Breast cancer malpractice

from pennsylvania

found a moveable lump in rght breast, march 1996. immediately went to family dr., who sent me directly to hospital for mammogram. nothing showed, so they did an ultra-sound. discovered it was a solid mass. radiologist sent me to general surgeon advising him the lump looked suspicious.
after exam, the general surgeon decided to wait 3 months before doing anything. he assumed it was only a fibroid tumor and i trusted him. but when i went back in June the lump had grown and was fixed. The dr. suggested a needle biopsy, i refused and told him i wanted it removed.
june 26, 1996 i was told it was infiltrating ductal carcinoma. the breast was removed and i recieved 6 months of chemo, was also put on tamoxofin. i was never told what stage cancer i had. but learned from my records in april 2001 it was stage 3. I was told that it had gone into my lymph nodes, but only one positive node out of 9 was found according to my dr.
everything seemed to be fine until nov. 2000, when i started having severe lower back pain. because i have a history of back problems i didn't think too much of it until the pain persisted much longer than usual. on dec. 29th, i went to the emergency room as the pain was so severe. i was given the usual pain meds. ect. and told to follow up with my doctor if the pain continued. i went to a reg. scheduled appointment with my neurologist jan.10, 2001 and she ordered an mri. the films showed a ruptured disc at l3-4, near total collapse of my lumbar spine and liesons on vertebra, t6, t11 and l1. she sent me to a neurosurgeon who told me i had metestatic bone cancer and there was no way he could operate on my ruptured disc under the circumstances. he sent me to see my onocologist that day.
over the next 45 days, i was given 2 more mri's and a bone scan. The mri's showed the lesions, the bone scan didn't. my onocologist repeatedly told me he and the radiologist were almost sure it was not bone mets....just spurs or arthritis. i was sent back to the neurosurgeon and once again told he could not operate because of the lesions, he even called onocology and told my onocologist that he could not possibly operate.
by this time, the lower back pain had subsided but i was having severe pain between my shoulder blades. the onocolgist decided to wait 2 months and give me another mri...his exact words to me were; "if there are no changes, then great, you don't have mets, and if there are, the wait will not have mattered because you're terminal anyway." unquote.
now i was angry, frustrated and scared so i called my family dr. again and he sent me to roswell park cancer institute. after the doctor's exam, looking at my mri films from my home hospital, and a biopsy. they told me i definately had stage 4 advanced metastatic breast cancer of the bones.
i feel sure that had the lump been removed by the general surgeon i was sent to by the radiologist in march of 1996, when the tumore was still moveable, i wouldn't be dieing now. i also feel that the care i was given after the lesions were found on the first mri, was sub-standard at best. in fact, i had had my dr. at roswell park send me to a different hospital in this area approx. 25 miles away for treatment because i refused to go back to the local hospital again! the very day i saw my new onocologist, he admitted me and i was there for nearly a month. the cancer had spread to my plural cavitiy. But for the first time since the leisons were found in january 2001, treatment's were started.
i am hoping someone in the legal field can tell me wether or not i have a case. i live in Pennsylvania, and know there is a 2 yr. statute of limitation, but only if you were aware of the harm done.
i had no idea until April of 2001, what the extent of my injuries were. so if anyone can give me some help on this it would be very much appreciated.

thank you,
dieingforinfo

[vrzirn]

I could write many chapters on breast cancer but the following is what I think you want to know.
There is a great deal of overlap in the mammographic and radiologic appearance of benign and malignant breast lesions. Several benign lesions mimic cancer. One of those is a fibroadenoma.
Invasive ductal carcinoma has breached the basement membrane and thereby gained access to vascular and lymphatic channels, meaning that metastases are now possible. The usual, or NOS (not otherwise specified) type of invasive carcinoma is the most common tumor type; it is what most physicians and patients think of when referring to "breast cancer". It presents most frequently as a hard palpable mass that may (or may not) be fixed to skin or pectoral muscle and that may (or may not) be associated with skin or nipple retraction, Many are nonpalpable and may be detected on screening mammograms.
It has the poorest prognosis of any of the common invasive carcinomas.
At the time you noticed the lump in your breast micrometastasis had already occured. A needle biopsy could have been done and the lump removed at that time. but the three month wait probably made no difference in the eventual outcome. The chemotherapyachieved all it could but some cancer cells were still hiding. Any treatment you received after the cancer was found in the pleural cavity was probably palliative.
I am truly sorry and realize how angry and frightened you are. I hope you are receiving sufficient medication for your pain.
From a legal point of view, you would have to prove that if the lump had been removed immediately you would now be in good health. But, even then, an error in judgement is not considered mal-practice.
Certainly, you may request all your records and have them reviewed by a mal-practice attorney.

Thank you for the reply Vrzirn,

I have my records Vrzirn, I was told by my lawyer to get them just in case. He said if the hospital got wind of my intention to sue, certain records could and have dissappeared before. He isn't a mal-practice lawyer and wasn't sure wether I had a case or not. One thing I found strange on the pathological report from the biopsy was the radiologist's conclusion that I had, Quote: "infiltrating ductal carcinoma in situ." unquote. I had no idea what that meant except that it was malignant. However, in the last year I've learned a whole lot more thanks to the computer and some very wonderful cancer web sites, I found out that in situ means confined to one area. But Infiltrating means just the opposite. So the pathologists diagnosis still baffles me to some extent.
Yes, I'm angry and scared and all the other little "niceties" that go with this disease.....like sick! But I did want to know if I had a suit, because I can't tell you how many times I've heard. the sooner cancer is found, the better your chances of surviving it are! When I found out last April that I'm Her2/neu positive which means (for the readers), that the cancer is more aggresive, I had to wonder wether or not that 3 months could've made a difference. I know I would've lost the breast reguardless, and if it would save my life that's OK. But I've always felt that if that Surgeon had biopsied sooner, especially given the radiologist's report and suggestion, he should've done so. Maybe, I wouldn't be in the shape I am now. It's the "if" that it seems I'll really never have an answer to. I can't help but wonder what that same doctor would've done, had it been his wife, mother or daughter? I seriously doubt he would've waited to "see" for 3 months. Do you?
Bone Mets, from everything I've read in the past year is one of the most painful cancers you can have. I'm believing it now eventhough I haven't had any broken bones yet, I'm certainly not looking forward to that. To be honest, I've been contemplating not taking any more chemo treatments. My quality of life isn't much now, I had to sell my home and car, I'm near totally dependant on my son and daughter-in-law. I can't even fix myself a meal anymore. I haven't been allowed to live alone for nearly a year.
I would hate to see any other woman have to go through this unnecessarily. Consequently, I tell every woman I can, that should they EVER find a lump.... go immediately to their Dr. and insist it be biopsied at the very least! If he won't do it then find a doctor who will...regardless of what the mammogram or ultra sound says...get it out! At least, you'll know you did everything you could and will never have to ask yourself, "what if". This disease has no perferences, it doesn't care who's mother, grandmother, wife, sister or friend you are. It doesn't care what plans and hopes you have...you're simply a body, a host for it to feed on and grow. I always thought it wouldn't happen to me but you'd better believe it will kill anyone. Even the death it deals you is not something you can imagine unless you happen to be going through it. Vrzirn is right, my treatmeants now are pallative, which boils down to, they are giving me treatments just to slow the progression of it as long as they can, it can't be cured at this point. I'm on drugs to help with the pain....mostly morphine, I'm advanced enough now that the chemo doesn't seem to be doing much anymore and I've been told I won't see another Christmas. However, should you find a lump or any other woman you know finds one....make her go to the doctor....don't take no for an answer!! Then stand by her no matter what!! Love and support do make a difference. She will need all of that you can give, because a good frame of mind is absolutely necessary. Also ASK questions, lots of them! Find out what stage cancer you have as you cannot make informed decisions about your own treatment unless you know what your dealing with. You need to know if you're HER2/neu positive or negative...that's very important. You will need to know if you're ER/PR positive as well. Find out as much as you can because from everything I've seen Doctors don't share this info unless prodded to do so. There are alot of great sites out on the web where you can read about breast cancer, one of them is the American Cancer Society's page.
Lastly, should you or someone you know find a lump in her breast and says or thinks, "I'm not going to the Dr. because I'm afraid it's malignant." Keep these words in mind, 80% of breast lumps aren't cancer, but if yours is and you refuse to go to the Dr. because you're afraid....you are depriving yourself of any chance you have of surviving it and writting your own death sentence. Breast cancer isn't always terminal.. there are alot of survivors now. Don't play Russian roulette with your life!

Thank You,
Just Dieing but you don't have to.

[vrzirn]

Although the use of the word "carcinoma" in a diagnosis of ductal carcinoma in situ (DCIS) suggests cancer, it really is not cancer. It is a lesion.Non-invasive! With the use of mammograms, there are many more diagnosed cases of DCIS, especially with non-palpable masses.
Management of DCIS has become the most controversial topic in breast disease. While mastectomy has been the traditional treatment, many now feel that it is excessive in most cases. Conservative treatment with breast conservation is recommended. Although DCIS CAN progress to invasive cancer, MOST do not. I am referring to those non-palpable lesions detected by mammograms or ultrasound.
The fact that your tumor was palpable suggests that it was already invasive - no longer in situ. It may have originally been a simple DCIS or, it was from the outset, a more aggressive cancer. Without reading the file and the pathology reports my opinion is an educated guess. I do not know how old you are, the familial history of cancer and how often you had a mammogram.
You have obviously done a great deal of research on the net and are well-informed. If there are any other areas I am able to clarify for you, please ask.
I hope you do not stint yourself on the morphine. Now is not the time to worry about addiction.

Thank you again Vrzirn,

I was 46 in March of 1996 when I first found the lump. After the biopsy in June 96' the pathology report summed it up as Infiltrating ductal carcinoma in situ. It really made no sense to me when I finally did find out what it meant. It seemed to be contradicting it's self.
I was within 6 months of my 5 yr. cancer free anniversary when the neurosurgeon told me I had mets. At that point there was no cancer history on either side of my family. But later that year, I lost two aunts and an uncle to different kinds of cancers(none BC). All seemed to be very aggressive cancers however, as they died shortly after diagnosis. And all within a 3 month period! Uncle in Nov.96', Aunt in Dec.96', Aunt in Jan. 97'. All were on my Mother's side of the family.
What bothered me so much about this time is: I was a 49 yr. old woman with a history of stage III BC. I went to the doctor complaining of severe back pain that had been going on for over 3 months. The MRI showed lesions and bone collapse in my spine. I saw the films myself and the T6 vertebra looked EXACTLY like an example of one I saw on the internet. It looked as though someone had taken a small woodworking tool and gouged out part of the bone. Also my Onocologist gave me a cat scan of the head and chest, there was some fluid in the plural cavity on the right side. It was noted but otherwise ignored and I was never told about it. He also gave me two more MRI's which showed severe bone collapse in the lower spine and a bulging disc in the cervical spine.
I had done enough research by that time that I knew what the signs of Bones Mets were and I had nearly every single one!
The Neuorsurgeon had even called my Onocologist and told him I had Bone Mets. But I recieved no treatments of any kind because the very doctors who would've been giving me those treatments (my Onocologist and Radiologist), did'nt think I had bone Mets!
Even without mentioning this to the doctors at Roswell Park, my doctor came in after looking at my records, MRI films from my home hospital and examining me, and said: quote: "Well Vicki, from reading your records I can see you have needed a tie-breaker". Unquote! It was that obvious to her. Then she told me I did have mets but in order for the insurance to pay for treatments it would be best to do a biopsy, so on April 18,2001 that was finally done. On April 19th, I went to see my new Onocologist at the Falk Cancer Center in Elmira, NY. I was admitted to the hospital that day and started radiation treatments within the next couple days. I never went back to my Onocologist at the hospital in the town where I live. I refuse to go back there because I felt as if the same thing was happening to me again that had happened in March of 96' when that General Surgeon had said we'd wait 3 months and see....despite what the chief of radiology in the Breast clinic wrote in my chart, that he felt the lump was very suspicious!
To be honest with you Vrzirn, our local hospital used to be this area's pride and joy! But for about the past 10 yrs. the quality of care people are recieving is lacking at best. They've done a lot of building on, renovations ect. and it's probably one of the nicest looking hospitals you'll see. But the care has taken a nose dive! You can't talk to anyone in this Valley who hasn't had a bad experience there or knows someone who has. It's riduclous things. I have a friend who's 3 yr.old grandson went in for a hernia operation and the surgeon operated on the wrong side! A woman who was told she had BC, they removed her breast and it turned out she never had BC, she sued and won. Another lady, (who's husband my husband worked with), went to have a tooth extracted, something went wrong and she ended up having to have brain surgery. My own Mother was kept on a respirator after a massive stroke and being diagnosed as brain dead. Her eyes were fixed and dilated, her EEG was flat lined, she had no responses at all, they had to put her in a drug induced coma to stop the violent seizures she started having, (a symtom of severe brain damage), but I had to fight to have her taken off life support, because the Head of Neurology, who wouldn't even talk to us himself, was using her as a guineypig, DESPITE a living will saying DNR! The list goes on and on. I simply don't trust that hospital or it's doctors anymore. All this may sound wacky to you, but I assure you, it's absolutely true. The hospital I go to now, may not look like something out of better homes and gardens, but at least I'm getting the care I need and deserve to have.
As for the morphine, so far the dosage I'm on plus Endocet every 4 hrs. as needed has done a fairly good job....but I have been getting increasingly more uncomfortable if I try to sit for any length of time. I need a walker to get around now and have a wheelchair as well. I tried taking two morphine tablets every eight hrs. but they knocked me for a loop (I'm also on Dilantin and Primidone for epilepsy). I couldn't even see straight with that dosage of morphine!! I saw double and triple of everything! That isn't good since my son and daughter-in-law are gone quite a bit and I surely don't want to take another fall. Been there, done that a few times already. We called hospice, unaware that they can't come in to help unless the patient is no longer recieving treatments. Let me go on record as saying I feel that's ridiculous.
Well enough of my griping....haha. All I really wanted to do was answer your questions and say thank you for replying. I don't know if this has helped but I've given you everything I can think of. Oh I forgot, you asked when I had had my last Mammogram before I'd found the lump in 1996. I'm ashamed to say, it had been eight yrs. I was one of those who always thought it wouldn't happen to me, especially since there was no history of cancer in my family. I sure thought wrong!

Thanks again,
God Bless,
dieingforinfo

[vrzirn]

Evidently, the cancer began as a simple DCIS-non-invasive lesion, easily treated with conservative methods when found during routine mammogram. Undetected for many years, it progressed at some point to being an aggressive cancer. The key word in the pathology report is "infiltrating". By that time, as I mentioned before, the outcome was probably inevitable. I doubt the three month delay was significant.The micrometastases had already invaded other parts of your body.
The decision as to when you enter a hospice is yours. They will not discontinue your MS or the other medications. The intent is to keep you comfortable. Right now you have the connection with the internet and that is very important. I hope you have found some good support groups. I know this is a terrible time for you.

Dear Vrzirn,

Thanks for all your help. Yeah, I've seen better days for sure! I actually haven't been in any support groups on here. I suppose I should, maybe it would help. In 96' I had all kinds of support, but this time has been just the opposite. Even the guy I'd been seeing for nearly 6 yrs. dumped me for someone else just days before Christmas. Bottom line is, he let me stay with him until I sold my home and had given him alot of furniture, ect. then he threw me out. Real nice guy. Not!!
Anyway, I guess I've spent so much time researching that I just never got involved with looking for a support group. Now that I know there's nothing that can be done, and I'm alone so much, that might be best.
So thank you again! I've appreciated your help. All the best to you and yours.

God Bless,
dieingforinfo

[vrzirn]

Most good support groups on the net are private, by invitation and run by a list server. Join the following group, although it is not what you require, and ask them where you may find a list better suited to your needs.
[email]caregiver-online@peach.ease.lsof.com[/email] They are a wonderful and compassionate group and will be happy to help if they can.
You might ask the Cancer Society if they are aware of any on-line groups.