News: An patient was undergoing regular prostate-specific antigen (PSA) screenings given his particular background and medical history. Despite awareness of the patient’s risk factors, a physician failed to order sufficient screenings. Eventually, the patient was diagnosed with and died of prostate cancer exacerbated by hepatitis C. His family sued, alleging his death was caused by a physician’s failure to properly screen for cancer and hepatitis C. The jury found the physician negligent and awarded the plaintiffs approximately $2.7 million in damages.
Background: A patient elected to undergo regular PSA screenings because of his age and family history of prostate cancer. His physician was aware of these risk factors, but did not order sufficient PSA screenings to diagnose the patient’s prostate cancer at an early stage.
In 2012, the patient’s PSA was 1.0 ng/mL. In 2014, the patient’s PSA measured 1.2 ng/mL. A year later, the patient’s PSA level had tripled to 3.0 ng/mL. The physician failed to order additional tests to detect prostate cancer. Finally, in 2017, the physician ordered another PSA test, which measured more than 250 ng/mL. A prostate biopsy found cancer a few weeks later. Due to the progression of the cancer, the patient passed away in 2018.
The patient also was at high risk for hepatitis C due to his age, history of blood transfusions, and abnormal liver function tests. However, the physician did not order screenings for hepatitis C. At some point, the patient contracted hepatitis C. It continued unchecked until it caused cirrhosis and liver cancer, which contributed to the patient’s death.
The patient’s surviving family filed a medical malpractice action, arguing the physician’s failure to screen was negligent due to the patient’s risk factors, including a family history of prostate cancer. Furthermore, he was at risk for hepatitis C because of his age, history of blood transfusions, and abnormal liver function tests. However, the physician ordered infrequent PSA screenings that, if properly ordered, would have detected the patient’s cancer earlier.
The patient’s family alleged these failures constated medical malpractice, as a reasonable physician in the same or similar circumstances would have ordered additional testing and monitored the patient closer. The defendant physician denied liability, arguing the patient’s own actions contributed to his injuries and death because he failed to follow the physician’s order and obtain timely lab work. During jury selection, eight medical professionals — ranging from nurses to hospital administrators — were selected.
After four hours of deliberations, the jury found the physician’s failure to screen the patient and failure to act on the patient’s abnormal PSA values enabled his cancer to advance, which led to his death. The jury also found these failures fell below the applicable standard of care; thus, the physician was negligent.
The jury awarded $3 million to the patient’s surviving family. Half was allocated to the patient’s pain and suffering caused by undiagnosed prostate cancer, and half was allocated to pain and suffering because of the undiagnosed hepatitis C. The jury partly agreed with the physician’s defense and found the patient was 20% at fault for the undiagnosed hepatitis C, since the patient failed to obtain lab work on one occasion. The verdict was reduced by $300,000 to correspond with the patient’s fault, bringing the award to $2.7 million. The family’s attorney credited the quick verdict to the eight medical professionals on the jury because they could easily recognize the lapse in the standard of care.
What this means to you: This case illustrates the importance of risk factors in setting the standard of care for medical screenings and testing. Many patients will not require frequent screening for prostate cancer and hepatitis C. However, for certain patients, such as the one in this case, risk factors require a physician to take a different course of conduct. Because of this patient’s litany of risk factors, the physician should have ordered additional or more frequent screening and testing.
Discussing a patient’s history and background, including the patient’s family medical history, is important for a physician to determine the applicable standard of care. It is important for physicians and care providers to listen to patients, not only about their current symptoms, but also to listen to the patient’s history. Every patient is different. The individual is in the best position to relay the underlying data to enable a physician’s diagnosis. Physicians and care providers should be cautious about making assumptions or disregarding data provided by patients. A physician who fails to inquire about relevant current or historical information, or who fails to act after receiving such information, may be committing malpractice.
In this case, the physician knew about the patient’s significant risk factors, yet failed to take appropriate action. This patient was a primary candidate for more screenings for good reason — and the unfortunate reality is the patient did eventually develop prostate cancer at a young age. While that inevitability would not have been prevented, if the physician would have adhered to the applicable standard of care, the patient’s cancer could have been detected far earlier and have been treated more aggressively and timely.
It is unclear why the physician failed to order the timely screening, or why the patient contributed to these screening failures by not appearing for ordered testing. One potential explanation is that with the ongoing pandemic, rates of preventive care, screening, and non-emergency care have declined. Many providers have experienced this firsthand, whereby patients put off care that otherwise would have been a matter of course. Adapting to this current reality may be challenging, and physicians and care providers can only do so much to encourage patients to adhere to orders or to seek testing when risk factors indicate such screenings are warranted.
While it is the physician who provides the care, it is incumbent on the patient to seek out the physician — and to follow through. Physicians and providers cannot force patients to seek or receive treatment or testing, even when such testing could be life-saving. In the context of a medical malpractice action, it might be possible for a care provider defendant to demonstrate the patient’s own actions caused the injury. There are various legal terms and differences among jurisdictions about exactly how these doctrines apply; generally, liability correlates with fault. If the patient is at fault for his or her own injury, then the patient could be precluded from recovering any damages, or their damages may be reduced.
In this particular jurisdiction, the jury attributed 20% of the fault to the patient and reduced the monetary damages accordingly. Physicians and care providers can take solace when they have advised a patient on a certain course of treatment or testing, and the patient then fails to adhere to the advice. It might be a sensitive topic to broach in a malpractice action, particularly where the patient has actually suffered grievous injury or death, because it could be perceived as attacking the victim. But patients are not always blameless in their own injuries. When that is the case, it is absolutely appropriate for physicians and care providers to cautiously demonstrate the patient might have contributed to his or her own injury.
Yet another lesson from this case is the importance of jury selection. It is surprising that eight medical professionals served on the jury, simply because juries are selected from the voting population as a whole. The odds of including so many within the medical field for a medical malpractice action is rare. Jury selection is a complicated process, and it often is difficult to speculate about the outcome based solely on the jury selection. In this case, the jury’s deliberation could indicate the jury’s inherent medical knowledge facilitated the swift resolution with a four-hour deliberation for this multimillion-dollar verdict. The laypersons on the jury may have simply deferred to the medical professionals, who quickly determined they would have acted more cautiously or differently given a similar patient. It is far more common for a jury to be more balanced and to possess less inherent knowledge, which may facilitate a physician or care provider’s presentation of expert testimony critical for defense.
REFERENCE
- Decided Oct. 22, 2021, in the Court of Common Pleas, Philadelphia County, Pennsylvania, Case Number 1804-04705.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content