Case Summary
An adult male with a history of COPD, hypertension, tobacco use, and lung cancer scheduled a bronchoscopy due to pulmonary nodules. The pulmonary nodules were identified on a chest radiograph many years after his lung cancer remission. The patient refused an image-guided needle biopsy. Therefore, the patient scheduled a bronchoscopy. However, while sedated, the patient allegedly eventually consented to an image-guided needle lung biopsy.
There were procedural complications from the needle-guided lung biopsy. As such, the placement of a right-sided chest tube was required due to the development of complications of pneumothorax and hemothorax during the procedure.
A tension pneumothorax, acute hypoxic respiratory failure, and persistent pneumothorax complicated his hospital stay. Despite intensive care, the patient suffers significant sequelae including persistent atelectasis of the entire right lung. The patient also has severely diminished pulmonary function.
Case Theory
In this case, potential negligent bronchoscopy and needle biopsy of pulmonary nodules resulted in permanent lung damage. There is a potential lack of consent present.
Expert Witness Q&A
- What is the standard when diagnosing and treating patients who present with pulmonary nodules?
- Was a bronchoscopy a viable diagnostic tool for this patient?
- For patients who undergo a needle biopsy of the lungs and/or bronchoscopy, what measures can be implemented to prevent the incidence of pneumothorax and hemothorax?
- What complications are potential or expected risks with a lung needle biopsy?
- Which patients present the highest risk and at what percentage on average?
- How do these risks outweigh the need for biopsy in this patient?
- Were these potential complications, their risk factors, and frequency discussed as the standard of care with the patient?
- Was the patient’s consent to biopsy under sedation valid?
Expert Witness Specialists
Pulmonology and Critical Care Physician Expert
A pulmonologist and critical care physician can speak to causation, the extent of damage present, and patient prognosis.
Surgical Oncology Expert
A surgical oncologist can speak to the surgeon’s performance, the operative process, and the expected risks and benefits of the procedure. This expert can also identify the likely cause of the injury and prognosis.
Anesthesiology Expert
An expert in anesthesiology will be important in providing the standard of care regulations for patient consent. This expert can also identify any possible anesthesia complications that could have affected the outcome of the procedure.
About the author
Erin O'Brien
Erin O'Brien is a senior medico-legal writer and editor, with 25 years of experience authoring healthcare deliverables. Previously, Erin authored an award-winning column in the health and wellness sector, guest hosted a wellness radio show, and received an FMA Charlie Award for Excellence in Writing.
Erin has reviewed and completed case studies for thousands of medical malpractice cases, both plaintiff and defense nationwide, and was presented the US Chamber of Commerce Best Small Business Blue Ribbon designation. Erin is an experienced Medical Risk Consultant and device start-up project manager. She has consulted for numerous successful healthcare and bio-tech start-ups. After completing a Bachelor of Science degree at the University Of Wisconsin, Erin pursued an educational background in Healthcare Risk Management at the University of South Florida. Erin crafts her work with attention to detail, readability, healthcare marketing regulations, and medical standard of care.
