Pulmonologist Ignores CT Findings and Fails to Diagnose Lung Cancer

This case involves a sixty-two-year-old patient who was treated by a pulmonologist for chronic obstructive pulmonary disease (COPD). He had an eighty year history of smoking. The pulmonologist was treating his COPD with an ipratropium and albuterol combination formula. The patient began to experience shortness of breath and cough which produced small amounts of blood. The patient had a CT scan performed, which revealed several lung nodules. The radiologist recommended in a report, as well as verbally, a repeat CT scan in six months to monitor the patient for possible progression to cancer. The CT scan findings were disputed by the pulmonologist, who decided that he would be analyzing imaging studies of the patient moving forward. This was not communicated to the patient. The pulmonologist determined that a repeat CT scan was unnecessary based on his findings. Two years later, an additional CT scan was ordered, which revealed advanced lung cancer with significant metastatic disease. The patient was diagnosed with advanced small cell carcinoma of the lung with distant metastases. The patient had several rounds of chemotherapy with external beam radiation, but the patient died seven months after being diagnosed.

Question(s) For Expert Witness

1. Did this physician follow the proper standard of care for this patient, and what could have been done to prevent the outcome of this case?

Expert Witness Response

The physician failed to follow the proper standard of care in a pulmonary patient. Chronic obstructive pulmonary disease (COPD) is a lung condition further divided into emphysema and chronic bronchitis. Both conditions are related to smoking. Smoking is a significant risk factor for lung cancer, and COPD patients should be monitored for the development of malignancy. The presence of a bloody cough is one of many signs suggesting lung cancer. Other symptoms include weight loss, night sweats, fever, difficulty breathing, and paraneoplastic syndromes (SIADH, Lambert Eaton Syndrome, Cushing’s Syndrome, Hypercalcemia, and Polycythemia). A CT scan was properly ordered when the patient began experiencing symptoms differing from his long-standing COPD. A trained professional in reading medical images, such as a radiologist, should establish the diagnosis of lung cancer. If nodules are found, repeat CT scans with biopsy should be done to stage the possible cancer. If the cancer is caught in its earlier stages, interventions can prolong the patient's life significantly. Ignoring these findings and/or delaying further testing could lead to aggressive cancer and death.