Death of Daugther Due to Brain Tumors

What is the name of your state? North Carolina

My daughter was diagnosed with a benign tumor in 1994 at the age of 11. Following surgery, which did not get all of the tumor; were hormone replacements and radiation therapy. In 1999, it was discovered that her tumor had grown back and another surgery was performed. This time, I was told that the entire tumor was removed. 8 months later, a post-op MRI was done and we found out that not only had her tumor returned (the doctor neglected to tell us that. Her type of tumor was a very very slow growing tumor and could not possibly have returned in that time), but also a new cancerous tumor had appeared out of nowhere. My daughter passed away in 2001. I want to know what happened to my daughter, but I can't afford to have copies of her MRI's made and don't know how to read them. Why did the doctor tell us that he had gotten the tumor when obviously he hadn't and where did this second tumor that killed her come from? I don't know who to go to and don't want to waste a lawyer's time, if there is no case.

[ellencee]

One option that does not require an attorney is for you to speak with your own physician and explain that for your peace of mind, you would like to have the MRI films reviewed and explained to you. If your physician agrees to assist you, your physician can request the MRI films from the appropriate facility and can review the films with you.

You have not stated the location of the tumor(s) or the name(s) of the type of tumor your daughter had. With this information, I may be able to assist you in understanding what happened to your daughter. You do not have to provide that information; the choice is yours alone.

In order for a claim of malpractice to exist, four conditions
have to be met (for this explanation, I will refer to physician/patient relationships):
1) there must have been a duty by the physician to the patient.
2) there must have been a breach of duty by the physician; an act of negligence for which the physician knew or should have known would result in damages to the patient.
3) damages to the patient must have occurred as the result of the act of negligence by the physician.
4) 'but for' this act of negligence, no damage would have resulted.

In your situation, the physician had a duty (1) to diagnose and treat your daughter within the acceptable standard of care, or within the acceptable adherence to procedure(s). In order to prove a breach of duty(2), you would have to prove that the physician failed to remove the tumor as best that could be done in this situation, failed to provide proper medical treatment of her condition, or failed to correctly read and interpret the MRI films and take appropriate action. The death of your daughter (3) must be as a result of the breach of duty by the physician, and the death of your daughter would not have occurred BUT FOR the negligent act by the physician (4).

With the information you have provided, I can not make a reasonable guess as to whether or not prompt diagnosis and treatment of the malignant tumor would have spared your daughter's life. Some malignant tumors can be removed and there is never any return of malignancy. Other times, malignant tumors are the product of a noncurable form of malignancy, and no treatment will prevent the loss of the patient from this illness.

I offer you my sincerest sympathy on the loss of your daughter; my heart aches for you as will the hearts of others who read your message. I believe I can speak for all of us here 'on the forum' when I say that we wish you comfort and peace and the best of life in the future. EC

Dear Ellen,

Thank you for your reply and kind words. Speaking to my daughter's physician is a good idea.

For more information, the original tumor was a Craniopharyngioma. It was partially removed in 1994 and we knew that there was a chance that it would return. In 1999, it did return and again my daughter had surgery. This time, we were told that it had been completely removed. 6 months after surgery, I made several calls to my daughter's doctor asking for an appt because my daughter started complaining about numbness in her face. No one called me back and we wound up going to the already scheduled appt. By this time, it was 8 months later and immediately after the MRI we saw the doctor. At this time, all he said was that there was another tumor, a Brain Stem Glioma. He gave us a box of tissues and left the room.

It was at this point, that I called Duke and transferred my daughter there. At that appt, my daughter's new doctor actually got irate when viewing the MRI's. He never actually would say anything, I'm sure, because we had enough on our plates.

My question is: My daughter was being seen by a neurosurgeon, who 1: told us that he had removed her entire tumor ( I know this tumor was not the cause of her death).
2: In 1999, when at her surgery, were there signs of the cancerous tumor. At which point, maybe something could have been done sooner.

Thank you for answering.

[ellencee]

GrievingMom
Before I start on explanations of your daughter's tumors, in my first response, I meant for you to ask your own personal physician, not your daughter's as your daughter's physician may be very reluctant, or even refuse, to review the films with you. I believe the neurosurgeon may be your best bet for a consultation appointment, other than your own personal physician. Some of the physicians at Duke are willing to sit down with family members and provide explanations that allow the family members to move past the questions of 'what if?' and 'was enough done?'. It certainly never hurts to ask.

The shorter version of my answer to you is this: earlier recognition and treatment of the brainstem glioma may have prolonged your daughter's life, but would not have changed it to a curable condition wherein earlier recognition and treatment could have prevented her death from the glioma's affect on the brain.
Therefore, you will not be able to prove BUT FOR the failure of the physician to recognize the glioma and provide prompt treatment, your daughter would not have died.

Would she have had a life of quality had she received intervention to shrink the glioma? Perhaps for a number of years she would have; perhaps not.
Does this give rise to a claim of malpractice--her being denied a few good years? I can't answer you on that issue. I do have personal, professional experience in a malpractice case based upon this very issue. The patient had cancerous tumors that were present on film, were undiagnosed by the radiologist and the physician, and the patient died several years earlier than he would have if he had received treatment. His estate prevailed on his behalf against the radiologist and the physician. He did not have brainstem glioma.

I found a 0% frequency of pituitary tumors (craniopharyngioma) becoming gliomas. This relieves your daughter's physician of responsibility to anticipate the occurrence of a glioma.

That's the end of the shorter version. Below I have some resource information for you and some explanations of what the disease progress would have been. Whether or not you read the long version, please scroll to the last paragraph or so.

Johns Hopkins Medical Institutions has an excellent web site for brain tumors with message boards, Q & A's, easy to understand explanations, etc. You can find their site by simply searching for Johns Hopkins Radiosurgery Craniopharyngioma News. The site also offers the user a method of following a tumor, such as glioma, through radiosurgery treatment and gives outcomes at each stage.

copied text from Johns Hopkins site:
"Gliomas: Tumors derived from the "glial" cells of the brain. The glia are "interstitial" cells of the brain that provide nutritional and mechanical support for the neurons of the brain."
"Glioma / Glioblastoma
Malignant gliomas are treatable using surgery, radiotherapy, chemotherapy and radiosurgery. The size and location of the tumor, as well as the symptoms, are important."
"Malignant tumors are similarly characterized by the microscopic, radiographic (MRI) and clinical presentations (symptoms and "signs" seen on the neurological examination). Under the microscope the malignant tumors show high percentages of cells undergoing division (mitosis), cellular atypia (bizarre shapes of nuclei and cells) and a high ratio of the size of the nucleus to the size of the surrounding other volume of the cell (cytoplasm). Radiographically, malignant tumors can "infiltrate" (spread) into the surrounding normal brain. On the MRI the malignant tumors can show much swelling or "edema" in the surrounding normal brain. "
"Surgically, these factors make complete removal difficult or impossible without damaging large volumes of surrounding normal brain. Examples are the: Malignant Gliomas include glioblastoma multiforme (GBM), anaplastic astrocytoma, anaplastic oligodendroglioma, gliosarcoma."

This information tells us that the brainstem glioma was a tumor that could not have been completely removed due to the resulting damage to the brain. That means that this tumor may have been able to be reduced, but it would have continued to interfere with the nutritional status and functioning of the brain stem.
The brainstem is composed of three parts, the medulla oblongata, the pons, and the midbrain. Life is not possible without a functioning brainstem.
The medulla oblongata controls heart rate, blood pressure, breathing, and reflexes such as coughing, sneezing, swallowing, and vomiting. The pons is made up of thick fibers that connect certain parts of the brain (transmits to and from certain parts of the brain) and has two respiratory centers that work with the medulla oblongata. The midbrain also connects certain parts of the brain and is the reflex center for the eyes and head movement in response to visual and auditory stimuli.

As the glioma progressed, and the function of the brainstem lessened, your daughter would have lost her ability to cough, sneeze, swallow, or vomit, to respond to sight and sound, and lastly to breathe and have a heart rate. I'm sure this is familiar information and something you have witnessed.

On the Johns Hopkins site, you will be able to follow the glioma through a radiosurgery treatment program and be able to tell what each year with treatment would have meant to your daughter's physical status. This information may help you make the decision whether or not to pursue additional information regarding malpractice.

If you decide to pursue the matter further, make a consultation appointment with a malpractice attorney in your area. Only an attorney in your area will be able to tell you if pursuing such a claim is worthwhile. The cost of a malpractice suit is high. Prior to actually filing a claim, an expert must have reviewed the records and made a statement that in his or her professional opinion, professional negligence (malpractice) occurred. Experts can be very expensive; and you are talking neurosurgeon, which is even more expensive. If the attorney believes that you will prevail and that compensation will be enough to merit pursuit of the claim, the attorney may take your case on a contingency basis and pay for all expenses upfront, recouping his expenses and collecting his fees at the closure of the claim.

Life can't be measured in dollars and cents, but money is the only method of compensation the courts can grant. So, the final decision on whether to pursue or not to pursue may lie in the cost versus gain area.

If the decision is made (with an attorney) to pursue a claim, be prepared for a long haul. The last I read on average time from first client interview with the attorney to resolution of the claim is five years.

If I can explain anything further, or anwer any additional questions, please feel free to email me: [email]ellencee@hotmail.com[/email] (the account that will not close, no matter how hard I try!)

Best wishes, again.

Dear Ellen,

Thank you, thank you from the bottom of my heart. How wonderful of you to have taken so much time with my question. I will be going to the Johns Hopkins site and reading up on this situation. I will also be emailing you if that is ok. You have truly helped.

[ellencee]

you are welcome and I look forward to hearing from you if I can help explain things further.