***Medical Oncologists only***
Please do not leave a comment if you are not a medical oncologist.
31 y/o Female patient c/o pain in neck and upper thoracic area.
In November 2016 a chest CT identifies 1-cm R posterior 3rd rib tubercle lesion. Finding ignored. May, 2017, chest X-ray shows 3.5cm soft tissue mass with destruction of posterior 3rd rib.
In November 2018 the patient is diagnosed with Osteosarcoma, osteoblastic type, high grade 3/3.
Patient died in May 2020.
In Fl, all claims must satisfy the "more likely than not" standard.
The causation question is had the diagnosis been made in Nov 2016 or May 2017, more likely than not (>51%), would the patient have survived?
In other words, given the aggressive nature of this cancer, was this patient chance for survival less than 50% despite onset of diagnosis.
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Do you believe there might have been medical error?
In 2016, it is difficult to make a good decision unless a CT or an MRI was done. However, in May 2017, it should have been investigated. We know the common sites of involvement of osteosarcoma are the metaphyseal areas of long bones of the extremities with its occurrence in the lower end of the femur, the upper end of tibia, the upper end of the humerus and the upper end of the femur. It is rare for it to develop in the rib which probably was locally advanced.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Patient would have got neoadjuvant treatment with radiation to downsize the tumor followed by resection. The patient missed the chance for possible early resection.
What makes you a good expert for this case?
Clearly there was deviation due to the fact, the patient was not appropriately investigated. from causation, patient definitely would have had better survival.
How often do you encounter cases similar to this one in your practice?
I have done cases with missed diagnosis of lung lesion which developed into lung cancer.
Do you believe there might have been medical error?
This is a young woman with an obviously rapidly progressing disease in 5 months, of which she died. Osteosarcoma is only curable at early stages, which it appears to be, based on a small size when it initially presented.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
She dies if a disease which was not diagnosed or investigated, or followed. That established causation with a more likely than not probability. Localized disease has a survival of 70-75 percent and instead she died of it.
What makes you a good expert for this case?
I am an academic oncologist with 30nyeara of experience and had been chief and director in several institutions. I have excellent writing and verbal skills and testified in about 25 cases in court.
How often do you encounter cases similar to this one in your practice?
About 4 times a year. I practiced at one time in a university hospital with a bone cancer program, the only one in the state of NJ.
Do you believe there might have been medical error?
If chest X-ray in May 2017 showed a 3.5 cm soft tissue mass with destruction of 3rd rib and that finding was ignored and diagnosis was not made until November 2018 (which is 18 month later), then definitely it should be called medical negligence.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
In May 2017, if patient could undergo curative-intent surgery and most probably would have stayed alive until now.
What makes you a good expert for this case?
Never ignore any radiological findings even if they are subtle changes from normal.
How often do you encounter cases similar to this one in your practice?
Not very often. And if detected by me always would been discussed with the patient or beneficiary.
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