Notable Cases

Patient not informed of chest nodule, need for follow-up

Dies of lung cancer; $850,000 settlement

By: Mass. Lawyers Weekly Staff March 17, 2022

In February 2017, the decedent presented to an emergency room with complaints of difficulty breathing, coughing and dizziness. He was 69, unmarried, a smoker, and had one independent adult son. 

A chest CT revealed acute pulmonary emboli, enlargement of the main pulmonary artery, and a 1.7 cm nodule posteriorly within the left upper lobe. The radiologist recommended a follow-up chest CT at three, nine and 24 months along with dynamic contrast-enhanced CT, PET and/or tissue sampling. 

The admitting emergency room physician diagnosed the decedent as having bilateral pulmonary embolism, hypoxia and sinus tachycardia and then admitted him for an in-patient stay. The ER physician did not discuss the 1.7 cm nodule finding or the recommendations for further evaluation with either the decedent or his primary care physician. 

After a six-day stay, the decedent was discharged. The discharging hospitalist did not inform the decedent or his PCP of the 1.7 cm nodule and recommendations for further evaluation.

In August 2018, the decedent was admitted for an inpatient hospital stay with complaints of chest pain, worsening cough, and episodes of hemoptysis. A chest CT revealed, in part, a 3.8 cm nodule posteriorly within the left upper lobe. It was at this time that the decedent first became aware of the 1.7 cm nodule on the chest CT taken in February 2017.

Ultimately, the decedent was diagnosed as having clinical stage IIIB T2a N3 MO adenocarcinoma of the left upper lobe of the lung. The decedent’s treating oncologist opined the extent of the cancer was too great to be treated with radiotherapy treatment as such treatment would result in significant pulmonary compromise. 

The decedent died in June 2019 from complications of lung cancer. The plaintiffs brought claims against the admitting ER physician, discharging hospitalist and hospital. 

The plaintiffs obtained expert opinion that both the emergency medicine physician and hospitalist deviated from the standard of care when they failed to communicate all chest CT scan results and recommendations for further treatment to the decedent and to the decedent’s PCP. 

The plaintiffs’ expert further opined that, as a result of the deviation, the decedent was deprived of the probability of a better outcome. 

The plaintiffs also obtained an expert opinion from a cardiologist who opined that after hospitalization in February 2017, the decedent’s condition had stabilized and he could have undergone thoracic surgery, either bronchoscopy, biopsy or lobectomy, between the six weeks after hospitalization and at least three months following it. 

The plaintiffs obtained another medical expert opinion from an oncologist concerning the issue of whether the decedent’s outcome would have been different had he undergone evaluation of the lung nodule in February 2017. The oncologist opined that had the decedent undergone further evaluation at that time, it is likely that he would have been found to have pathologically confirmed stage IA lung cancer and would have had an associated survival of greater than 80 percent. He further opined that the overall survival for stage IIIB is less than 20 percent at five years.

The defendants obtained opinions from an expert oncologist and cancer surgeon. The experts opined, in part, that the decedent’s cancer was a primary adenosquamous carcinoma of the lung, which is a mixed histologic tumor and reflects components of both squamous cell carcinoma and adenocarcinoma. 

The defendants’ experts opined that survival after lobectomy for early-stage disease was significantly reduced for adenosquamous carcinoma compared to single histology tumors with five- and 10-year survivals at roughly 25 percent and 19 percent, compared with 42 percent and 39 percent, respectively for contemporaneous cohort of patients with single histology adenocarcinoma. 

The defense experts opined that it was more likely than not that the decedent would have died from the cancer regardless of the time of the diagnosis and that the decedent’s opportunity for longer-term survival would have been substantially hampered by his underlying comorbidities such as congestive heart failure, coronary artery disease, cardia tachyarrhythmias and thromboembolic disease.

The case was mediated after a short period of discovery. The case settled for $850,000.

Action: Medical malpractice

Injuries alleged: Diminished chances of survival of lung cancer

Case name: Withheld

Court/case no.: Withheld

Jury and/or judge: N/A (mediated)

Amount: $850,000

Date: Sept. 16, 2021

Attorney: John P. Connor of Stobierski & Connor, Greenfield (for the plaintiffs)

https://masslawyersweekly.com/2022/03/17/patient-not-informed-of-chest-nodule-need-for-follow-up/

Partial blindness of patients linked to anesthesiologist

$2.175 million settlement

By: Mass. Lawyers Weekly Staff November 21, 2018

On May 20, 2014, the three plaintiffs — ages 63, 73 and 81 — were each blinded in one eye during a routine cataract surgery at the defendant surgical center’s outpatient facility.

The plaintiffs later learned that a contracted anesthesiologist had caused eye injuries to a total of five patients, including the plaintiffs, on that same day. The injuries were sustained during the administration of peribulbar blocks, a technique whereby anesthesia is applied by needle injection around the sclera of the eye. In some cases, the anesthesiologist perforated the globe (sclera) of the eye. In others, he perforated the retina. It was his second day on the job at the surgical facility and his first day actively treating patients there.

The plaintiffs brought claims against the anesthesiologist, the eye surgeon, the surgical center, and the agency that supplied the contracted anesthesiologist to the surgical center.

The plaintiffs alleged that the anesthesiologist deviated from the standard of care when he failed to adequately appreciate the anatomy around the eye when administering block injections; failed to use the proper angle and technique when administering the block injections; failed to undergo adequate training in how to properly administer eye blocks; and failed to offer less intrusive anesthesia techniques, such as topical (needleless) anesthesia.

They brought claims against the eye surgeon for failure to supervise the anesthesiologist, failure to properly vet the anesthesiologist to assure he was properly trained and up to speed on block techniques, and lack of informed consent. Claims against the surgical center and placement agency sounded in respondeat superior and negligent credentialing.

The cases were mediated after a short period of discovery. Negotiations were complicated by the anesthesiologist’s limited insurance coverage for five individual claims and lack of applicable coverage for the placement agency.

The eye surgeon was prepared to defend the claims on the basis that he did not control the work of the contracted anesthesiologist and was not present to observe the alleged substandard technique.

The surgical center was prepared to introduce an expert opinion that it properly relied on the placement agency, which was uninsured, to vet and credential the anesthesiologist. The surgical center further argued that it did not directly employ the anesthesiologist and there was no respondeat superior liability.

The three plaintiffs’ cases settled for a total of $2.175 million.

Action: Medical malpractice

Injuries alleged: Partial blindness

Case name: Withheld

Court/case no.: Withheld

Jury and/or judge: N/A (settled)

Amount: $2.175 million

Date: March 15, 2018

Attorneys: John P. Connor and Allison K. Murphy, of Stobierski & Connor, Greenfield (for the plaintiffs)

https://masslawyersweekly.com/2018/11/21/partial-blindness-of-patients-linked-to-anesthesiologist/

Surgical injury results in loss of patient’s left kidney

By: Mass. Lawyers Weekly Staff November 21, 2018

On June 30, 2017, the plaintiff lost her left kidney as the result of a surgical injury while she was undergoing removal of her ovaries and fallopian tubes. The procedure was commenced laparoscopically but was transitioned to an open procedure due to complications encountered in visualization during the laparoscopic attempt.

The plaintiff had an extensive surgical history, leaving her with adhesions in her abdominal cavity that made her a high-risk surgical candidate. She also had a “pelvic kidney,” meaning her left kidney had an atypical location. The pelvic kidney should have been known to the surgeon, as it was noted in the patient’s chart and ultrasound imaging was available.

The surgeon encountered adhesions upon entering the abdominal cavity and caused an enterotomy in the small bowel when attempting to dissect an abdominal wall adhesion. A second surgeon was called in to repair the enterotomy and perform adhesiolysis for two hours. Despite the complications, the defendant surgeon chose to move forward with the procedure.

The surgeon continued with lysis of adhesions around the pelvis area. During that stage of the surgery, significant bleeding was noted from the left kidney. It was determined that the kidney had been lacerated and that the renal vein possibly had been entered.

The decision was then made to refer the plaintiff to another hospital, and she was transported by Life Flight.

When the plaintiff arrived at the second hospital, she was hemodynamically unstable and was transferred to an operating room. There was significant bleeding from the left pelvis and significant hemorrhage from the kidney and renal hilum. The hilum of the kidney was noted to be “very heavily dissected.” When the large renal vein and renal artery were clamped, the “torrential hemorrhage” from the central portion of the kidney immediately stopped.

Once most of the hemorrhage was under control, the trauma surgeon determined that the degree of repair and time that would be required to repair the kidney was too significant for her to undergo. As a result, the kidney was removed.

The plaintiff had a difficult but successful recovery. She tendered G.L.c. 231, §60L, letters to the defendant surgeon and hospital after her recovery. The parties agreed to enter settlement discussion as the end of the §60L period approached.

Action: Medical malpractice

Injuries alleged: Loss of kidney

Case name: Withheld

Court/case no.: Withheld

Jury and/or judge: N/A (settled)

Amount: $500,000

Date: May 30, 2018

Attorney: John P. Connor of Stobierski & Connor, Greenfield (for the plaintiff)

https://masslawyersweekly.com/2018/11/21/surgical-injury-results-in-loss-of-patients-left-kidney/

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