By Damian D. Capozzola, Esq.
Law Offices of Damian D. Capozzola
Jamie Terrence, RN
President and Founder, Healthcare Risk Services
Former Director of Risk Management Services (2004-2013)
California Hospital Medical Center
Tim Laquer, 2015 JD Candidate
Pepperdine University School of Law
News: The patient, a 51-year-old woman, was concerned about enlarged lymph nodes and the possibility that she had lymphoma. She sought treatment at a local medical center in September 2007. A CT scan was performed that revealed a 1.9 cm lesion on the patient’s liver. The patient was referred to a physician for diagnosis and treatment. In April 2008, the physician did not order a liver biopsy because he believed it to be unnecessary. Over the course of more than a year, the patient visited the physician and other specialists at the medical center, but the lesion never was tested, and no subsequent scans were performed. In May 2011, the patient had a CT scan performed at a different clinic, which showed a grossly enlarged liver with an 11 cm malignant tumor. The patient died from liver cancer a little more than a year after this second scan. The patient’s surviving husband brought suit against the physician and medical center and claimed that the failure to follow-up and properly diagnose the liver cancer amounted to medical malpractice. The defendants denied liability. The jury found for the patient’s husband and awarded $5.7 million in joint and several damages.
Background: In this matter, the patient had enlarged lymph nodes and was concerned about the possibility of lymphoma. She was admitted to a local medical center in September 2007 where a CT scan was performed, which revealed a 1.9 cm lesion on her liver. She was referred to a physician for diagnosis and treatment. When she visited the physician in April 2008, the physician did not order a liver biopsy. The physician believed that it was unnecessary given the patient’s symptoms related to her lymph nodes. From this point until August 2009, the patient visited the physician and other specialists at the medical center on multiple occasions for treatment. The physician had recommended “watchful waiting” to see if further symptoms developed, and the physician planned to schedule another CT scan in 2010. However, the liver lesion never was tested, and the recommended CT scan never was scheduled or performed. In May 2011, the patient sought treatment at a different clinic, which performed a CT scan. This second scan showed a grossly enlarged liver with an 11 cm malignant tumor. By this point, there was no opportunity for treating or controlling the cancerous growth. The patient died as a result of the liver cancer in June 2012.
A year after the patient’s death, her surviving husband brought suit against the physician and medical center. He alleged that the original CT scan in 2007, which revealed the lesion on the patient’s liver, should have necessitated follow-up scans and examination. He said the physician’s failure to diagnose the liver cancer earlier caused the patient’s death. The plaintiff and his medical experts argued that liver cancer, when caught early enough, is treatable and that a patient can make a full recovery after receiving timely, appropriate medical care. Furthermore, the plaintiff claimed that the lesion could have been surgically removed when it was small, but the care providers negligently delayed and failed to correctly diagnose and treat the patient, which resulted in the tumor’s growth beyond control. The defendants argued that the patient was treated aggressively and appropriately for the suspected lymphoma and that her symptoms did not suggest that she had this type of liver cancer. Accordingly, the defendants claimed they provided the appropriate standard of care given what was known by the patient’s physician. The defendants said they had not acted negligently, but rather her symptoms proved to be misleading for her actual condition. After three days of jury deliberation, the jury found the physician and medical center failed to provide the appropriate standard of care, and it awarded the patient’s husband $5.7 million in joint and several damages.
What this means to you: Medical malpractice liability can arise from a healthcare provider’s failure to diagnose a patient. A misdiagnosis or failure to diagnose cancer can lead to extremely high damages as a result due to the potential for tremendous injury to the patient. In legal terms, medical malpractice is a specific type of negligence. It requires four basic elements: a duty to another individual, a breach of that duty, causation, and damages. Physicians and hospitals owe a duty to their patients to provide healthcare services that meet the appropriate standard of care, which is care that a reasonable physician would provide in the same or similar circumstances. If a physician or hospital fails to meet this standard, then there is a breach of that duty and a possibility for liability. However, a plaintiff also must prove causation and damages. If the breach of the duty doesn’t injure the patient, or if the patient’s injury is caused by someone or something else, then the healthcare provider will not be liable for medical malpractice. In the case of a failure to diagnose, such as the case here, it is often quite clear that a patient’s injuries were caused by the care provider’s actions or inactions, and the injuries can be grave. This cause and effect is especially the case when the correct diagnosis is made at a later date by a different physician. It can be easy to trace the patient’s change in health over time and attribute that change to the condition that originally was missed.
Injuries caused by medical malpractice might not occur immediately following the breach of a duty. There were many opportunities here for the physician to follow-up with the patient regarding the lesion that was spotted on her liver. It originally was seen in a scan in September 2007, and the patient continued to receive treatment from the physician as well as other specialists from the medical center for more than two years. If any one of these medical professionals had identified the suspicious lesion as concerning during this time, the patient’s injuries could have been lessened or eliminated completely. It is crucial for healthcare providers to note conditions that might need action at a later date and to follow through with these notations. An original negligent action, such as an improper or missed diagnosis, might be able to be remedied later, before it becomes a serious problem, and this remedy can prevent or greatly reduce medical malpractice liability.
Healthcare providers should be cautious about solely relying upon the symptoms a patient personally reveals or presents with, as these might be misleading. If a scan, examination, or test reveals a potentially problematic condition, this condition needs to be investigated, even if unrelated to the symptoms the patient describes. The defendants in this case attempted to argue that the patient’s symptoms suggested lymphoma and that they appropriately treated her for that. However, despite the patient’s enlarged lymph nodes, it remained true that a lesion was identified on the patient’s liver, and this lesion was never investigated. The care providers did not biopsy the lesion, conduct a CT scan at a later time to determine if it was growing, or rule out liver cancer. Given the expert medical testimony, the jury determined that this care did not rise to the level of what a reasonable physician would have done given the same or similar circumstances. Misdiagnoses might occur despite all reasonable efforts, but physicians and hospitals must be certain that these reasonable efforts are taken.
- Allegheny County Court of Common Pleas, PA. Case No. GD-13-007761. April 9, 2015.