Emergency Medicine Witness Case
Letter From Medical Expert Witness
I, XXX M.D., M.S., am licensed physician board certified in Emergency Medicine, Family Medicine, Geriatrics and Forensic Medicine. I am a physician licensed to practice medicine in XXX and XXX. I currently practice or teach is the areas of medicine applicable to this case. I am familiar with the standard of care for medical practices that currently relate to issues of care and treatment of patients such XXX. I am familiar with the standard of care in this case by virtue of my training, education and experience for over 25 years in the same filed and/or related healthcare providers practiced when treating XXX. The board of emergency medicine, geriatrics, family practice and internal medicine share the same knowledge, training, education and experience when treating a X year old patient like XXX. I can fairly evaluate the quality of care that was provided. Attach is a copy of the current curriculum.I have reviewed the available medical records of XXX.
These include the following:
- XXX Hospital.
- Dr. X (PCP)
I have the expertise to evaluate the reliability of these records. These records are the type usually relied upon by reviewers such as myself. I have used the accepted medical techniques of record examination to evaluate the care provided. As healthcare has become increasingly complex, it is important for reviewers like myself to keep the documented interaction between a patient, healthcare institution and healthcare providers including physicians at the heart of the review process.
While it is true to some extent that all patient interactions are unique, however, there are specific medical practices that a treating physician and treating institution would be expected to provide to meet the applicable standard of care. I have specifically reviewed these records to determine whether within reasonable degree of medical certainty that the standard of care was met. The above records disclose the following facts in summary:
On X, Mr. X was a long-standing patient of Dr. X diagnosed with COPD. On X, Mr. X fell at home with injuries to his face and jaw. Mr. X arrived at the emergency department around. The emergency department physician assigned to the Mr. X was X, M.D. Due to Mr. X mechanism injury Mr. X underwent CT scan with contrast of chest, abdomen and pelvis.
The results included “There is an indeterminate 10mm nodular focus with mildly irregular margins in the right lower lobe on image 75. PET imaging recommended to further evaluate, to exclude the possibility of a primary lunch neoplasm.” There is nothing documented by Dr. X that she was aware of this finding nor was Mr. X ever notified of these results. It is documented by Dr. X under “Summation” “I have independently reviewed all data and labs and directly visualized the radiologic studies prior to the interpretation of the radiologist as documented in this TSEP.” Also, under “Summation” “CT negative for IC hemorrhage.” And further on under “Secondary Data” Dr. X Adds her interpretation of the radiology studies that have been done and documented. “CT- chest traumatic injury”. Dr. X is documented as Mr. X PCP.
Subsequently on X, Mr. X was diagnosed with a jaw fracture and referred to an oral surgeon following examination by the ER physician M.D. and trauma surgeon Dr.
A few days later, Mr. X called Dr. office complaining of chest pain. Dr. instructed Mr. that the CT scan did not show any rib fracture and if continued with problems of pain to go to a local emergency department. Apparently, Mr. paid did subside, so he did not go back to the emergency department.
Mr. X did return to see Dr. During this visit there was no follow-up of the results of the chest CT. Dr. X medical record demonstrates that reports from other CT scans obtained from X at the time of the ER visit are in the chart. It is unclear from review of Dr. X chart whether he ever received and/or reviewed the report of the chest CT scan.
Subsequently, Mr. X continued to follow-up with Dr. X in the office for his care. No follow-up on chest CT was ever scheduled.
Mr. X was examined in consultation. During that visit the CT chest scan report from X was discovered. Unfortunately, at the time of discovery, the nodule had grown substantially to 6.5 cm and was metastatic to the patient’s brain.
Subsequently, Mr. Was referred to X for treatment of his metastatic lung cancer.
It is my professional opinion that X, M.D. emergency department physician on X, at the X emergency department deviated from the standard of care by:
- Failure to correctly and completely interpret the CT chest radiographic examination.
- Failed to review CT report published by radiology around…
- Failed to inform Mr. X at any time of his CT chest abnormality
- Failed to recommend at any time during or following his emergency department visit to follow-up with his PCP or pulmonary consultant for the abnormal chest CT.
Based upon a reasonable degree of medical certainty that M.D. did not use such care as reasonably prudent healthcare providers practicing in the same field in the same or similar locality would have provided under similar circumstances. It is my opinion these breaches in care caused a significant delay in the diagnosis of lung cancer; resulting in the development of a progressive state of lung cancer with metastasis to the brain. Mr. current condition of metastatic lung cancer with is inoperative is a direct and proximal result of breaches in the standard of care.
Furthermore, it is my professional opinion that Dr. primary care physician, deviated from the standard of care by:
- Failed to refer for the evaluation and treatment with diagnosis of advanced COPD. More likely than not within a reasonable degree of medical certainty had. Dr. referred Mr. for pulmonary consultation the patient’s lunch cancer would have been identified and treated at an earlier stage.
- If the facts in discovery demonstrate that Dr. in fact received the CT chest report dated the following deviations occurred:
a. Failure to received CT scan report
b. Failure to review CT scan report
c. Failure to refer patient to pulmonary specialist and/ or oncology specialist.
d. Failure to education patient as to the significant findings on the CT scan chest report.
Based upon a reasonable degree a medical certainty, it is my opinion that Dr. X did not use such care as reasonably prudent healthcare providers practicing in thee same in the same of similar locality would have provided under similar circumstances. It is my opinion that these breaches in care caused the delay in the diagnosis of lunch cancer; resulted in the development of progressive state of lung cancer with brain metastasis. The development of metastatic advanced pulmonary lunch cancer was a proximal result of Dr. X breaches in the standard of care.
Furthermore, it is my professional opinion that the radiologist MD, deviated from the standard of care by:
- Failure to call significant pulmonary results in the ER physician specific to the indeterminate 10mm nodular mass with irregular margins in the right lower lobe on image 75. These findings were of significant magnitude so as the standard of care required the radiologist to call the ER physician with the significant findings.
- If discovery demonstrates that in fact had in place a system for the radiologist to inform the patient’s primary care physician and the emergency department physician of significant abnormal findings requiring timely follow-up then the following standard of care deviations occurred:
- Failure to utilize the system and to follow policies and procedures for notifying the emergency department attending physician and the patient’s primary care physician of significant radiographic findings requiring timely follow up.
Based upon reasonable degree of medical certainty, it is my opinion that M.D. did not use such case as reasonably prudent healthcare providers practicing in the same filed or same locality would have provided under similar circumstances. It is m opinion that these breaches in care caused the delay in diagnosis of metastatic lung cancer resulting in the development of progressive state of lunch cancer with became inoperable. The development of metastatic primary lunch cancer was a direct and proximal result of M.D.’s, on behalf of breaches in the standard of care.
I specifically reserve the right to add to, amend or subtract from this report as new evidence comes into discovery or as new opinions are formulated.