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Case #1078: Cancer Misdiagnosis


On September 7, the Plaintiff’s Decedent saw the Defendant for complaints involving his left knee and hip. After examination, the Defendant prescribed Vioxx in an effort to treat the Defendant’s condition conservatively.

As a result of the continuing knee pain, the Defendant referred the Plaintiff’s Decedent for an MRI of the left knee on November 2. It is alleged that the MRI was completed and confirmed the presence of a tumor in the area of the femur extending to the anterior cortex. The size of the tumor was approximately 4 x 3 x 3 centimeters, and was suspicious for malignancy. The radiologist suggested other studies be performed. However, after the MRI was completed, the Defendant advised the Decedent that he required a knee replacement. Relying on the Defendant’s advice, the Plaintiff consented, and the surgery was scheduled for November 20, at the Defendant Hospital.

On November 14, the Plaintiff’s Decedent was seen at the Defendant’s office by his nurse who explained the knee replacement procedure. On November 16, Plaintiff’s Decedent underwent a preoperative CT scan of the knee pursuant to the Defendant’s order. This study was performed at the Defendant Radiology center. The CT scan again confirmed the presence of a tumor which was seen as a destructive lesion surrounding soft tissue abnormalities. This November 16 CT scan, in conjunction with the November 2 MRI, clearly confirmed the presence of a lesion compatible with a malignancy in the Decedent’s left knee.

The Plaintiff alleged that the standards of care required the Defendant to rule in (or rule out) the malignancy through appropriate tests and studies prior to performing a knee replacement. Tragically, the Defendant ignored the findings on both radiological studies and simply proceeded with the knee replacement surgery. The Plaintiff alleged that the knee replacement violated the standards of care as it was an improper procedure to perform in the presence of a bony malignancy. The standards of care required the Defendant to biopsy the lesion, confirm the malignancy and remove the tumor en bloc — without disrupting the tumor and spreading the cancer. Had the Defendant acted in accordance with the standards of care, he would have confirmed the malignancy by biopsy, advised the Plaintiff’s Decedent of the malignancy, and proceeded with appropriate surgery to remove the tumor.

The Defendant alleged through sworn deposition testimony that, prior to proceeding with the November 20 left total knee replacement, he spoke with the Defendant radiologist regarding the CT scan of November 16. The Defendant alleged that the Defendant radiologist reviewed the MRI of November 2 and the CT of November 16, 2000, and advised him that there was no tumor present. Further, the Defendant testified that if the Defendant radiologist had advised that any of the studies were compatible with a malignancy, he would not have gone forward with the knee replacement on November 20.

If the Defendant radiologist advised the Defendant surgeon that there was no tumor present in the November 16 and/or November 2 studies, he violated the standards of care in his interpretation. It would have been a breach in the standards of care for the Defendant radiologist to interpret and report the November 2, 2000 MRI and/or the November 16 CT scan as showing no tumor. The Defendant surgeon alleged that had the Defendant radiologist accurately interpreted and reported these studies the Defendant surgeon would not have proceeded with the left total knee replacement on November 20, and would have referred the Plaintiff’s Decedent to an orthopaedic oncologist for removal of the tumor en bloc and any other treatment necessary.

During the earliest stages of the knee replacement surgery, the Defendant surgeon submitted a frozen section biopsy from the area of abnormality to the Defendant pathologist for interpretation. It is alleged that the Defendant pathologist had the responsibility to examine the Decedent’s tissue and render an accurate report regarding the presence or absence of a malignancy. The Defendant surgeon testified in deposition that the Defendant pathologist examined the tissue specimen and indicated that there was no malignant tumor present. The Defendant surgeon further testified that had the Defendant pathologist indicated that there was a malignancy present, he would not have gone forward with the knee replacement surgery. Moreover, the Defendant surgeon testified that had the Defendant pathologist stated that he was unsure whether or not the frozen section represented a malignancy, the Defendant surgeon would not have gone forward with the knee replacement. In sum, the Defendant surgeon testified that he was assured by the Defendant pathologist that there was no malignancy present so that it was safe to proceed with the knee replacement.

If the Defendant pathologist interpreted the frozen section as indicating no malignancy, he violated the standards of care. Had the Defendant pathologist complied with the standards of care, he would have indicated that he was not able to rule out the malignant tumor based on the frozen section. Accordingly, the surgery should not have gone forward and more definitive studies, including a review of prior radiological studies, should have been completed which would have resulted in a diagnosis of cancer.

Notwithstanding the CT scan, MRI and frozen section, the Defendant surgeon proceeded with the left total knee replacement. During the course of the procedure, he “found” the tumor in the femur and disrupted it while completing the procedure — thereby spreading the malignant cells. Thereafter, pathology confirmed the presence of an osteosarcoma (a malignancy in the bone). It was only after completion of the procedure that the Plaintiff’s Decedent learned for the first time that he had a malignancy and required further treatment. Further, because of the nature of the negligent surgery completed by the Defendant, the cancer had been spread with residual tumor remaining in the area of the operative site.

As a result, the Plaintiff’s Decedent sought consultation with an orthopedic oncologist as well as oncologist, underwent a partial amputation of the leg, and subsequently received chemotherapy. At the time of the diagnosis, various studies were completed which documented the fact that he had not suffered any metastasis prior to the Defendant’s negligent surgery.

However,a year later in October, a CT scan of the lungs revealed the presence of new metastasis which essentially rendered the Decedent’s diagnosis terminal. The Plaintiff alleged that the Defendants’ negligence in ignoring the findings on both radiological studies conducted pre-operatively and in the pathology study intra-operatively directly resulted in inappropriate surgery, the disruption of the tumor and spread of the cancer. Accordingly, metastasis traveled to the Plaintiff’s Decedent’s lungs, grew and was visible on the CT scan completed in October of 2001.

As the direct and proximate result of the negligence of these Defendants and each of them, the Plaintiff’s Decedent suffered unending physical pain, emotional anguish, fear and anxiety, ultimately culminating in his death three years later on July 28.

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