Injured party's car was struck by a driver who admitted he did not stop at a stop sign. Injured party was taken by ambulance to an emergency department. She sustained three fractured ribs and a pneumothorax and was hospitalized for three days, two in ICU. The day after discharge, she was rehospitalized after developing hemoptysis (coughing up blood). She required a bronchoscopy. One week after second hospital discharge she continued to have chest and rib cage pain and intractable coughing. She was diagnosed with pneumonia. Her car was "totalled" and she missed one month of work. She attempted to settle with the insurance company on her own, and later sought legal assistance when the insurance company tried to get her to sign off quickly for a low amount before she was recovered from her injuries. Plaintiff attorney requested review and analysis of medical records and a detailed written report.
Christine, a Certified Legal Nurse Consultant and owner of LASH & Associates, reviewed medical records for injuries, past medical history, contributing factors, appropriateness of medical and nursing care received, and medical bills. The review included ambulance records, emergency department records, hospital records, post discharge physician office records.
Plaintiff alleged a delay in diagnosis after he was diagnosed with a malignant bone tumor. He was found unconscious by a passerby and later reported he was mugged and his truck was stolen; he was brought to a police station, evaluated by paramedics; he declined transfer to an emergency department. The next day he went to an emergency department with complaints of headache and stiff neck. A CT of the spine as well as an MRI showed a large mass involving the cervical spine (C2 spinous process). He was admitted to a hospital, had a three day stay and was evaluated and treated by a neurosurgeon, interventional radiologist, radiation oncologist, and orthopedic pathologist.
The pathology report from a CT guided needle biopsy described a mass consistent with a large osteochondroma, no features of malignancy. An osteochondroma is the most common type of benign bone tumor. Pathologist's recommendation was to judiciously observe. Discharge instructions were to followup with a neurosurgeon in four weeks. Records indicate he had a repeat MRI seven weeks after discharge showing that the mass was essentially unchanged. Records indicate that he was instructed to seek medical care for any worsening neck pain.
The next records were from an office visit with a neurosurgeon one year and ten months later. He complained of neck pain, numbness and weakness in both arms and legs. He underwent surgery due to progressive spinal cord compression (a cervical tumor resection and C2-5 fusion). The surgical pathology report diagnosis was that of a chondrosarcoma, low grade 1/3, a malignant bone tumor.
Research of authoritative literature supported that the medical workup and care received by the plaintiff was consistent with ACR (American College of Radiology) guidelines. Of note is that the incidence of primary osteochondroma undergoing malignant degeneration into a secondary chondrosarcoma is less than one percent. Upon the plaintiff's presenting for healthcare, the workup, surgical intervention, and diagnosis of a malignant bone tumor were performed in a timely manner. As the plaintiff stated that even though he was having increasing neck pain he did not have any medical care for nearly two years (from the original incidental finding of a benign bone tumor until a finding of a malignant tumor), a delay in diagnosis was not supported.