Delay in Diagnosis of Thyroid Cancer Results in $900,000 Settlement

2010 Medical Malpractice Trial Report

Lawsuit claimed physician breached standard of care when he failed to follow-up on the plaintiff’s thyroid ultrasound results and radiologist’s recommendation to order CT scan

The plaintiff was a 54-year-old man who was diagnosed with metastatic papillary carcinoma of his thyroid in June of 2007. His medical history is significant for a multi-nodular goiter discovered in October of 2002. On 10/3/02, the defendant, who was the plaintiff’s primary care physician since 1994, ordered an ultrasound of the plaintiff’s neck for a possible left thyroid nodule. On 10/24/02, the plaintiff underwent a thyroid ultrasound which showed that the right lobe measured 6.3 x 3.1 x 3.2 cm and contained several nodules, the largest of which was in the upper pole and measured 2.3 x 1.6 x 1.5 cm. The left lobe measured 4.7 x 2.3 x 1.8 cm and contained a hypoechoic mass adjacent to the upper pole. That mass measured 5.4 x 3.3 x 3.4 cm which was noted to potentially represent an exophytic thyroid nodule The radiologist noted that a CT scan of the neck would be suggested as further evaluation to exclude an extra thyroid mass.

The plaintiff continued to see the defendant on a regular basis up until November 2006. On 3/15/07, the plaintiff presented to a new primary care physician. His new doctor noted that the plaintiff had a history of a multi-nodular goiter. He noted upon examination of the plaintiff’s neck that his thyroid was normal size with no nodules or masses. He also noted that the plaintiff had normal neck range of motion and no cervical, supraclavicular, axillary or inguinal lymphadenopathy.

On 4/5/07, the plaintiff presented to his PCP’s office and was seen by a different doctor who noted that the plaintiff years ago had a thyroid ultrasound that was positive for thyroid enlargement and multi-nodular goiter. Upon physical examination, this doctor noted that the plaintiff had a palpable multi-nodular and indurated thyroid and that it was non tender on exam. The plaintiff was advised to proceed with a thyroid biopsy which ultimately led to the diagnosis of metastatic papillary thyroid cancer.

The plaintiff underwent an extended total thyroidectomy, bilateral modified radical neck dissection, upper mediastinal dissection, and anterior tracheal wall dissection. The pathology report revealed metastatic papillary carcinoma in several lymph nodes at several levels, with tumor extensively involved the left lobe and isthmus as well as the superior pole of the right lobe. There was also extensive lymphovascular invasion and extrathyroidal extension identified.

The plaintiff underwent radioactive iodine treatments for his papillary thyroid cancer. At the time of the settlement, there was no known recurrence of the plaintiff’s cancer.

The plaintiff claimed that the defendant breached the standard of care for a primary care physician when the defendant failed to immediately follow-up on the plaintiff’s thyroid ultrasound results and failed to immediately follow-up with the radiologist’s recommendation and order a CT scan of the plaintiff’s neck. The plaintiff further alleged that this negligence led to a delay in the diagnosis and treatment of the plaintiff’s thyroid cancer.

The defendant contended that he did not violate the standard of care and that nothing he did or failed to do caused or contributed to cause any harm to the plaintiff. The defendant further contended that due to the type of thyroid cancer that the plaintiff had, there was no harm that occurred due to any alleged delay in diagnosis and treatment.

The case settled during discovery for $900,000.

Lawyer for the plaintiff: William J. Thompson, Lubin & Meyer, P.C.

Rhode Island Court: Providence Superior Court

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