrap blocks, two at a time, and place in a jiffy bag for mailing.
6. Complete a Federal Express Airbill.
7. Your outgoing package should include the following:
   
   
   1. Legal letter for release of blocks signed by the pathologist
   2. A copy of the pathology report(s) requested
   3. Accompanying block(s) for the pathology report(s)
   4. Federal Express Airbill attached to front of package

Forwarding/Returning Materials

The Department of Surgical Pathology handles a large number of outside consultations in addition to rendering diagnosis for specimens received from the numerous surgeries performed for research protocols.  All tissue blocks and slides, whether submitted from outside institutions or processed here at NIH, become the sole responsibility of our department the moment we obtain possession of the material.  Daily, our department receives verbal and written requests to return material that was submitted to us for consultation and/or to forward our own material to various institutions.  The following regulations apply to the return and the forwarding of pathology materials.

Return of Patient Pathology Material (Slides and/or Blocks)

The following policy establishes how patients’ material (slides/blocks) submitted to the General Surgical Pathology are returned to the submitting facility, requestor, or forwarded to a third party healthcare facility or research institute. Please share this information with your patients and nursing or clinical support staff, who typically request the return of submitted pathology material. If you have any questions regarding this policy please contact the General Surgical Pathology Office at 301-480-8470. 

Patients with an NIH Medical Record (MR) number:

All requests for Pathology material for NIH patients must be processed through the Medical Records Department, Medicolegal Section, 301-496-3331.  For NIH patients, LP will only process requests with an NIH Clinical Center Medicolegal release form, accompanied by an Authorization for the Release of Medical Information signed by the patient or authorized party. The Medicolegal form must clearly state the requestor and intended recipient or facility to receive the slides and/or blocks, including third institutions or other NIH institute. 

A medical record release form is not necessary for returning to the submitting facility. In accordance with the Privacy Act of 1974, the recipient’s address will be verified (e.g. request memorandum letterhead must match the address of the originating facility). If the facility or patient requests that the material be sent to a third party facility, that request has to be verified in writing on their letterhead 

Patients with NO NIH Medical Record (MR) number:

If slides or blocks are to be returned to the originating facility (the healthcare facility that sent the material to us in the first place), a request from that institution on their letterhead fulfills our policy. We do not typically return material based on the accompanying request when submitted, but we will return material to the submitting facility without a second request if we are asked. 

Meaning, a facility will typically include ‘return our material’ with the original submission. We do not return the material automatically based on this request.  If asked for the return of the material at a later date, we would request a new faxed request on that facility’s letterhead. LP no longer requests an additional fax request if returning submitted material to the submitting facility at their verbal request, but it has to be based on the request to return to the submitting facility.

If the patient or facility requests the material to be sent to a third party, a formal request on letterhead or a copy of an identification card from the patient with a signed request is required.  The patient or facility will fax their request to Surgical Pathology. Keep all records of the request and identification with the case file to be scanned in archive.

Returning Material to NIH Staff:

If the material is requested by the NIH investigator or their staff, LP will return the material to the submitting investigator, institute within the NIH, or to the patient upon verification of identification. A card generated by the Pathology office must be signed and dated to document the transfer of the patients’ material.

Requests for Pathology material require at least 48 hours, and sometimes up to a week, to process depending on the physical location of the material.  We understand that there are certain situations that require urgent requests. For these cases, we will make every effort to have materials ready for pick up at the end of the same day or early the following day.

Additional Information on this topic is as follows:

Additional Circumstances under which slides/blocks are returned:

1. Institutions may send blocks for the Laboratory of Pathology to recut if they desire return of the slides.
2. If the hospital or patient has an urgent specific need for the slides.
3. Medical legal cases require all slides and materials be turned over.
4. Immunoperoxidase studies performed by outside institution, touch preps and smears are one of a kind and should be returned.

1. When a hospital requests return of slides:

1. 1. If need is non-urgent, institution may authorize LP to retain a representative slides, send unstained slides or blocks for the Laboratory of Pathology to recut if they desire return of their original slides.
   2. Urgent requests (for example, block is exhausted and slides needed for review for treatment or referral to another institution-hospital can recut own blocks quicker in many instances than we can return slides): 

• If only one slide, it should be returned.
• If multiple slides, the staff member who signed out the case should review the case and send sufficient material to render a diagnosis.  If the specific staff member who signed out the case is not available (illness or travel), the person in charge of the clinical service is responsible for the case and will review the slides.

2.  When a patient requests return of the slides:  The patient must sign for the slides in Surgical Pathology.

3.  Medical Legal Cases:  Consult with Senior Staff Pathologist before distributing any slides or blocks.

• Must sign for material and acknowledge that material is our property and that it will be returned.  Must agree in writing that material will be made available to all parties.

4.  Release of Slides:

1. 1. In Surgical Pathology cases, there is a card to be filled out in the General Surgical Pathology office.
   2. For Hematopathology consult cases:  Only Hematopathology personnel can release slides. 

For unforeseen situations not covered by the policy-Dr. Barr, or in his absence, his designated medical officer will make the final decision.

Returning Tissue Blocks Submitted from Outside Institutions

All tissue blocks submitted from outside institutions are held in the Histology Laboratory for one month, after which they are returned to the appropriate institution.

• Pathology reports are printed for corresponding blocks using the CRIS.  (Reports may also be pulled from the files and copies).

• A card is produced and filed in the box labeled “Blocks & Slides Mailed Out” for each report and the corresponding blocks being returned.

The following information is included on each card:

•   Current date
•   Patient’s name
•   Our Surgical number
•   The number of blocks and the outside surgical number for each block(s) being returned
•   The name of the Pathologist and the address to which the block(s) are being returned
•   The name of the attending pathologist who reviewed the case.

The blocks are wrapped, two at a time, and are then placed in an envelope along with the report.

Returning Tissue Slides Submitted from Outside Institutions

The majority of slides received for consultation from outside institutions are held here at the NIH in concordance with regulation set forth by the Association of directors of Anatomic and Surgical Pathology.  At the request of outside institutions, slides are returned.

• The Pathology report(s) is printed for slide(s) being returned.

• A letter of Referral of Pathology Material is produced which includes the following information
  • Patient’s name
  • Outside Surgical number
  • Address and name of person/institution to whom slide(s) is being sent
  • Our surgical number
  • Number of slides being sent
  • Signature of Attending Pathologist who reviewed the case.

If the request is verbal, please obtain the name and phone number of the person requesting the material and include it in the letter.  As necessary or as requested, Federal Express materials.  Obtain the outside institutions Federal Express account number whenever possible.

• A card indicating the material being sent out is produced and filed in the file box labeled “Blocks & Slides Mailed Out” for all slide(s) being returned.

• File a copy of the letter “Referral of Pathology Material” with the corresponding report.

If the request is written, file the request along with the letter and corresponding report.

• Place the slide(s) in a padded slide container to prevent them from breaking during shipping and secure with tape.  Wrap slide container in bubble wrap and place in a jiffy bag for mailing.

-   Preparing slides for mailing is very important.  Please be sure to provide enough padding in the slide container to prevent the slides from moving and you MUST secure the slide container with tape so that the slides do not fall out of the container during shipping.

THE MORE PADDING, THE BETTER!