Medical expert witnesses are crucial when analyzing a medical malpractice case, especially one concerning errors in diagnosis. In the medical field, few diagnoses are more serious, or life-threatening, than cancer. According to the American Cancer Society, over 12.5 million individuals in the United States are living with cancer. It estimates that half of all men and one-third of all woman will develop cancer during their lifetimes.
The treatment of most kinds of cancer is largely dependent on how fast the specific cancer is identified. Most cancers are organized into stages, with stage one being the least invasive (usually localized to a specific tumor or area) and stage four or later being extremely invasive, usually to other tissues and organs in the body. Given this, survival rates dramatically decrease the longer it takes for an accurate diagnosis to occur. Because of this, an efficient diagnosis is critical to saving the life of a cancer patient.
Medical practitioners have a specific duty to appropriately identify and treat cancer in patients. Unfortunately, in some cases, there are errors which cost the patient valuable time to begin treatment. Subsequently, malpractice suits are brought against practitioners who fail to identify such issues. Overall, failed or delayed diagnoses are the most prevalent claims brought against medical practitioners in malpractice suits.
In medical malpractice suits involving diagnosis errors, medical expert witnesses are needed to discuss the standard of care by the diagnosing practitioner and any subsequent treatment decisions. Specifically, given the numerous stages and treatment options available, many cases require numerous medical expert witnesses to speak on the progression of a case. For example, in a recent case, a patient who displayed symptoms for lung cancer, namely blood when coughing and shortness of breath, had reports done by a radiologist, who recommended further tests, and a pulmonologist, who stated that further testing was not needed.
The patient was later examined, and it was revealed that he had advanced small cell carcinoma of the lung with distant metastases. In this type of case, medical expert witnesses are needed to discuss the actions of the pulmonologist, but medical expert witnesses can also be brought in to discuss the actions of the radiologist (specifically regarding his/her interactions with the pulmonologist).
While this case deals with lung cancer, it highlights the different layers of each case. When examining a failure-to-diagnose case, attorneys should be aware of the different medical practitioners involved and the roles they played. Cancer is complex, and failure to diagnose cases can be just as difficult. Finding the right medical expert witnesses can analyze the specifics of the case and where errors may have been committed.
Introduction to cancer
Cancer is a general name for a group of more than 100 diseases, but all cancers are caused by abnormal cells growing out of control. Specifically, cancer refers to a malignant tumor (as opposed to a benign tumor, which is defined as being noncancerous). To determine whether a tumor is malignant, it needs to be described as “locally invasive” and “metastatic.” Locally invasive implies that the tissues around the tumor can be invaded by the tumor “sending out a ‘finger’ of cancerous cells.” Metastatic tumors are when the tumor, “can send cells into other tissues in the body, which may be distant from the original tumor.”
Also, for purposes of treatment and diagnosis, it is important to note that the cancer is named for the location where it starts. “For example, breast cancer that has spread to the liver is called metastatic breast cancer, not liver cancer.” For a more detailed explanation of cancer, and the manner in which cancerous cells proliferate, see below:
While certain links run through all types of cancer, symptoms, risk factors, and treatment options vary widely among the different types. Furthermore, even within similarly classified types of cancer, and different stages of cancer, treatment options vary. This places an even greater importance on identifying the correct diagnosis, and stage of cancer. If a practitioner fails to diagnose a patient, this may give rise to litigation.
Failure to Diagnose/ Delayed Diagnosis
In cases where a patient alleges a failed or delayed diagnosis, the key factors revolve around the different opportunities for diagnosis. This can include whether the treatment was ongoing, what specific complaints the patient had, and what symptoms the patient displayed. A lack of diagnosis can be for numerous reasons. In some cases, the error occurs because the doctor negligently ignored relevant risk factors or symptoms, and in other circumstances, the error can be in the manner in which the actual complaints were investigated.
The types of cancer usually have different symptoms, which, if present in a patient, should give an indication to the treating physician that something may be wrong. Risk factors, however, also play a role, and can suggest something amiss within the patient. Overall, it is a cumulative effect, and conclusions are reached by examining the totality of the circumstances. Medical expert witnesses can be brought in to analyze the different aspects as they existed in the individual case. Let’s start with risk factors, which, if present and missed by the physician, may be grounds for malpractice in a cancer case.
General risk factors for cancer
According to the National Cancer Institute, the ten most common risk factors for cancer are:
1) Growing older
While cancer can occur in people at any age, most instances occur in adults over the age of 65.
With the numerous carcinogens found in cigarettes, NCI states that studies indicate that smokers are more likely to develop cancer of the lung, larynx, mouth, esophagus, bladder, kidney, throat, stomach, pancreas, and cervix. Also, they are more likely to develop acute myeloid leukemia.
Ultraviolet (UV) radiation, which is produced by sunlight and tanning booths, can damage skin and significantly increase an individual’s risk of skin cancer.
4) Ionizing radiation
Radiation found in radioactive fallout, radon gas, and x-rays can increase an individual’s risk of leukemia, thyroid cancer, breast cancer, lung cancer, and stomach cancer.
5) Certain chemicals
Studies have indicated that asbestos, benzene, benzidine, cadmium, nickel, and vinyl chloride increase the risk of certain types of cancer.
6) Some viruses and bacteria
HPV, HIV, and certain kinds of Hepatitis, among other types, increase risks for different kinds of cancer.
7) Certain hormones
Namely citing specific hormones that were prescribed to women to help mitigate the effects of menopause, studies revealed that the hormones tended to increase a woman’s risk of breast cancer and blood clots.
8) Family history of cancer
Due to its genetic nature, some types of cancer tend to have a higher probability of occurring within families. Specific examples include breast, ovarian, prostate, and colon.
9) Excessive alcoholic usage
Similar to some of the harms associated with smoking, consistently having more than two drinks a day increases one’s risk for cancers in the mouth, throat, esophagus, larynx, liver, and breast.
10) Poor diet and lack of physical activity
Maintaining a healthy lifestyle is important to ensure that the body is functioning and developing correctly.
Symptoms of different types of cancer
While risk factors have a significant amount of overlapping, when discussing specific symptoms, the breakdown is tailored to the diagnosis in question. In most cases of malpractice, there are usually some signs of cancer, but they were missed by the treating physician. In order to better comprehend a malpractice claim, medical expert witnesses can help an attorney understand what symptoms are usually suggestive of cancer. The eight most prevalent types of cancer in the United States are listed below along with the number of new diagnoses made every year and the symptoms that should give rise to a diagnosis.
Prostate Cancer: 238,590
Prostate cancer is the cancer of the prostate gland, a small, walnut-sized gland that is part of the man’s reproductive system. Symptoms include issues with urination, blood in urination or semen, or pain in the lower back (after the cancer has spread).
Breast Cancer (Female/Male): 232,340/2,240
Breast cancer is a malignant tumor that begins in the breasts. Symptoms usually include a lump or thick mass that feels different than the surrounding tissue, and a bloody discharge from the nipple. Other abnormalities including changes to either the shape of the breast or nipple may be indicative of said cancer.
Lung Cancer: 228,190
Lung cancer is the abnormal growth of cells in the lung and is the leading cause of cancer deaths. Symptoms usually include harsh coughing, wheezing, difficulties breathing, and blood when coughing.
Colon/Rectal Cancer: 142,820
Colon cancer is cancer of the large intestine (colon), the lower part of the digestive system. Rectal cancer is cancer of the last several inches of the colon. Symptoms can include inconsistent bowel movements, rectal bleeding, blood in one’s stool, constant abdominal pain, weakness or fatigue, and unexplained weight loss.
Melanoma is the most serious type of skin cancer and is characterized by 4 types: superficial spreading melanoma, nodular melanoma, lentigo maligna melanoma, and acral lentiginous melanoma. Symptoms usually include a sore, lump, mole, or growth, especially if it bleeds or changes the skin color.
Bladder Cancer: 72,560
Bladder cancer is cancer in the part of the urinary tract that stores urine until it is ready to be excreted. Symptoms include frequent UTI’s, blood in the urine, painful urination, and frequent urination.
Non-Hodgkin’s Lymphoma: 69,740
Non-Hodgkin’s lymphoma “is cancer that originates in your lymphatic system, the disease-fighting network spread throughout your body.” Symptoms can include swollen lymph nodes, abdominal pain or swelling, chest pain, fatigue, fever, and weight loss.
Thyroid Cancer: 60,220
Thyroid cancer is cancer that starts in the thyroid gland located in the front of the lower neck. Symptoms can include persistent coughing, swallowing issues, enlarged thyroid gland, and swelling in the neck.
Types of medical expert witnesses in a medical malpractice suit
If a particular type of cancer is identified after the patient sought medical assistance, and symptoms or risk factors were present, there may be a viable medical malpractice case against the treating physician. For such a case, however, medical expert witnesses are critical to establishing the elements required.
Medical expert witnesses to address specialty involved
The medical expert witness you select needs to have a similar background to that of the treating physician. The ideal candidate has the same subspecialty and the same board certification. If a specific procedure was performed during the diagnosis, the medical expert witness will be familiar with the procedure and ideally perform it frequently. For example, in a recent breast cancer case, a surgeon performed a bilateral mastectomy, but chose to leave the axilla intact. This later became an issue during litigation, and the medical expert witness had to speak to their specific experience performing a bilateral mastectomy. When explaining aspects of the standard of care, relevant experience is a critical component, especially when discussing the different parts of cancer treatment.
Oncology expert witness
Oncology is the study of cancer, and oncologists are usually involved with the diagnosis and treatment of the disease. There are three specific types of oncologists that are particularly important in the context of a cancer diagnosis. Medical oncologists will oversee the general care that a patient may receive, and will be in charge of chemotherapy, hormone therapy, and immunotherapy. Also, they will be visited for long-term, regular checkups.
Radiation oncologists focus on utilizing radiation therapy to treat cancer. They will have specific interactions with radiologists and discuss treatments, accordingly. Surgical oncologists may be called in to diagnose cancer with a biopsy, and can treat cancer by way of surgery. If an error occurs with the analysis of the biopsy, then a suit may be brought against the practitioner performing the biopsy.
General medicine expert witness
In many cases, patients may have limited symptoms that prompt a visit to their family physician. In these cases, if risk factors are present, coupled with symptoms, the general practitioner should refer the patient for more testing. If this does not occur, a malpractice suit may be brought for failure to recognize the introductory stages.