Delay in Diagnosis of Lung Cancer: $1.5M Settlement

2017 Medical Malpractice Trial Report

Failure to address cough and order chest x-ray leads to delay in lung cancer diagnosis

The plaintiff was a 62-year-old man who was diagnosed with metastatic lung cancer in March of 2013. The plaintiff claimed that there was a seven month delay in diagnosis of the cancer, leading to a worse prognosis.

On 8/9/12, the plaintiff presented to his primary care physician (PCP) at Beth Israel Deaconess for a cough that began 3 months earlier. He described his cough as exacerbated with food or drink. He was able to exercise without exacerbation of the cough or shortness of breath. He had a history of Schiatzki’s Ring, which was diagnosed in 2005 following an upper endoscopy. He had GERD and was taking omeprazole. His lungs were clear to auscultation. The PCP’s impression was GERD, and he questioned aspiration. His plan included a request to the treating GI for an EGD study. He also recommended the patient increase his omeprazole to twice per day.

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Missed cancer xray photoA missed cancer case is often referred to as a "failure to diagnosis" or a "delay in diagnosis" of cancer, and is one of the most common reasons patients file a medical malpractice lawsuit.

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On 12/6/12, the patient returned to his PCP with continued complaints of cough. He reported that he was able to climb 6 flights of stairs and ride a bike. He denied having shortness of breath. His PCP’s impression was that it was not a cough variant asthma. The PCP questioned why the patient had not followed his advice from August. He repeated his recommendation for an EGD and repeated his recommendation to increase omeprazole to twice a day.

On 1/9/13, the patient underwent an upper endoscopy (EGD) which was essentially unchanged from the prior study.

On 3/18/13, the plaintiff was seen by a pulmonologist who noted the patient’s intermittent, but lingering cough since May 2012. The pulmonologist noted that the plaintiff’s medical history included GERD and an esophageal Schatzki’s ring. On examination, the patient’s lungs were clear to auscultation and percussion. The pulmonologist also thought the cough was GERD related, however he ordered pulmonary function tests and a chest x-ray for further evaluation.

The chest x-ray showed a round 4-cm homogeneous soft tissue density mass along the superior portion of the left hilum, concerning for a malignancy. Further testing confirmed metastatic lung cancer.

The plaintiff claimed his PCP should have ordered a chest x-ray sooner. The PCP argued that it was reasonable to believe the cough was related to GERD, had been intermittent for 20 years, and that any delay was caused by the plaintiff not getting the EGD study, to rule out GERD as the cause.

The case settled on the third day of trial for $1,500,000.

Middlesex Superior Court

Lubin & Meyer attorneys for the plaintiff: Andrew C. Meyer and William J. Thompson.

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