Pt. with benign tumor consents to total hysterectomy relying on "rare malignancy" dx.
ISSUE: How often does a patient ever see the pathologist who makes a determination of whether his or her condition is malignant or benign? In this extraordinary Connecticut case, a pathologist not only was sued but was just one of several individuals and/or entities joined as defendants because they had participated in the pathology process that resulted in an error in diagnosing a patient's tumor as malignant instead of benign.
CASE FACTS: In February of 1995, Michelle DiLieto sought medical attention because of intense and prolonged bleeding during her menstrual periods. DiLieto consulted Dr. Scott Casper, an obstetrician-gynecologist employed by County Obstetrics and Gynecology Group, P.C. (County Obstetrics). Dr. Casper recommended that the patient undergo a D&C. After the D&C, a sample of the patient's uterine tissue was sent to Dr. Thomas Anderson, a pathologist, at Waterbury Hospital. Dr. Anderson examined the tissue. He diagnosed the specimen as a "florid endometrial stromal proliferation consistent with a low grade endometrial stromal sarcoma," a rare and potentially deadly malignancy. Dr. Anderson, who had no contact with the patient and had no involvement in the case beyond his review and analysis of the tissue, signed a written report containing his diagnosis and submitted a copy of his report to Dr. Casper. After Dr. Casper received the diagnosis, Dr. Casper contacted the patient to discuss the diagnosis with her in person. Dr. Casper explained to the patient that the pathologist's report indicated that she had stromal sarcoma, a rare uterine malignancy. Dr. Casper further explained that the treatment of the malignancy involved a total hysterectomy and bilateral salpingo-oophorectomy. Dr. Casper consulted with Dr. Peter Schwartz, a professor of obstetrics and gynecology at Yale, who asked Yale's pathologists to review the patient's slides. Yale professors, Maria Luisa Carcangiu and Vinita Parkash, both of whom were pathologists, reviewed the slides and agreed that they evidenced endometrial stromal proliferation consistent with endometrial sarcoma. The Tumor Board determined that special stains would be necessary in order to distinguish between stromal proliferation and a benign condition of the underlying uterine muscle tissue (myometrium) known as "highly cellular leiomyoma." Drs. Parkash and Carcangiu determined that the slides supported Dr. Anderson's original diagnosis of an endometrial stromal proliferation consistent with endometrial stromal sarcoma. The patient underwent a total hysterectomy. Frozen tissue analysis did not reveal any evidence of sarcoma. The patient experienced other symptoms, after surgery, including pelvic discomfort and pain. She sought treatment from a neurologist and a pathologist in the Boston, Massachusetts area. The pathologist reviewed the patient's pathology slides and concluded that the patient's uterine tissue sampled during the original D&C likely implicated a benign leiomyoma or tumor. The pathologist submitted his findings to the patient's family practice physician, who advised the patient that she had not had cancer. The patient brought suit against Drs. Anderson and Casper, County Obstetrics, and Yale, as the employer of Drs. Parkash, Edraki, and Schwartz. After a jury trial, the trial court entered judgment in favor of the defendants Dr. Anderson and Yale University School of Medicine (Yale). The plaintiff appealed.
COURT'S OPINION: The Supreme Court of Connecticut reversed the judgment of the lower court only with respect to Yale. The court remanded the case for a new trial against that defendant. The judgment of the trial court was affirmed in all other respects.
LEGAL COMMENTARY: Undisputed facts guided the resolution of this case. Before trial, the plaintiff indicated that she intended to offer evidence that she had not been fully informed of her medical condition and that she would testify as to what course of treatment she would have chosen had she been told that her condition might have been benign. The court found that the trial court erred in concluding that the testimony of the patient at trial would have been too speculative. The court found that the patient, a woman in her 40s, could have testified, based on her personal knowledge and life experience, whether she would have undergone the hysterectomy knowing that her condition might have been benign. Accordingly, the court concluded that the trial court improperly excluded the patient's testimony as speculative.
Meet the Editor & Publisher: A. David Tammelleo, JD, is a nationally recognized authority on health care law. Practicing law for over 40 years, he concentrates in health care law with the Providence, R.I. firm of A. David Tammelleo & Associates. He has presented seminars on medical, nursing and hospital law throughout the United States. In addition to his writings as Editor of Medical Law's, Nursing Law's & Hospital Law's Reagan Reports, his legal articles have been published in the most prestigious health law journals. A prolific writer, his thousands of articles, as well as his achievement as an attorney and lecturer, have won him recognition in Martindale-Hubbell's Bar Register of Preeminent Lawyers, Marquis Who's Who in American Law, and Who's Who in America.
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|Title Annotation:||Medical Law Case of the Month|
|Author:||Tammelleo, A. David|
|Publication:||Medical Law's Regan Report|
|Date:||Aug 1, 2003|
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