Doctors Fail to Diagnose Acute Leukemia

Case Overview

The Plaintiff initially presented to the hospital complaining of diarrhea and vomiting along with a chronic cough. She was taking a variety of medications, including Benicar and Lipitor, and she initially believed she was suffering from side effects of the medications. However, once she arrived at the hospital she was diagnosed with gastroenteritis and discharged.

The Plaintiff was seen again at the same hospital multiple times over the course of several months presenting a multitude of symptoms including fatigue, dizziness, discomfort breathing, chills, and chest pain. After these visits, she was diagnosed with suspected pneumonia, in addition to a host of other speculative diagnoses. Her blood work showed an elevated white blood count and low hemoglobin. Eventually, a biopsy was performed, which revealed that Plaintiff had acute leukemia. The Plaintiff then underwent a series of treatments over the course of several weeks. Eventually, she developed a fever and was subsequently diagnosed with an antibiotic-resistant infection. The symptoms of this infection persisted, until she suffered a massive heart attack and was pronounced dead.

Questions to the Hematology expert and their responses

At what point in the diagnosing process do you usually consult/evaluate patients?

In cases like this, I usually consult/evaluate patients once an abnormality on the Complete Blood Count had been identified.

How many patients on average do you diagnose within a year and how long does the diagnosis process take?

On average, I see 6-10 AML patients a year, a few of whom I diagnose. Prior to 2008 when I left my academic position and went into private practice, about twice that many.

Given the patient's presenting complaints what should have been the differential diagnosis?

Given the patient's presenting complaints, there could have been a different diagnosis. Any elevated white count should bring up the possibility of acute leukemia. There is usually something in the CBC report that gives it away and there may be something in this case, which will make the failure to diagnose earlier more egregious. The issue then is a delay in diagnosing acute leukemia. While there is not much literature on delayed diagnosis in AML, because it is a rapidly fatal disease if not diagnosed, my opinion would be that delay allowed her leukemia to progress and made treatment more difficult to treat. I note the weight loss, which makes her more susceptible to complications and the apparent progression from slightly elevated white counts mimicking infection to such high counts that she required leukophoresis. High white count at diagnosis is a poor prognostic feature. In summary, the delay in treatment allowed her leukemia to progress.

About the expert

This highly qualified, board certified, extremely well published expert earned his bachelor's degree from Yeshiva University and his medical degree from the State University of New York Downstate Medical College. This was followed by a residency in internal medicine at the New York Presbyterian Lower Manhattan Hospital and at Hahnemann University Medical Center. This expert then completed his formal medical education by pursuing a fellowship in Hematology and Oncology at the Long Island Jewish Hillside Hospital Medical Center. This expert has earned numerous awards for his contributions as a physician. This expert is extremely well published, having authored 28 Peer-reviewed Journal Articles, 10 Abstracts and 16 reviews. This expert's mastery of research has allowed him to serve as reviewer and editor for numerous leading medical journals. This expert previously held numerous positions, serving as Director of the Cancer Center of Generations Manhattan, Chief of Hematology and Oncology and associate director of the cancer center at Lincoln Medical Center, Co-Director of the Division of Medical Oncology and Hematology at Brookdale University Hospital, Associate Professor of Clinical Medicine at Cornell University and as Associate Professor of Medicine at the University of Medicine and Dentistry of New Jersey. This expert currently serves as Associate Attending at a regional hospital and on the Medical advisory board for a pharmaceutical company.