Family doctor failed to test slow-growing lump on patient’s back
Medical Malpractice Verdict – Family doctor failed to test slow-growing lump on patient’s back – $500,000 Settlement
By: Virginia Lawyers Weekly
The decedent was an 84-year-old woman in good health who was living alone, cutting her grass with a push mower and driving her car until August 2011. Since approximately June 2007, she was treated by her primary healthcare provider. According to her family, she had a large “lump” on her back for approximately 10 years. During the time she treated with the PCP, she mentioned the lump to her family doctor on more than one occasion (although not charted) and he would tell her “it’s nothing to worry about” or “it is just a calcium deposit.” Her family remembered first noticing it as a golf ball sized lump, which gradually got bigger over the years. The PCP’s records made no mention of the mass whatsoever; however, he did reference physical examination of the decedent and noted on more than one occasion “lungs clear to auscultation and percussion.” This indicated he would have had occasion to see the mass on her back during routine office visits.
Since approximately 2005, the decedent received treatment for lumbar and cervical spine pain from a chiropractor. On three occasions in 2005, 2008 and 2009, the chiropractor noted the palpable mass on the left thoracic spine. In 2009, he sent his X-ray films out to a radiology consultant because of his concern for the mass. The radiologist interpreted the mass as being “a triangular soft tissue density overlying the dorsal spine which may correspond with the density medial to the aortic knob. The possibility of a paraspinal lesion should be considered and additional imaging is respectfully suggested.” The radiologist also stated, “An MRI of the upper thoracic spine is respectfully suggested. Previous chest films should be used for comparison purposes.”
Upon receiving the radiologist’s recommendations, the chiropractor immediately faxed the report to the PCP and requested that he order an MRI. At the same time he, he sent a release to the local hospital requesting copies of any records or reports for anything related to the spine. That same day he received a facsimile reply stating, “nothing spine related.”
On June 11, 2009, the decedent had an MRI. The hospital faxed a copy of the MRI results to the PCP and the chiropractor on June 15. On June 16, the chiropractor wrote to the PCP and pointed out that the MRI was of the lumbar spine and did not include the area of concern. He requested the PCP examine the decedent and see if a thoracic MRI was warranted. The PCP’s records that were provided to plaintiff’s counsel did not contain a copy of the June 11 MRI report, nor did they have a copy of the June 16 letter from the chiropractor. Thereafter, the PCP saw the decedent on July 28, 2009, and there is still no mention of the palpable mass or a second MRI. He did however again note on that visit “lungs clear to auscultation and percussion.”
On March 16, 2012, the decedent reported to the emergency room complaining of moderate nausea and vomiting and a headache. The ER doctor’s attention was immediately drawn to the mass on her back. He ordered labs, a CT without contrast and a chest X-ray. The decedent was discharged from the emergency department later that night with a diagnosis of nausea and vomiting, hypernatremia and headache. She was instructed to discontinue the Bactrim and follow up with her PCP within three to five days, or return to the emergency department if her symptoms worsened. The following day, the ER doctor was provided with a copy of the results from the chest X-ray. Those films revealed a “3.5 cm left upper lung mass.” He immediately called the decedent and advised her of the results. She was instructed to follow up with her PCP on March 19.
The decedent called the PCP’s office on March 19, and was instructed to return to the hospital on March 21 for a basic metabolic panel and for a check on her creatinine and nitrogen levels. On March 23, she had a CT of the chest. The CT revealed a “mass arising from the left seventh rib at the left costovertebral junction. The right is expanded by mass measuring about 5.5 x 6.8 cm. Mass extends into the left posterior lung as well as left posterior soft tissues. Impression: Large soft tissue mass arising from the left seventh rib posteriorly extending to the lung and posterior soft tissues. It may be primary neoplasm versus metastatic lesion.”
On March 26, the PCP referred the decedent to an oncologist. A biopsy taken on April 2, 2012, gave a preliminary diagnosis of a low-grade chrondosarcoma.
On Aug. 3, 2012, the decedent was taken to surgery with a thoracic surgeon and a neurosurgeon. She had a resection of the seventh rib base chondrosarcoma, including portion of ribs 6, 7 and 8 and transverse processes at T6, T7 and T8. There was no lung or aortic involvement. Following surgery, she awoke in the PACU with bilateral lower extremity numbness. She was immediately evaluated and transferred to the neuro ICU. She was later diagnosed with T5 complete paraplegia.
The decedent was discharged from the hospital on Sept. 6, 2012, to an acute rehab facility. She remained in this facility until approximately Nov. 5, 2012, when her family took her home to care for her. The family cared for her in her home until she passed away on July 4, 2013. The death certificate listed her cause of death as chondrosarcoma of the spine.