delayed treatment malpractice?

[rondafitz]

What is the name of your state? Happened in Mass. live in NY.
My father went to a highly respected cancer treatment center in Boston for consideration for surgery for lung cancer. Because the tumor was initially too large, they recommended chemo/radiation and a return followup. After undergoing chemo/radiation, he returned to Boston 4/30 for followup testing including PET/CT, brain MRI, and stress test to evaluate for surgery. Met with World Famous Surgeon 5/1 and was told all looks good for surgery (he even brought up the PET/CT and reviewed the actual pics himself while we watched), but you have to have surgery on your throat before to insure proper airway, involving overnight stay, several extra trip to Boston, etc. Surgery on his throat was more extensive than quick and easy injection surgery available because he was to have a lung removed and WFS wanted him to be able to cough properly to prevent pneumonia very dangerous with only one lung. Lung surgery was to be scheduled immediately after throat surgery was complete. When I called May 24th to find out when lung surgery was scheduled, was told it was cancelled this morning because PET/CT from MAY 1ST showed several metastasis. Not only were we not informed on May 1st, or shortly thereafter, we wouldn't have been informed until next available appt with WFS. It took me a dozen ever more insistant calls to get someone to call me back to let me know what the heck was going on. Because we weren't given this information, treatment for this very aggressive cancer was not started, and now he can't start it because he has to wait 3-4 weeks for his throat to heal - total time to any sort of chemo delays 8 weeks. Very good chance he will now die since he was delayed so long. He's 69 yrs old, still works every day, and continued to work through all of his treatments so far. I spoke to a Dr. friend I went to school with, and she confirmed this was just WRONG.

Is this malpractice?

I really put my trust in this surgeon to have his facts straight, how could someone who's been doing this for decades not see the hot spots on the PET/CT (even I saw them, and would have questioned them had the Dr. not been so renown - I figured he knew what he was talking about), but even if he didn't see them, shouldn't he have contacted us or at least Dad's local Doctors when the Final PET/CT was completed later that day?

The hospital has a special pre-op center that did a very through (and expensive) workup on Dad before his throat surgery - shouldn't they have questioned why this patient was having surgery instead of getting immediate chemo?

It's possible, but not certain, the surgeon relied on a preliminary radiology report - but even the newest radiologist should have been able to note the dozen hot spots on his scan for the prelim read. Could this be complicit?

I had to tell my dad that basically he's dying and there isn't much hope (of course, we'll keep looking for newer treatments and clinical trials). Should I be sending him to a malpractice attorney? If so in which state should we look, and should it be someone in or away from Boston?

Thanks,
RondaWhat is the name of your state?

 

[ellencee]

What is the name of your state? Happened in Mass. live in NY.
My father went to a highly respected cancer treatment center in Boston for consideration for surgery for lung cancer. Because the tumor was initially too large, they recommended chemo/radiation and a return followup. After undergoing chemo/radiation, he returned to Boston 4/30 for followup testing including PET/CT, brain MRI, and stress test to evaluate for surgery. Met with World Famous Surgeon 5/1 and was told all looks good for surgery (he even brought up the PET/CT and reviewed the actual pics himself while we watched), but you have to have surgery on your throat before to insure proper airway, involving overnight stay, several extra trip to Boston, etc. Surgery on his throat was more extensive than quick and easy injection surgery available because he was to have a lung removed and WFS wanted him to be able to cough properly to prevent pneumonia very dangerous with only one lung. Lung surgery was to be scheduled immediately after throat surgery was complete. When I called May 24th to find out when lung surgery was scheduled, was told it was cancelled this morning because PET/CT from MAY 1ST showed several metastasis. Not only were we not informed on May 1st, or shortly thereafter, we wouldn't have been informed until next available appt with WFS. It took me a dozen ever more insistant calls to get someone to call me back to let me know what the heck was going on. Because we weren't given this information, treatment for this very aggressive cancer was not started, and now he can't start it because he has to wait 3-4 weeks for his throat to heal - total time to any sort of chemo delays 8 weeks. Very good chance he will now die since he was delayed so long. He's 69 yrs old, still works every day, and continued to work through all of his treatments so far. I spoke to a Dr. friend I went to school with, and she confirmed this was just WRONG.

Is this malpractice?

I really put my trust in this surgeon to have his facts straight, how could someone who's been doing this for decades not see the hot spots on the PET/CT (even I saw them, and would have questioned them had the Dr. not been so renown - I figured he knew what he was talking about), but even if he didn't see them, shouldn't he have contacted us or at least Dad's local Doctors when the Final PET/CT was completed later that day?

The hospital has a special pre-op center that did a very through (and expensive) workup on Dad before his throat surgery - shouldn't they have questioned why this patient was having surgery instead of getting immediate chemo?

It's possible, but not certain, the surgeon relied on a preliminary radiology report - but even the newest radiologist should have been able to note the dozen hot spots on his scan for the prelim read. Could this be complicit?

I had to tell my dad that basically he's dying and there isn't much hope (of course, we'll keep looking for newer treatments and clinical trials). Should I be sending him to a malpractice attorney? If so in which state should we look, and should it be someone in or away from Boston?

Thanks,
RondaWhat is the name of your state?

Regarding the cancelled surgery and terminal prognosis, there are no damages that would not have occurred even if the physician had cancelled the surgery at the appointment during the first of May.

The only area of damages possibly related to possible negligence is your father's undergoing unnecessary throat surgery since he will not be having surgery to remove his lung and won't be needing to cough effectively to prevent pneumonia.

With mets, chemo and radiation would not necessarily have made your father a candidate for lung removal.

You can run this by a medmal attorney but I doubt an attorney will be interested in pursuing the claim because your father's status was improved by the surgery regardless of the fact that he is no longer a candidate for removal of one lung. Consulting with a medmal attorney will provide you with some peace of mind, though; so, it won't be a waste of your time.

Perhaps it is time to talk with a representative from a hospice program in your area. The family support gained from hospice is wonderful. Hospice really does make the whole loss process much easier on everyone.

You have my deepest sympathy and my very best wishes for you, your father, and your family.

EC

 

[dedlock]

What is the name of your state? Happened in Mass. live in NY.
My father went to a highly respected cancer treatment center in Boston for consideration for surgery for lung cancer. Because the tumor was initially too large, they recommended chemo/radiation and a return followup. After undergoing chemo/radiation, he returned to Boston 4/30 for followup testing including PET/CT, brain MRI, and stress test to evaluate for surgery. Met with World Famous Surgeon 5/1 and was told all looks good for surgery (he even brought up the PET/CT and reviewed the actual pics himself while we watched), but you have to have surgery on your throat before to insure proper airway, involving overnight stay, several extra trip to Boston, etc. Surgery on his throat was more extensive than quick and easy injection surgery available because he was to have a lung removed and WFS wanted him to be able to cough properly to prevent pneumonia very dangerous with only one lung. Lung surgery was to be scheduled immediately after throat surgery was complete. When I called May 24th to find out when lung surgery was scheduled, was told it was cancelled this morning because PET/CT from MAY 1ST showed several metastasis. Not only were we not informed on May 1st, or shortly thereafter, we wouldn't have been informed until next available appt with WFS. It took me a dozen ever more insistant calls to get someone to call me back to let me know what the heck was going on. Because we weren't given this information, treatment for this very aggressive cancer was not started, and now he can't start it because he has to wait 3-4 weeks for his throat to heal - total time to any sort of chemo delays 8 weeks. Very good chance he will now die since he was delayed so long. He's 69 yrs old, still works every day, and continued to work through all of his treatments so far. I spoke to a Dr. friend I went to school with, and she confirmed this was just WRONG.

Is this malpractice?

I really put my trust in this surgeon to have his facts straight, how could someone who's been doing this for decades not see the hot spots on the PET/CT (even I saw them, and would have questioned them had the Dr. not been so renown - I figured he knew what he was talking about), but even if he didn't see them, shouldn't he have contacted us or at least Dad's local Doctors when the Final PET/CT was completed later that day?

The hospital has a special pre-op center that did a very through (and expensive) workup on Dad before his throat surgery - shouldn't they have questioned why this patient was having surgery instead of getting immediate chemo?

It's possible, but not certain, the surgeon relied on a preliminary radiology report - but even the newest radiologist should have been able to note the dozen hot spots on his scan for the prelim read. Could this be complicit?

I had to tell my dad that basically he's dying and there isn't much hope (of course, we'll keep looking for newer treatments and clinical trials). Should I be sending him to a malpractice attorney? If so in which state should we look, and should it be someone in or away from Boston?

Thanks,
RondaWhat is the name of your state?

Rhonda,

You said your father had radiation and chemotherapy then he returned to Boston. Was the chemo/rad rx effective at all in shrinking the tumor?

Was the mets (spots) to the lung not previously affected by the cancer?
No. This is not complicit. That term is used regarding failure to report something criminal and in not doing so made be implicated in the crime.

They may still be planning to start another course of chemo/rad rx when when his neck heals. If it is effective in reducing the tumor they may still be able to do the surgery.

I wonder if the neck surgery was a tracheotomy?

The answer to your question about malpractice- I assume you are asking that if your father dies, can this be wrongful death? as related to a delay in a second round of chemo/radiation.

You will need to have some reason to believe that if he dies it is because of the delay. Don't give up hope.

 

[rondafitz]

Rhonda,

You said your father had radiation and chemotherapy then he returned to Boston. Was the chemo/rad rx effective at all in shrinking the tumor?

Was the mets (spots) to the lung not previously affected by the cancer?
No. This is not complicit. That term is used regarding failure to report something criminal and in not doing so made be implicated in the crime.

They may still be planning to start another course of chemo/rad rx when when his neck heals. If it is effective in reducing the tumor they may still be able to do the surgery.

I wonder if the neck surgery was a tracheotomy?

The answer to your question about malpractice- I assume you are asking that if your father dies, can this be wrongful death? as related to a delay in a second round of chemo/radiation.

You will need to have some reason to believe that if he dies it is because of the delay. Don't give up hope.

Dear Dedloc and EC,

Thank you for your replies.

The chemo/radiation greatly reduced the initial tumor from the size of a lemon to the size of a gumball. It's uncertain whether the numerous metastases in his lungs, chest, adrenal gland, and kidney were present immediately following his last treatment since we were told to wait until April 30th for the PET/CT scan due to problems with the radiation interferring in the results. The CT scan done immediately following the last treatment showed the tumer greatly reduced, and nothing else remarkable.

Chemo will certainly be recommended as soon as his throat heals, we've been told radiation wouldn't help with the multiple sites now showing. He is no longer a candidate for surgery since once the cancer has spread, it doesn't make sense to remove the lung as it can no longer lead to a cure.

The neck surgery was to "shim" a frozen vocal chord which was preventing him from speaking properly and was causing some problems with coughing and aspirating when swollowing. There is a much simpler poceedure that would have been a ten minute office visit with a max one week healing time that would have been suitable, but is only a temporary fix - 4-5 years which would have been plenty for what he's facing.

We haven't given up hope, but all the research shows his chances now are very slim.

Would he have died had we been informed in a timely manner - most likely, but then again, he would probably have a few months extra added to his life from earlier treatment. And there is also the fact that this has caused so much pain for our entire family. When we returned to Boston after the chemo/radiation we had very low expectation he would qualify for surgery - very, very few stage 3b patients do. When the doc told us he was a great candidate, and that it was possible - even likely - he would be cured, we made many decisions based on that possibility - we hired and trained a staff to run his business while he was recovering, we rearranged his financial situation to accomodate his probable return to his work after his recovery, we invested time, money and heart in making sure he'd have something to come back to. I can't describe the incredible pain it has caused to find out he never was a candidate. And all that time and money wasted that could have been better spent looking for a suitable treatment and making final arrangements for his business to close. And all the time now, him getting worse every day and we can do nothing until his throat heals - it's torturous.

EC - I don't understand why you say there are no damages that that would not have occured if we had been given the proper information at the May 1st appointment. Would you please explain your reasoning? I agree he would not have been a candidate with the mets, and I wouldn't want him undergoing such a dangerous surgery without the hope of a cure - but with any aggressive cancer, delay of treatment certainly will affect outcome.

Thank you for your kind words. We will bring hospice in when the time comes. To do so right now would only cause my father and my family additional pain. Although hope for a long life are slim, we aren't quitters, and we will persue all options still available to us until the time comes when it becomes clear he can no longer function in his day to day life, or until his pain requires treatments only available through them.

I greatly appreciate the time and thought you've put into your replies.

Warmest Regards,
Ronda

 

[ellencee]

Medical malpractice lawsuits require that damages be attributable only to the act(s) of negligence. This is not feasible in your father's case as regardless of any act of negligence, the cancer is in control of what happens. From what you stated in each of your posts, your father's cancer has spread to the point that pallative care is his only real option. Chemo and radiation may be used to provide comfort by relieving pain and distress caused by the cancer but no chance of a cure exists from medical science.

Cancer does not always present itself in nice neat packages with pictures of its presence. It can appear on one set of films and be absent on another set of films. It may never show up on any test that is performed. That is the nature of cancer and not the fault of any medical test or medical professional.

The surgery your father had was planned in anticipation of his having one lung removed. You state a more simple surgery could have been done if he had known that his lung would not be removed. If this proves to be true, then the difference in expenses, time lost from work, pain and suffering would be possible damages that would not have otherwise occurred. However, after reading your second post, it seems the more extensive surgery was the way to go because he has so many other cancers now present, identified, and which will cause further physical debilitation.

What I'm seeing in your post is a daughter's grief, a seeking of someone to blame (which is a normal stage of grief) and a heavy dose of denial.

Hospice is indicated now. Your father is not required to die within the qualifying time-period for hospice. He is welcome to live for years and years with Hospice still being provided. Hospice can go with him to his MD apppointments, along with his family. Hospice is available 24/7 for any need the family or the patient has.

Your father is the one to make the decisions about his treatment and I'm afraid from what you've posted in your second post that your goal is to make him take every treatment option available and fight, fight, fight. To do so is to make him suffer, suffer, suffer, until he draws his last agonized breath. Hospice offers a peaceful death while maintaining maximum independence, maximum enjoyment of time left, etc., while the patient receives appropriate medical care and intervention. I'm not advocating that he stop all treatments now.

It is possible that any life insurance that your father has will pay his death benefit now, before his death. That is something your father may wish to investigate.

There are other legal matters that your father needs to consider, ie.: a living will, a heath care proxy or power of attorney, a durable power of attorney, a "regular" will. He needs to get these things taken care of now, before he cannot do so.

Although I am a Registered Nurse with more years experience than you probably are in age, I have personal as well as professional experience with hospice programs and with death and dying.

This form of communication does not lend itself to the reader's hearing compassion in the voice and if the reader has a "hostile" mind-set, there is no way for the reader to "hear" or accept that compassion exists in the writer. I want to assure you, that although my written word may be flat and unemotional, I am filled with compassion for your and your family. My heart aches for you and for what you and yours will be going through and will be losing.

EC

 

[dedlock]

Staging, prognosis and hospice

Rhonda,
Thank you for your response. I understand why you are upset with the physician. You have a right to be if he told you that removing the lung would cure your father’s cancer.

Again you do not have a wrongful death medical malpractice claim. Your father is alive and he has had a recent course of chemotherapy that effectively reduced the tumor.

Remember the reason for doing the chemo was to make the tumor small enough to increase the odds that ALL of it might be removed. When he heals it's likely chemo and radiation will work again to reduce the size and his symptoms of the progressive disease.

If your father was already stage IIIb his cancer had spread (metastasis). The surgeon had to know this if your father was previously staged. Surgery is very rare and reserved for only those stage IIIb patients who are relatively healthy. BUT the chances of removing ALL the tumor with surgery are much less.

When the cancer spreads or metastasizes in stage IIIb it is to the lymph nodes. The size of those nodes increases and decreases daily. They may appear and be felt one day and not another. The danger of mets is to other organs (brain, bone, liver).

Hospice is a philosophy. The hospice service is ordered by a physician, discharge planner, or a medical professional when the patient’s life expectancy is 6 months or less. Has your father’s physician told your father and or family that?

Statistics show that 10-20% of patients with stage IIIb can have a life expectancy up to 5 years and do well with the effects of chemo and radiation alone.

Stage IV is when the cancer (primary lung) has spread to other organs and it is then that the physician may suggest thinking of hospice in lieu of aggressive treatment.

The metastasis of the May 1 CT/PET was the same before as after the neck surgery. Whomever you spoke to on the phone and gave that as the reason had no business telling you and should have had the surgeon (or his staff) contact your father. There is another reason for not doing the surgery. Your father can learn this from his oncologist.

Once you understand the real reason for canceling the surgery you may have a different opinion. This is only a guess- during the operation on his throat, something was discovered or his ability to withstand what was to be a minor procedure complicated his prognosis for the lobectomy.

 

[ellencee]

You may send me a private message and I will respond.

You still have the option of speaking with a medmal attorney in your area and I strongly suggest that you do so as the information you will learn will give you some measure of peace.

EC

 

[moburkes]

You have a right to be if he told you that removing the lung would cure your father’s cancer.

Can the doctor say that removing ANYTHING will CURE cancer? I didn't know that cancer was curable.

 

[dedlock]

Can the doctor say that removing ANYTHING will CURE cancer? I didn't know that cancer was curable.

Some non-small cell lung cancer are curable with surgery.

 

[ellencee]

mo--

To my knowledge only two types of cancer are curable: Hodgkin's lymphoma and acute myelocytic leukemia in children.

Don't fault the OP; families and patients hear what they want to hear. Even keeping a diary of events and conversations reflects the perception of someone in acute emotional turmoil.

More likely than not, the surgeon said removing the lung may remove all the known cancer but that the patient would need follow-up care and monitoring for a recurrence or mets.

The US is the only country in the world whose society does not accept death as a natural part of life. Our society believes death only occurs when some bad person could not prevent the death or caused the death. We are a society of self-centered fools.

FYI--We are also the only country with private rooms in hospitals (except for presidents and royalty). Most countries have open wards and a semi-private room or a quad-shared room is a rare luxury. Surprisingly, the rate of nosocomial infections and super bug infections is equitable throughout the world, regardless of room vs. ward issues. We bring upon ourselves a great portion of these ridiculously high healthcare costs. We demand multiple tests when one simple test would suffice. We demand a pill for everything. We have brought it on ourselves.

EC

 

[moburkes]

Thanks, EC, for the response.

 

[dedlock]

Thanks, EC, for the response.

Mo,
since you are a nursing student you may find these interesting regarding lung cancer and removing tumors:
http://www.healthall.com/Cancer/Lung/treatment.html
http://www.nlm.nih.gov/medlineplus/ency/article/007194.htm

Small cell lung carcinomas (oat cell cancer) are the most difficult to treat sucessfully.

I see you are in Ohio, Mo. You may find the research at OSU interesting
http://medicalcenter.osu.edu/mediaroom/press/article.cfm?ID=1492&i=75

 

[dedlock]

Rhonda,
It has been many years since I worked in hematology/oncology. The advances in cancer treatment are astounding. My most recent experience has been personal as my husband was diagnosed with one of the many non-Hodgkins Lymphomas. He was diagnosed by local physicians who also completed the staging. We then went to Sloan Kettering NYC for a second opinion. He worked with that Oncologist/Hematologist as well as his local doctors and received excellent results with treatment.

I wish the best for you and your family.

 

[Lydarose]

I can emphathize with you. I am dealing with my sister who is 45 years old and has stage 4 Lung Cancer as well as Multiple Sclerosis. She was diagnosed nearly a year ago and underwent targeted treatment since she wasn't a candidate for chemo. You can find support and talk online to people who understand at the Lung Cancer Support Community http://lchelp.org

Hope this helps. Thoughts and prayers are going your way.

Lyda