Doctor Fails to Biopsy Urinary Lesion

This case takes place in Massachusetts and involves a middle-aged female patient who died of bladder cancer. The patient had a history of incontinence that had persisted for several years, for which she was under the care of the defendant urologist. Eventually, the patient was found to have a lesion on her bladder that was not biopsied or investigated. The cancer was ultimately diagnosed by another urologist, however by that time it had already spread to multiple other organs in the woman’s body. It is alleged that the defendant urologist should have performed diagnostic tests on the lesion far sooner than he did, and that he was negligent in continuing to treat the patient without addressing the lesion or informing the patient of its presence.

Question(s) For Expert Witness

1.) Do you routinely treat patients similar to the one described in the case? Please explain.

2.) Have you ever had a patient develop the outcome described in the case? If so, please explain.

3.) Do you believe there may have been a deviation in the standard of care that contributed to this patient's poor outcome?

4.) Please tell us why you're qualified to serve as an expert reviewer of this case.

Expert Witness Response E-014220

This is a case of delay in diagnosis of a bladder malignancy. This cancer appeared to be clinically evident when the patient first began seeing her urologist but was not evaluated at that time to confirm the diagnosis. As a result it progressed without treatment for several years. By that time the cancer metastasized. This is consistent with natural history of untreated cancers, particularly high grade disease. I do routinely see and manage patients with these malignancies. Patients typically present with hematuria (micro or gross). The diagnosis suspected with contrast aided imaging revealing space occupying lesion within the organ and suspicious or positive urine cytopathology. The diagnosis is confirmed with endoscopic evaluation (i.e. ureteroscopy) and biopsy. This can be a life threatening disease, particularly at an advanced stage. The mainstay of treatment for localized/locally advanced cancer of this variety is surgery with/without chemotherapy. If the cancer spreads beyond the originating organ it is non-curable. I have not had a case similar to this case. In this case, I would say with reasonable amount of medical certainty that the care provided by the physician did not meet the acceptable standard of care for the evaluation and management for the malignancy. This was in the context of persistent symptoms and concerning urine cytopathology. Despite these risk features the lesion/mass was not investigated via endoscopic evaluation and biopsy. I suspect the cancer was locally confined and curable at this time. Unfortunately this cancer was not diagnosed until it was too late. The cancer progressed over the years and ultimately metastasized to the patient's other organs. It is clear the delay of diagnosis resulted in this patient dying of this disease.