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| Disposition:
(Settlement/Arbitration/Trial) |
Settlement |
Date: |
7/21/2004 |
Type of Case: |
Medical Malpractice |
Allegation(s): |
Patient not referred to urologist despite high PSA |
Result: |
$850,000 |
Case Name: |
John Doe v. Roe Physician and Unnamed Medical Group |
Facts: |
Plaintiff, an active, 65-year-old attorney, had always been in excellent health. He and his wife have been married for 30 years.
Plaintiff had been receiving his medical care from ROE MEDICAL GROUP for a number of years. DR. DOE became his primary care physician in March of 1995. At that time, Plaintiff was 56 years old.
During a routine physical on March 1, 1995, on digital rectal exam, Dr. DOE noted a small left posterior nodule on Plaintiff's prostate. He confirmed in his deposition that such a finding made Plaintiff's prostate exam "abnormal." A PSA done from blood drawn on that date was found to be 3.1 (normal range is 0 to 4). At that time, no additional recommendations were made by Dr. DOE to Plaintiff concerning his prostate.
Plaintiff's next complete physical examination by Dr. DOE was on January 19, 1998. The prostate exam was listed as normal at that time. A PSA test was not done.
On April 14, 1998, Plaintiff sent a fax to Dr. DOE indicating that as part of an insurance examination, the lab work showed a PSA of 5.3. Plaintiff wrote a note on the letter to Dr. DOE saying he thought he had had a normal PSA in January, and asked the doctor to call him. Dr. DOE indicated that the PSA had not been re-checked in January and instructed Plaintiff to come in for a test. Blood was re-drawn on April 14, 1998, and the PSA came back with a reading of 3.5. Dr. DOE communicated with Plaintiff that his PSA was within a normal range and nothing further needed to be done, and not to worry.
The next complete physical examination done by Dr. DOE on Plaintiff was on March 8, 2001. At that time, it was noted that Plaintiff's father died of liver cancer, and that he had prostate cancer as well. The digital rectal exam done at that time again showed a small left posterior nodule on the prostate - an abnormal finding. The blood collected on that same date, March 8th, returned a PSA of 4.7, clearly abnormally high. Dr. DOE signed off on the results of the lab work, including the PSA, confirming that he was aware of it. Plaintiff also underwent a sigmoidoscopic examination, on April 10th, which revealed that the prostate was enlarged.
On April 16, 2001, Plaintiff called and left a message for Dr. DOE asking that the doctor call him with the test results. Again, Dr. DOE's handwritten notes indicate he received the message, and called Plaintiff to tell him that his labs were "within normal limits." No additional follow-up was suggested concerning the abnormal prostate exam or the abnormal PSA.
Plaintiff returned for his next complete physical exam on February 14, 2003. At that time, his prostate exam showed it to be 1+ enlarged, as well as firm on the left without discrete nodule. In his note, Dr. Doe indicated that if Plaintiff's PSA was in the 3 to 4 range, that Plaintiff would be referred to a urologist. Plaintiff's PSA came back at 14.1.
On self-referral, Plaintiff was seen by urologist Stephen Bridge on March 26, 2003. A transrectal ultrasound and biopsy were performed, which showed prostate cancer in both the right and left lobes of the prostate, although the left was the primary lobe involved. Bone scans subsequently showed that Plaintiff had metastatic spread in the right pubis, the right femur and the right tibia. Plaintiff was started on androgen ablation (hormone) therapy and scheduled to receive an injection of Lupron. As the cancer had already spread beyond the prostate, surgery has not been and will not be an option for Plaintiff.
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| Injury/Injuries: |
Plaintiff's prostate cancer was not diagnosed until there was already distant metastatic spread. At this point, there is no treatment to provide cure for Plaintiff's prostate cancer. The treatment can only be palliative. Dr. Millard, a treating physician not retained as an expert, testified that the statistical probability is that Plaintiff will not survive more than three years from the time of his diagnosis.
Plaintiff claimed general damages in the amount of $250,000.00, and economic damages in the amount of $667,628.00, which did not include out-of-pocket future medical care needs.
Although not a named plaintiff to the lawsuit, Plaintiff's wife's future claim for the wrongful death of her husband was also a consideration in this case. She claimed the maximum general damages amount allowed under California law of $250,000.00 for her potential wrongful death action.
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| Contentions: |
This is a clear case of liability. Defendant ROE MEDICAL GROUP's own records contained an algorithm for prostate cancer screening used there. This document indicates an abnormal digital rectal exam is grounds for referral to a urologist for a biopsy. Further, an abnormal PSA (more than 4.0) is a separate ground for referral to a urologist.
Plaintiff alleged that the first abnormal prostate examination, i.e., the exam showing the nodule on the left lobe of the prostate in March of 1995, required at least a discussion by Dr. DOE with Plaintiff about the need for referral to a urologist to determine if a biopsy needed to be done.
Plaintiff alleged there was a second violation of the standard of care in 1998, when Plaintiff had a PSA of 5.3 as part of the insurance eamination. Even though the subsequent PSA came in at 3.5, the fact of the matter is that these PSA' can fluctuate, and this should have been a second opportunity for referral to a urologist.
Lastly, plaintiff alleged there was no doubt that in March of 2001, with an abnormal prostate examination, i.e., a nodule on the left lobe of the prostate and a PSA of 4.7, that Plaintiff should have been referred to a urologist for a biopsy at that time.
Experts retained by plaintiff, including a prominent urologist at Cedars-Sinai, Dr. Brosman, who specializes in prostate cancers, as well as a prominent pathologist, Dr. Contardo, were prepared to testify that had this diagnosis been made, as late as March of 2001, Plaintiff's cancer would have been confined to the prostate and he would have had an 80 90% probability of five-year survival and cure. He would have needed surgery only.
Defendants alleged that they complied with the applicable standards of care, and that there was no causation.
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| Special Notes: |
On June 22, 2004, Plaintiff and his wife agreed to accept $850,000.00 in full settlement of both Plaintiff's claims against the defendants, and his wife's claim for her potential wrongful death action. The settlement occurred before expert witnesses were deposed.
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