Dana-Farber Wrongful Death Trial Finds Two Docs Negligent

Lawyers’ Trial Report 2008

Failure to diagnose and treat infection leads to the death of 40 year old woman

In April 2003, Amy Altman was diagnosed with Ewing’s Sarcoma, a form of cancer most commonly found in children. After diagnosis, Ms. Altman presented to the Dana Farber Cancer Institute to discuss treatment options. After meeting with one of the defendant oncologists, Suzanne George, M.D., Ms. Altman agreed to enroll in a clinical trial in which she would receive an aggressive chemotherapy regimen every two weeks rather than the standard treatment protocol of every 3 weeks. This particular clinical trial had been offered to children and adults at other institutions; however, Dana Farber had never treated an adult patient on this experimental protocol.

Over the next 8 weeks, Amy Altman received 4 cycles of chemotherapy without any serious complications. However, in mid-June 2003, she developed significant diarrhea. On a June 16, 2003 visit, she reported 5-10 bouts of diarrhea over the past 3-4 days. Despite the fact that diarrhea was not a common side effect of the particular chemotherapy drugs being administered to Ms. Altman, and despite the fact that her body was weakened as result of the chemotherapy in her system (which rendered her more susceptible to infection), the defendant doctors failed to order stool cultures, prescribe antibiotics, postpone her chemotherapy, or otherwise evaluate her diarrhea. Instead, they dismissed her complaints as an “expected” side effect of her chemo treatment, continued her chemotherapy, and sent her home without evaluation.

Over the next two weeks, Ms. Altman continued to suffer from diarrhea. On June 30, 2003, she complained of 17-18 straight days of persistent diarrhea to the defendant doctors, including the attending oncologist, Jeffrey Morgan, M.D. Once again, the defendants failed to order stool cultures, prescribe antibiotics, temporarily halt her chemotherapy, or in any way work up her continued complaints of persistent and progressive diarrhea. Rather, the defendants dismissed her complaints as a “common” side effect of the treatment, initiated her 6th cycle of chemotherapy, and sent her home without proper evaluation.

Over the next week, Ms. Altman’s diarrhea persisted. On July 8, 2003, Ms. Altman presented to the emergency room at Brigham & Women’s Hospital with abdominal pain and difficulty urinating. She was immediately admitted to the hospital and within hours was diagnosed with sepsis and necrotizing fasciitis, a devastating flesh-eating infection. By this time, Ms. Altman was so immuno-compromised by a combination of the chemotherapy and the underlying infection that had caused 25 straight days of diarrhea that her body was too weak to fight off the infection or to withstand life-saving surgery. Over the next two days she continued to deteriorate, and on 7/10/03, at just 40 years of age, Amy Altman died, leaving behind her husband, and 10 month old daughter, and a 5 year old daughter.

An autopsy confirmed the cause of death as infection (sepsis and necrotizing fasciitis). Additionally, the autopsy confirmed that Ms. Altman’s Ewing’s Sarcoma was completely cured.

In response to Ms. Altman’s death, Dana Farber suspended the clinical trial in which Ms. Altman had been enrolled. Eventually, the trial was re-opened for pediatric patients, but the Dana Farber never enrolled another adult patient in this protocol. In 2007, the results of this nationwide clinical trial revealed that, out of all the adults across the country who had participated in this trial, only Amy Altman had died on the protocol. The official report listed her cause of death as infection and concluded that the therapy provided by the defendant doctors was a "major cause of [her] death. "

At trial, the plaintiff presented expert medical testimony that the defendants were negligent when they failed to order a stool culture to test for signs of infection after Ms. Altman reported 3-4 straight days of diarrhea, and again after she reported 17-18 days of persistent diarrhea. The jury heard expert medical testimony that the proper medical practice when treating a patient on an experimental chemotherapy protocol, who reports persistent diarrhea, is to immediately suspect infection as a cause of the diarrhea, to order stool cultures to test for an infectious cause of the diarrhea, and to order broad spectrum antibiotics to treat the infectious diarrhea. The plaintiff presented further expert testimony that Dr. George and Dr. Morgan were negligent when they failed to postpone the administration of Ms. Altman’s fifth and sixth cycles of chemotherapy long enough to allow her immuno-suppressed body an opportunity to recover and fight off the infection.

The plaintiff also presented expert medical testimony that had Amy Altman been treated properly, her infectious diarrhea would have been diagnosed and treated when her body was still strong enough to fight infection, her infection never would have progressed to the point of a super-infection, and she would not have died.

The defendants presented expert medical testimony that it was not necessary to suspect the diarrhea was caused by infection, and for that reason, it was not necessary to order a stool culture, administer antibiotics, or postpone chemotherapy. They presented further expert medical testimony that the persistent diarrhea from which Amy Altman suffered over the 25 days preceding her death was unrelated to the infection that ultimately killed her.

After a six day trial, the jury deliberated for approximately 9 hours. The jury found both Dr. George and Dr. Morgan negligent and that their negligence was the cause of Amy Altman’s death. The jury found that the care provided by the third defendant, Jayesh Desai, M.D., was not negligent.

The jury returned a verdict of $9,436,000. With interest the judgment was $13,587,000.

See also Boston Globe report: $13.5 awarded in hospital death

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