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Articles Posted in Delay to Treat or Failure to Diagnose a Medical Condition

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Small_cell_carcinoma_of_the_ovary_hypercalcemic_type_-_low_magIn 2011, Oriana Sousa, a Portuguese psychologist who is now 28 year-old was diagnosed with a rare form of ovarian cancer. When the symptoms started doctors initially failed to diagnose the cancer. For several months Oriana suffered from frequent constipation and fatigue. She was also thirsty all the time. Then she started to have terrible abdominal pain and began vomiting. Her doctor told her she was fine and she shouldn’t worry. Her aunt who is a nurse recommended that she see visit another doctor. The new doctor performed a CT scan and found a massive tumor. Oriana was diagnosed  with a very rare, aggressive and fatal form of ovarian cancer.

Immunotherapy shrank the tumor to the surprise of the doctors

During several years Oriana went through surgery, chemotherapy and radiotherapy to try to eradicate the tumor however new tumors would grow back. Then Oriana convinced her doctor to give her nivolumab, an immunotherapy drug that was not supposed to be used on her tumor. The tumor reacted immediately and shrank. As she continued to take the drug the tumor shrank to the point that she has no more evidence of the disease. Now doctors and researchers are trying to figure out why they were wrong.

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African American Patient with DoctorsMedical Malpractice may have been committed on many American Africans who were previously diagnosed with hypertrophic cardiomyopathy.  A recent study found that some genetic variations that were linked to this condition were indeed harmless. These specific genetic variations were found more often in black Americans than in white Americans. Therefore many patients from African descent may have been misdiagnosed or are still being treated for a condition they don’t suffer from.

Also called, abnormally thick heart muscle, hypertrophic cardiomyopathy is a genetic disease that affects 1 out of 500 Americans. The disorder can cause arrhythmia and can be fatal. Symptoms may include chest pain, difficulty, breathing, fatigue and swelling in the ankles and feet. For a complete list and diagnostic testing see The American Heart Association web site. Sometimes there are no symptoms.

Abnormally thick heart muscle is diagnosed through genetic testing. A patient who tests positive for  the condition will often be required to change his or her lifestyle. These changes may include healthy diet, additional physical activities, losing excessive weight or stopping smoking. Patients diagnosed with hypertrophic cardiomyopathy  are often prescribed specific medication to treat the condition.  Various types of surgeries are also commonly used as well as  alcohol septal ablation, a noninvasive procedure.

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alcohol withdrawal symptoms vary depending on the level of addictionFailure to diagnose alcohol withdrawal symptom (AWS) can be medical malpractice that may cause severe injury or even death in some cases. The ECRI Institute  is looking at options to  better “Identify Alcohol Withdrawal Symptoms Early and Ease Patients’ Care”.

An estimated 20 % of the patients that are admitted in US hospitals show symptoms of alcohol abuse or dependence. Those that are admitted for alcohol poisoning and detoxification may be difficult to treat but their alcohol withdrawal symptoms will usually be properly diagnosed and addressed.

Patients at a higher higher risk to be misdiagnosed for alcohol withdrawal symptoms are those who are admitted for a different medical condition than alcohol intoxication or dependence.

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newbornFailure to diagnose or delay to treat a bacterial infection in a newborn can be medical malpractice. Doctors (and also parents) may sometimes be reluctant to submit a young infant  to a lengthy and complicated process in order to  find out if a fever may  be caused by a bacterial infection. Thanks to new research this process may become much easier in the future.

Fever is usually one of the first symptom of a bacterial infection. However it can also be caused by other medical conditions. When a health care provider evaluates a young infant with fever and suspect an infection, there is no quick way to find out if the infant suffers from a bacterial infection. The actual method consists in isolating live bacteria from blood, urine or spinal fluid and grow a bacteria culture in a laboratory. This may require difficult and traumatizing medical procedures such as spinal tap. Additionally the  infant may necessitate hospital admission and an antibiotic prescription until the results of the tests are available.

A recent study that was published on Aug. 23, 2016 in the Journal of the American Medical Association found that through advances in genetic sequencing technology it may soon be possible for doctors to diagnose bacterial infections in infants with fevers quickly and in a non invasive manner.  More work is needed but in the future only a small blood sample may be enough to immediately determine if an infant suffers or not from a bacterial infection.

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Desmoid-type_fibromatosis.gross_pathology Although very rare, failure to diagnose and treat desmoids tumors, also called aggressive fibromatosis, a tumor that develops in the fibrous tissue that forms tendons and ligaments, can be medical malpractice. Desmoids tumors are very rare and difficult to diagnose and doctors are still debating what is the most appropriate categorization and treatment. In a recent article in the Washington Post, Sandra G. Boodman writes about a 24 year woman who suffered several episodes of excruciating stomach pain before being diagnosed and treated for a desmoid tumor.

Johanna Dickson was 23 years old when the first symptoms of the disease occured. She had just come back from South Africa when she suffered a first episode of acute abdominal pain. She thought she caught some type of stomach bug in her last trip. The family doctor sent her to the hospital for various tests but nothing was found and the pain disappeared.

Another crisis happened six months later but it went away quickly so she didn’t even bother to see a doctor.

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renal mass

renal mass in a 3 year olds child

Failure to timely diagnose Denys-Drash syndrome can be medical malpractice that can lead to renal failure and ultimately death. Denys-Drash syndrom is a very rare congenital disorder that affects young children. There are only 150 known cases in the world therefore very little information is available for doctors to diagnose and treat this disorder.

What is known so far is that  90% of the children with this disorder develop a rare pediatric kidney cancer known as Wilms tumor. Undescended testes and severe proximal hypospadias are also associated with this disorder. The Journal of the American Academy of Physician Assistants (JAAPA) recently released an article describing the case of a 3 year old patient affected by this syndrome. The authors Shawn C. Smith,  Barry Chang and Laura Beth Fleming are all from the Cardon Children Medical Center in Mesa, AZ where the patient was admitted.  The article describe how the authors of the article diagnosed the disorder and which treatments were used to treat the patient. The complete article can be found here 

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Distribution of the maxillary and mandibular nerves, and the submaxillary ganglion. Source: Wikipedia

Facial nerves, Source: Wikipedia

Failure to diagnose a rare disease called trigeminal neuralgia (TN) can be medical malpractice. The disorder can cause pain so extreme to a patient that it has been nicknamed “the suicide disease”.

In a recent article in the Washington Post, Sandra G. Boodman describes the story of a 59 year old man who almost died after a cohort of doctors he visited were unable to make a proper diagnosis.

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Multiple cases of medical malpractice committed by several doctors including 3 neurosurgeons almost killed a patient according to a recent article written by Sandra Boodman in the Washington Post. Brad Chesivior from Maryland almost died after several doctors failed to diagnose a brain bleed. When a neurosurgeon finally made the proper diagnosis, the acute subdural hematoma that he was suffering from was as large as the size of an adult’s palm and was threatening to kill him. According to the neurosurgeon who made the proper diagnosis, Bard had probably no more than 24 hours to live and needed immediate surgery.

In the article the author describes how multiple doctors misdiagnosed the 60 year old man to the point that he almost died. The first significant symptoms appeared just after Thanksgiving 2013. Chesivoir suddenly became very weak and unable to walk. He was transported by ambulance to a Maryland emergency room. As he arrived at the ER he felt better and was able to walk again. The ER staff performed CT and MRI brain scans as well as multiple blood tests.  Doctors thought that he was the victim of a heart attack or a stroke but tests didn not show any of these. They completely missed evidence of multiple bleeds and sent Chesivior home with a diagnosis of headache.  They told him he should consult with his internist.  Chesivior went to see his internist who recommended he sees a neurosurgeon. The neurosurgeon looked at the previous scans made at the ER and missed the bleeds too. Instead she ordered additional tests and scheduled a follow up appointment almost two months later. In between, Chesivior’s headaches got worse. When they got even worse, he consulted with another neurosurgeon as his neurosurgeon was out of town. The second neurosurgeon told him that his problem was a typical migraine and prescribed amitryptiline. A few days later he developed double vision. The neurosurgeon told him it was an adverse effect from the medication and reduced his dose. The problem got worse. Two days later, he went to consult with a ophthalmologist who told his wife to drive him immediately to the ER where a fourth neurosurgeon finally proprely diagnosed the problem and saved him from death by operating on him the following day.

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Among the various types of medical malpractice suffered by hospital patients, misdiagnosis accounts for approximately 10% of patient deaths. In a recent Opinion Page from the New York Times, Sandeep Jauhar, a Long Island cardiologist, wants to Bring Back the Autopsy as a weapon to fight misdiagnosis.

With the evolution of medicine and the proliferation of medical tests, autopsy doesn’t seem as essential these days as it was in the past to determine the cause of death of a patient. Before 1971, community hospitals were required to perform autopsies on 20% of their dead patients to earn their accreditation from the Joint Commission. This requirement was dropped after that date. Furthermore in 1986, Medicare considered autopsies financially draining and stopped paying for them. Now an autopsy is mostly considered by doctors as an educational tool.

Recent studies however have demonstrated that despite the medical technological advances autopsy can be a very effective manner to reduce the rate of hospital misdiagnosis.  In his opinion Sandeep Jauhar suggests that Medicare and private insurers pay for them again so that financial considerations doesn’t limit their use.

 

 

 

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In a recent article, Sandra G. Boodman from the Washington Post writes about the case of a man whose doctors failed to diagnose Familial Mediterranean Fever (FMF) for months until he consulted with a well traveled gastroenterologist who suspected FMF. FMF is a disorder caused by a gene mutation. this disorder is known to affect Sephardic Jews, whose ancestry is Middle Eastern, as well as non-Jews from the Middle East, Italy and Armenia.

43 year old Jeffrey Sank suffered from recurrent abdominal pain for nearly a year. At the beginning attacks were intermittent but after several months the pain increased in severity and intensity. Jeffrey visited with multiple doctors including two gastroenterologists, a kidney specialist and an infectious-disease physician.  The infectious-disease specialist suspected he had FMF but but did not pursue it after Sank told him he wasn’t of Middle Eastern descent. The last gastroenterologist he saw also suspected it was FMF and even though Sank again denied any Middle Eastern descent again, he decided to prescribe him colchicine, a mainstay therapy for FMF. The drug worked immediately and the abdominal attacks almost stopped. Later on genetic tests demonstrated that Sank had indeed inherited mutated genes from both his parents.

 

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