Medical Malpractice - Liver Cancer
FAILURE TO MAKE A TIMELY DIAGNOSIS DUE TO RECURRENT MEDICAL MISTAKES: DISCUSSION OF 3 SUCCESSFUL SETTLEMENTS ACHIEVED AFTER EXTENSIVE RESEARCH AND CASE WORK UP
In the last 5 years Dennis Donnelly has handled 3 meritorious cases where due to 3 different types of medical mistakes, a diagnosis of liver cancer which should have been made was instead missed. In all 3 cases the negligently delayed diagnosis caused the patient to lose a substantial chance at cure and survival.
Although proper diagnosis and care of liver cancer can save lives, it requires up-to-date knowledge and thorough practice by radiologists, primary care doctors and internists or hospitalists who treat patients admitted to the hospital with complaints or imaging findings that can be red flags for liver cancer.
GENERALIST, STRIP-MALL RADIOLOGIST DOES INADEQUATE CT AND MRI WHICH LEADS HIM TO CALL AN EARLY LIVER TUMOR A “BENIGN FATTY LIVER DEPOSIT” AND FATALLY MISLED HIS PATIENT AND REFERRING PRIMARY CARE DOCTOR.
This error cost his patient 1.5 year delay in diagnosis. During that lost time, his tumor grew and spread and became incurable. Despite heroic efforts at later surgery and chemotherapy he died after suffering for almost 2 years.
One of the cornerstones of any cancer diagnosis is imaging studies such as X-rays, CTs and MRIs. However, imaging liver cancer requires specific techniques and knowledge in how to properly do such imaging studies.
One recurring reason for tragic medical mistake is that practitioners do not recognize their own limitations and refer patients who require more specialized care to more specialized caregivers. That was the lesson from this case which settled for $900,000.00.
PRIMARY CARE DOCTOR AND GENERAL SURGEON BOTH MISS AN ULTRASOUND REPORT WHICH CALLS FOR FURTHER IMAGING STUDIES TO DETERMINE THE TRUE NATURE OF A QUESTIONABLE LIVER MASS.
All of our modern medical knowledge is useless if repetitive but preventable human errors by physicians continue to occur. After careful analysis and discovery this case illustrated 2 such areas of recurring errors. The aged primary care doctor had not kept up on contemporary recognition that patients with hepatitis and cirrhosis of the liver are at increased risk of liver cancer. If he had, perhaps that would have caused him to notice and take seriously a recommendation in an ultrasound report for follow up CT of an area suspicious for being a liver mass. Instead he discounted it as one of many academic or general concerns that radiologists might raise. Here, a second caregiver was also involved and also missed that recommendation for imaging follow up. His “excuse” was that the patient was referred to him for gallbladder surgery and he did not have to read imaging reports about other organs which were not directly involved in his surgery. Both excuses were proven wrong by expert testimony. Both doctors lost their patient a substantial chance at surgical cure before the tumor grew and spread, and their patient died 1 year after his delayed diagnosis. Those were the lessons from this case which settled for $1,000,000.00.
FAILURE TO FOLLOW UP
MANAGING INTERNIST FAILS TO READ AND FOLLOW UP ON CT WHICH CALLED FOR MRI TO FURTHER DEFINE POTENTIAL LIVER MASSES DURING HOSPITAL ADMISSION FOR GENERAL GASTROINTESTINAL COMPLAINTS
In this case, the Patient was admitted to the hospital with acute gastroenterological issues and was discharged without his internal medicine attending doctor recognizing that 1 of 5 areas of concern on his CT report were 2 small potential masses in his liver. Here, even though he oversaw plaintiff’s hospital care for 2 days, and his resident also noted the finding of liver masses and the need for MRI follow up in her notes, his attending internist failed to see and follow up on that finding. The patient was discharged and his diagnosis of liver cancer was not made until 13 months later. This negligently delayed diagnosis lost him what experts believed was somewhere between a 25-50% chance of complete cure if an earlier diagnosis had been made. This clear error cost his patient a 13 month delay in diagnosis and death after an heroic 2 year effort to survive failed because his liver tumor had grown too large and spread while it remained undiagnosed. The case was settled for $1,650,000.00.
The number of serious imaging issues requiring follow up studies which are missed remains a serious recurring problem in medicine. See for example JAMA Intern Med. 2013 Mar 25;173(6):418-25. doi: 10.1001/jamainternmed.2013.2777: Types and origins of diagnostic errors in primary care settings, Singh H1, Giardina TD, Meyer AN, Forjuoh SN, Reis MD, Thomas EJ. (“Diagnostic errors are an understudied aspect of ambulatory patient safety.”) This is also a long standing problem with medical care which medicine has not cured. In 1991, the Harvard Medical Practice Study found that misdiagnosis accounted for 14 percent of adverse events and that 75 percent of these errors involved negligence, such as a failure by doctors to follow up on test results..”
You would think that electronic medical records would allow automatic reminders and alerts that would prompt follow up on all areas of concern expressed by radiologists. However, so far that has not occurred and we continue to see the same preventable human errors occur due to suspicious findings with recommendations for more definitive tests being overlooked by physicians.
None of these cases were recognized, flagged or reviewed by later physicians so that these doctors and other like them might learn from these errors and prevent future similar mistakes from recurring. However, in each case we did just that by filing and proving that negligent care had caused needless damage and death. We also won civil justice for the surviving spouses and children. Medical malpractice cases are complex, and costly in expenses and time, but this is what we achieve when we review medical records and find a wrong that needs to be revealed and corrected.