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

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Jappa.jpegFailure to diagnose May-Thurner Syndrome may be medical malpractice that can lead to post-thrombotic syndrome, potentially fatal pulmonary embolism, pulmonary hypertension, and in the worst case paradoxical embolism.

In a recent article published in the current issue of the Journal of the American Academy of Physician Assistants, the author Jaclyn Leitner who practice general medicine in Newark, New Jersey describes the case of a 28 year old female marathon runner who visited her office with groin pain. The author explains how to properly diagnose May-Thurner syndrome and the available treatments.

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In a very sad medical malpractice case a 16 year old girl died of brain cancer after none of the 13 doctors who failed to diagnose the brain tumor ordered an MRI. Natasha Simmons had all the symptoms of a brain tumor: headaches, numbness, back pain, vomiting and problems with her eyesight. She visited 13 doctors over a one year period but none of them ordered an MRI. An ER doctor refused a scan and said they were reserved for life and death situations. 11 months later, an MRI was finally done but it was too late. Natasha Simmons was diagnosed with a cancerous brain tumor and died 8 days later.

Read more in the Huffington Post

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Doctors often fail to diagnose cancer in women with dense breast tissue because mammograms screenings are not reliable for women with this condition. Recent statistics and studies also show that women with dense breast tissue have a higher risk of developing breast cancer. Therefore advocacy groups have been pushing for legislation that requires doctors to report breast density to their patient. In New York, failure to inform a patient about dense breast tissue is now against the law and may support a claim of medical malpractice. The legislation was signed by Governor Cuomo on July 23 2012 and took effect last January. A total of 18 states have enacted dense breast notification laws, and 10 more have laws pending. Who is supposed to do the reporting and what they are supposed to tell patients varies from state to state.

In “Dense Breast Legislation in the United States: State of the States” published in the December issue of the Journal of the American College of Radiology, Soudabeh Fazeli Dehkordy, MD, MPH, and Ruth C. Carlos, MD, MS, from the Department of Radiology at the University of Michigan School of Medicine in Ann Arbor provide a detailed review of the state of this law at states and federal level.


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Diagnostic errors are among the most significant medical malpractice areas in the United States. In the current issue of “Current Problems in Pediatric and Adolescent Health Care” entitled “Diagnostic Errors and Strategies to Minimize Them”, Satid Thammasitboon, William Cutrer, Supat Thammasitboon, Amy Flemming, William Sullivan, and Geeta Singhal provide a detailed overview of one of the most important patient safety problems in medicine Today.

More specifically the authors look at

  • the most recent cognitive theories related to how doctors think
  • how to teach diagnostic acumen
  • Contribution of diagnostic testing to the problem of diagnostic errors
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Misdiagnosis is the leading cause of medical malpractice claims. 160,000 patients suffer serious personal injury or wrongful death because of diagnostic errors every year. In her recent article “The Biggest Mistake Doctors MakeLaura Landro from the Wall Street Journal looks at solutions that are being developed by healthcare providers and various organizations to reduce misdiagnosis.

New technologies as well a change of culture among doctors are part of the solution. The new healthcare law requiring multiple providers to coordinate care should also help in making sure patients receive a proper follow up. Additional studies such as the one undertaken by the institute of Medicine (See previous blog) or the Society to Improve Diagnosis in Medicine should also contribute to curb this alarming trend.


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A recent study looked at the medical malpractice claims of the 2 largest insurance companies in Massachusetts during five years. The study, published in JAMA Internal Medicine and led by Doctor Gordon Schiff (Brigham and Women’s Hospital’s Division of General Internal Medicine and Primary Care) looks at patterns of primary care malpractice types.

During the five years under review there were 7224 medical malpractice claims of which 551 (7.7%) were from primary care practices. Out of these 551 cases, researchers found out that most medical claims were failure to properly diagnose a condition (72.1%). Other malpractice claims were related to medication errors (12.3%), medical treatment errors (7.4%), failures to communicate properly (2.7%), patient rights (2.0%), and patient safety or security(1.5%).

According to the author “many of these claims “appear to be due to failure in more routine yet high volume outpatient office processes”. The study also found some evidence suggesting that “outpatient primary care in general and diagnostic cases in particular were less defensible than other malpractice claims because they were significantly more likely to be settled (35.2% vs 20.5%) or result in a verdict for the plaintiff (1.6% vs 0.9%) compared with non–general medical malpractice claims.

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Diagnostic errors are among the leading causes for Medical Malpractice Claims in the US. They cause personal injury to patients and waste resources.

Recently the Society to Improve Diagnosis in Medicine (SIDM) announced that the Institute Of Medicine (IOM) had accepted the SIDM’s proposal to undertake a report on diagnostic error as the next volume in the Crossing the Quality Chasm series. The “Quality Chasm Series” started in 2000 with the report “To Err is Human”. The publication of this report is often associated with the beginning of the patient safety movement.

Other IOM’s Quality Chasm series includes Health IT and Patient Safety (2012), Preventing Medication Errors (2006), and Crossing the Quality Chasm (2001).

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Failure to diagnose Marfan Syndrom (MFS) may be medical malpractice that can have severe medical consequences and sometimes lead to death. It can also destroy the lifestyle of individuals and their familes.

In a recent article, Sandra G. Boodman, from the Washington Post, writes about Kevin Songer, a 54 year old man from Florida who underwent heart surgery and endured 50 years of pains and anxiety before a doctor correctly diagnosed him with Marfan Syndrom.

Marfan Syndrom is a genetic condition that affects the connective tissue. It is usually passed from parents to children. Indivuduals suffering from Marfan Syndrom are usually very tall and thin with longer than usual arms legs fingers and toes. Marfan Syndrom can cause dental and bones problems, eyes problems, blood vessel changes, cardiomyopathy, aortic root dilatation, arrhytmia as sometimes lung and skin changes. Even though there is no cure for MFS, early diagnosis can significantly increase the life expectancy of individual suffering from this condition.

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In this medical malpractice case the plaintiff was diagnosed with Stage 1 breast cancer in her right breast. She underwent a right breast mastectomy. She had a family history of breast cancer. Seven years later in 2007 she was diagnosed with ovarian cancer. The plaintiffs alleged that, given the plaintiff’s own medical history and that of her paternal family, as well as her father’s Ashkenazi Jewish ethnicity, defendant’s failure to recommend, prior to November 2007, “BRCA” genetic testing or prophylactic surgery removing her ovaries, which could have prevented the onset of her ovarian cancer, constituted medical malpractice. In reversing the Court below and reinstating the complaint the Court held:

“Here, the allegations in the bills of particulars concerning the period from March 2001 through November 2007, when the patient was under defendant’s care, were that defendant departed from the accepted medical practices of that time by failing to recommend “BRCA” genetic testing and “prophylactic oophorectomy or bilateral salpingo-oophorectomy” to the patient, given her personal and family medical history. Since the respondents’ expert failed to provide any information as to what the accepted medical practices were during the period at issue with regard to BRCA genetic testing, and did not refute or even address (see Berkey v Emman, 291 AD2d at 518) the specific allegations regarding the failure to recommend prophylactic oophorectomy or bilateral salpingo-oophorectomy, the respondents did not meet their prima facie burden on the issue of whether there was a departure from accepted medical practices.

Accordingly, the Supreme Court should have denied the respondents’ motion for summary judgment dismissing the complaint insofar as asserted against them.” See: Mancuso v. Friscia, et al., 2013 NY Slip Op 05515.

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An elderly woman with an history of pancreatitis was admitted for an emergency laparotomy after she showed symptoms of acute abdominal pain, nausea and vomiting. The diagnosis was small bowel obstruction. Her heart stopped during anesthesia and she had to be resuscitated and sent to the ICU. She died there the day after. The hospital’s case review committee concluded it was a misdiagnosis: the patient suffered acute pancreatitis and not a small bowel obstruction therefore surgery was contraindicated and death could have been prevented. This type of cases raises questions about the decision process in emergency surgery, specifically for elderly people. The complete case as well as a medical commentary, references and World Health Organization Surgical Safety Checklist can be found at Web M&M.