Failure to Communicate 'Doc-to-Doc' Blamed for Patient's Death

Roxanne Nelson, RN, BSN

October 14, 2021

The family of a man who died from a rare and feared complication of head and neck cancer has filed a $34 million lawsuit against the medical center where he was treated, alleging that his death would have been avoided had there been better communication between the surgical oncologist and the treatment team.

The patient was a 49-year-old man who was experiencing chronic pain in his right ear. He saw a local ear, nose, and throat specialist, who could find no apparent cause after conducting a physical exam.

A CT scan revealed a 1.4-cm mass in the right pharyngeal space. A 1.6-cm lymph node in the right retropharyngeal/parapharyngeal carotid space was affected.

The following week, the patient underwent a positron-emission tomography scan and was subsequently referred to a head and neck surgical oncologist.

The surgeon performed a right radical tonsillectomy and pharyngectomy. During the surgery, the patient experienced significant bleeding complications. The surgeon was able to remove the tonsillar mass but could not resect the affected lymph node, owing to its proximity to the carotid artery. The affected lymph node was not removed, and the patient was informed that the problem would be addressed at another time.

Pathology revealed stage III squamous cell carcinoma (T3N0M0) that was HPV/p16 positive.

According to the lawsuit, which was reported in Expert Witness Newsletter, a critical error occurred.

The surgical oncologist apparently did not clearly communicate the situation to the rest of the clinicians involved in the patient's care. The patient was treated as if the entire cancer had been surgically resected. He never underwent follow-up surgery to address the enlarged lymph node.

Because the care team believed that the patient had undergone a complete surgical resection, follow-up treatment consisted of radiotherapy without concurrent chemotherapy.

The patient underwent radiotherapy to a dose of 60 Gy over 30 treatment days.

About 5 months later, the patient once again presented with ear pain on the right side and difficulty speaking. Imaging showed that there was recurrence of a mass in his right parapharyngeal carotid space. Biopsy results indicated recurrent/progressive squamous cell carcinoma. The patient underwent a second round of radiotherapy. This time, he received concurrent chemotherapy.

Four months later, the patient presented to the emergency department complaining of episodes of syncope. Imaging revealed that the mass in his right parapharyngeal carotid space had increased in size, causing carotid stenosis. The patient was hospitalized for 4 days and was treated with steroids. The day after his discharge, he died at home.

Carotid Blowout Syndrome Due to Negligence

An autopsy was performed, and the cause of death was determined to be an acute massive bleed secondary to perforation of the right artery, which was "encased by a partially necrotic poorly differentiated squamous cell carcinoma." This is known as carotid blowout syndrome.

After his death, the patient's family contacted an attorney, who hired several expert witnesses to review the case. The alleged negligence by the head and neck oncologist was described as follows:

  • There was a failure to appropriately assess the patient's neck anatomy, and the entire tumor was not surgically removed.

  • Frank disease tissue was left behind, and the disease subsequently progressed.

  • The surgery was never completed; the cancer progressed and ultimately took the patient's life.

  • There was a failure to communicate the fact that the cancer had not been completely resected.

The alleged negligence by the radiation oncologist was described as follows:

  • There was a failure to realize that the tumor had not been completely resected.

  • The patient was given a suboptimal radiation dose of 60 Gy, which would have been appropriate only had the tumor been completely resected.

  • There was a failure to give a radiation dose of 70 Gy (ie, the appropriate dose for remaining tumor).

The medical oncologist was alleged to have been negligent because chemotherapy was not given when indicated.

Very High Stakes

None of the treating physicians were named in the lawsuit. Only the medical center where the treatment was given was named. The center is affiliated with an Ivy League university.

The patient was an extremely wealthy man who had worked as an insurance executive and investor. His premature death resulted in the loss of a massive amount of earnings, and the plaintiffs asked for a sum of $34 million as compensation. Because doctors do not carry insurance sufficient to cover that amount and generally do not have personal assets of that amount, the plaintiff targeted the hospital.

"The plaintiff knows that the physicians will never be able to pay an 8-figure settlement, so instead they go after the hospital itself," says the newsletter. "The physicians simply become pawns in a protracted legal game."

The lawsuit was settled out of court in 2021 for an undisclosed amount.

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