On February 25, 2021, patient DR had a CT of his Neck with IV contrast to evaluate a lump in the left side of his neck. There were findings consistent with a cancerous mass, but the cardiologist who ordered the CT scan never informed him or referred him to an oncologist. His PCP received a copy and did not inform or refer him either. 3 years later - he was diagnosed with the following:
• Malignant neoplasm of pharynx (7/24/2024)
• Metastasis (7/24/2024)
• Malignant neoplasm of base of tongue (7/24/2024)
Need to confirm deviations in the standard of care from the PCP and causation from an Oncologist as to the delay and diagnosis with overall impact on his health and survivability/life expectancy, as well as treatment.
Files:
No questions yet!
Do you believe there might have been medical error?
This scan should have been reviewed with the patient and a specific follow up plan discussed. While it is also on the onus of the patient to follow up with things, this should be documented clearly.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
By delaying a diagnosis and complete evaluation the cancer likely progressed and was diagnosed at a later stage.
What makes you a good expert for this case?
I am a board certified surgical oncologist who care for patients with head and neck cancers and lymphadenopathy.
How often do you encounter cases similar to this one in your practice?
I see patients with lymphadenopathy weekly in my practice.
Do you believe there might have been medical error?
Failure to act on an obviously abnormal study is a deviation from the standard of care. Primary care physicians are responsible for the care of their patients and studies ordered from their office and results received from specialists.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Failure to act for 3 years after an abnormal study will result in additional harm to the patient.
What makes you a good expert for this case?
I have extensive experience in primary care expert witness work. I see patients like this regularly.
How often do you encounter cases similar to this one in your practice?
I’ve diagnosed a number of patients with head and neck cancers.
Do you believe there might have been medical error?
I have reviewed the attached records. The initial CT (2-25-21) was done specifically to assess a lump in the neck - this was not an incidental finding on CT. The cardiologist ordered the 2-25-21 imaging and failed to follow up with results with the patient. The follow up CT (7-23-24) definitively showed progression of the same lesion. This is clearly negligence which directly resulted in harm to the patient based upon failure to diagnose. The responsibility of the PCP is less clear. Several questions arise that might clarify this: - When did the PCP receive a copy of the initial CT report? - Did the PCP have an ongoing continuity relationship with the patient? When was the most recent visit to the PCP around Feb 2021? Was he/she aware of the patient's lump in the patient's neck at any point around 2021? Additional question: were there any documented attempts by the cardiologist or the PCP to conatct the patient re: the 2021 CT results?
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Please see above. The findings on the CT are clear including mention of a possible dx of cancer by the radiologist. EP
What makes you a good expert for this case?
Mature board certified family physician actively practicing since 1984. I have seven years experience (2014-2021) as a physician member of the Arizona Medical Board reviewing cases and making discilpinary decision on standards of care for physicians in all medcial specialties. Very aware of standards of care and quality principles as I practice and teach in primary care settings.
How often do you encounter cases similar to this one in your practice?
Multple cases as a member of the Arizona Medical Board on delayed and completely missed follow up reporting on lab and imaging results - resulting in patient harm. Happily only very occasional instances of delayed results reporitng in practices that I have been associated with. Thanks, Ed Paul, MD
Do you believe there might have been medical error?
on February 25, 2021, Rodolfo Carrillo, MD was concerned about a mass and ordered a CT scan of the neck. The results were not normal and the internal medicine doctor should have referred Daniel Radison to an ENT or other head and neck surgeon for a biopsy and larnygoscopy. I also imagine that Dr. Carrillo did not examine Mr. Radison's oral mucosa well. If this was a metastatic lymph node, then Mr. Radison already had stage III disease already. From an FP point of view the doctor who ordered the 2/25/2021 CT scan, and others who read it, should have acted on the findings and referred to a surgical specialist. However, if client is still living, how much more different treatment did he receive because of the delay in treatment? The 2021 finding is not mentioned in the July 23, 2024 CT scan. I also want the 2021 CT scan re-read to see if the lingual mass was missed 3 years ago.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
The delay caused Mr. Radison's disease to progress from likely Stage III to Stage IV. But did he need more treatment because of the delay?
What makes you a good expert for this case?
I receive numerous radiology reports on lots of patients. When there is a positive finding, especially when I was concerned enough to send a patient for a CT scan with contrast, the standard of care requires addressing the abnormality.
How often do you encounter cases similar to this one in your practice?
monthly. Of all the concerns patients have, most are not dangerous (weekly), but if the workup shows a positive finding, then the differential diagnosis did not get smaller, and indeed, enlarged to include other pathology.
Do you believe there might have been medical error?
Assuming that the primary care doctor received the report, standard of care would absolutely be to follow up with the patient regarding the diagnosis found and additional work up needed. The person who ordered the report is always assumed to be responsible for findings, but a PCP would also follow up on this
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
A 3 year delay in diagnosis of a cancer has tremendous implications for treatment options and success versus failure of treatment
What makes you a good expert for this case?
I have been a PCP for 7 years and review reports ordered by other physicians on my patient frequently. There is a standard of care established that requires us to follow up on abnormal findings if we come across them
How often do you encounter cases similar to this one in your practice?
I frequently encounter reports on my patients that are ordered by other physicians. While the general consensus among physicians is to follow up on all findings in the labs or imaging you ordered, as PCP's we are also responsible for following up on abnormal findings for our patients
Want to open a case or submit response?
Comments are accepted only from Family Medicine - includes all subspecialties experts.