Earlier this year, a client hired Painter Law Firm to investigate health care that was provided to him at a hospital in Tomball, Texas.
His medical treatment started when he had cold symptoms that he could not seem to shake. He went to a free-standing emergency room in Magnolia, Texas, where they did an x-ray and CT scan. The emergency physician told him that he had pneumonia related to a pleural infection (an infection and buildup of fluid between the lungs and chest). The doctor sent him to the Tomball hospital by ambulance.
At the hospital, an internal medicine doctor told this patient that his lungs were full of fluid and masses. The internist said that he was 99% sure that he had lung cancer and even went so far as to make a drawing showing where the cancerous masses were located.
A surgeon took this man to the operating room for a robotic decortication procedure. Decortication is a major thoracic surgery involving opening and removing part of the pleural covering of the lungs to allow drainage of fluid and pus from the pleural space.
After the surgery, the surgeon said that he saw no evidence of cancer during the surgery. In the recovery room, the patient had very low blood pressure and the doctors eventually determined the he had internal bleeding. Blood transfusions did not work to restore his blood pressure to an acceptable level. An abdominal CT scan showed that his spleen had been cut during the surgery, which was causing internal bleeding.
The day after the decortication surgery, the patient was taken back to the operating room for a splenectomy (surgical removal of the spleen). The spleen is an important organ that helps fight infections and remove old or damaged blood cells from the body. Patients who have lost their spleen have a life-long higher risk of developing serious infections including meningitis, pneumonia, and influenza.
As a Houston, Texas medical malpractice attorney, this man’s story caught my attention. The standard of care requires surgeons to identify and avoid structures near the lungs, when performing a decortication procedure. The structures include nerves, blood vessels, and nearby organs, like the liver and spleen. I wanted to investigate how this happened by obtaining all the medical records and then study them closely with the assistance of a general surgery expert.
About six months after the original decortication surgery, our client’s wife called to inform us of a shocking development.
Her husband had recently returned to the Tomball hospital because of recurrence of his original symptoms. They found a fluid buildup in his lungs that had turned into pneumonia. This time, though, a doctor decided to order a lung biopsy, which showed that he had Stage III cancer.
When a physician suspects lung cancer, the standard of care requires performing a biopsy to aid in making the diagnosis and assigning a stage. This would be particularly easy to do when the patient was already taken to the operating room, under general anesthesia, for decortication procedure. Strangely, though, the medical team chose not to do a biopsy six months earlier during the patient’s original hospitalization.
Of course, now, we are expanding our investigation of this case to why there was a botched cancer diagnosis, which allowed this man to go six months without treatment.
According to the American Cancer Society, there are three main types of lung cancer.
Around 85% of lung cancers are non-small cell lung cancers. This type of cancer includes squamous cell carcinoma, adenocarcinoma, and large cell carcinoma.
Small cell lung cancer accounts for 10-15% of lung cancers. These are aggressive cancers that tend to spread quickly.
Less than 5% of lung cancers are large carcinoid tumors, which are also called lung neuroendocrine tumors. This type of cancer grows slowly and rarely spreads.
When a patient is first diagnosed with cancer, a physician stages the cancer before any treatment is given. There are two types of staging, clinical and pathologic.
Clinical staging is less specific. It is an estimate of the extent and spread of the cancer based on physical examination of the patient, as well as diagnostic imaging (like a CT scan), and tumor biopsy.
Pathologic staging can be done in conjunction with surgery. This is why it is often also called surgical staging. Pathologic staging gives the medical team more precise information that can be used to predict treatment and prognosis.
Experts agree that the faster cancer is diagnosed and treated, the better potential outcome for the patient.
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Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. In 2017, H Texas magazine named him one of Houston’s top lawyers. In May 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.