Man with cirrhosis, hep C never tested for cancer
By Mass. Lawyers Weekly Staff
A 69-year-old married retiree was a long-term patient of the defendant, his primary care physician, at a neighborhood satellite of a major Boston hospital.
Beginning in 1990, the combination of the patient’s significant history of daily alcohol intake and elevated liver enzymes (LFTs) led the defendant to suspect cirrhosis. The patient was referred to a gastroenterologist, who recommended a liver biopsy. The defendant claimed that the patient refused the biopsy, though that was not noted in the medical record.
Over the next 10 years, the patient’s abnormal LFTs persisted. In 2001, during a hospital admission for a GI bleed, the patient was diagnosed with hepatitis C. According to hospital records, the diagnosing physician had called the defendant with the diagnosis, and the defendant inaccurately replied that the patient had had a “full workup” for his liver pathology. At deposition, the defendant denied ever having received or responded to any such call.
According to plaintiff’s counsel, the patient’s new diagnosis, age, gender, alcohol use and cirrhosis combined to present a well-known and documented risk for hepatocellular carcinoma. Over the ensuing four years, however, the defendant never screened the patient for HCC.
In early 2005, the patient was admitted to a second hospital with acute GI symptoms and was ultimately diagnosed with advanced stage, terminal HCC. He died four months later.
The plaintiff’s experts were prepared to testify that the standard of care required biannual screening for HCC as of the time of the hep C diagnosis. The plaintiff’s causation expert was prepared to testify that had the standard of care been followed, the patient likely would have had a chance at a successful liver transplant or, with alternative treatment, would have lived at least another year.
The defendant claimed that, several times between 1995 and 2004, he discussed with the patient the complications of cirrhosis and hepatitis C, and that each time the patient refused any diagnostic or therapeutic intervention.
More than two years into litigation, the defendant produced seven notes, dated variously, handwritten in Italian and purportedly stored in the defendant’s locked office desk. The notes documented the discussions in question and were supposedly signed by the patient. The notes also stated that the patient’s refusals were for “personal reasons” and that the patient had “forbid” the defendant from telling anyone about the patient’s decision.
The plaintiff’s handwriting expert was prepared to testify that based on comparisons with several exemplars, the signatures on the seven notes likely were not those of the plaintiff’s decedent. The case settled one month before the scheduled trial date.
Action: Medical Malpractice
Amount : $625,000
Infant suffers facial droop after neck surgery
By Noah Schaffer
The minor plaintiff was born on July 1, 2006, and was noted to have a fullness of the right side of her neck. The defendant surgeon was consulted and determined that she had a benign growth that would need to be removed. A consulting radiologist indicated that an MRI was warranted prior to surgery in order to evaluate the mass, but the defendant never received the film.
The defendant performed surgery on the girl on Sept. 22. The operative note did not indicate that the defendant identified or protected the facial nerve during the surgery.
Immediately after the operation, the minor plaintiff was noted to have right facial droop. The defendant assured the parents that the condition was just from bruising and swelling and that it would resolve.
The minor plaintiff subsequently saw the defendant on three occasions. It was noted on each visit that there was a facial droop and incomplete motion of the corner of her mouth. The defendant kept assuring the parents it was the result of bruising and that it would go away.
Finally, the patient was sent for a nerve study, which revealed the facial nerve was not functioning at all. The minor plaintiff underwent surgery, during which it was found that the facial nerve was transected during the defendant’s surgery. Attempts to re-connect the facial nerve were unsuccessful. The girl now has a permanent facial droop and is unable to move the corner of her mouth.
The plaintiff expected to be able to prove that the defendant was negligent when he cut the facial nerve during surgery. The defense was prepared to present evidence that the nerve was not cut; rather, it disintegrated due to traction placed during the surgery, a known risk of the surgery.
Amount: $1.5 million