Preventing Malpractice Claims Entailing Misdiagnosis of Cancer

By Cliff Rapp, LHRM

According to the American Cancer Society (ACS), cancer is the second leading cause of death in the United States. The ACS has projected that over 565,000 Americans will die annually from various forms of cancer. Misdiagnosis of cancer is one of the most prevalent types of medical errors and accounts for a significant portion of all medical malpractice indemnity paid. Implementing fundamental risk management measures can easily prevent the majority of such claims.

Lung Cancer
Lung cancer is the leading cause of cancer death for both men and women. It accounts for almost 29 percent of the total cancer deaths in the U.S. A recent study conducted by the Physician Insurers of America (PIAA) found that communication issues were the most prevalent root cause of lung cancer claims. Failure to respond to an abnormal x-ray and inadequate follow-up were frequent contributing factors to the misdiagnosis of the disease.

The most prevalent root cause of diagnostic error involving lung cancer claims is communication. More than 64 percent of malpractice claims involve some aspect of inadequate, inappropriate or faulty communication. Approximately half of claims involve the failure to respond to abnormal x-rays.

Colorectal Cancer
Colorectal cancer is the third most common cause of cancer deaths for both men and women. While there are a number of non-controllable risk factors (age, personal history of inflammatory bowel disease, polyps and race), there are also several controllable factors that patients can and should be counseled about such as diet, smoking and alcohol usage, as well as the management and control of diabetes and obesity. Although screening tests for colorectal cancer are readily available and have been found to be effective in the early detection and treatment of this form of cancer, screening for colon cancer lags significantly behind the testing done for other cancer forms. The Center for Disease Control (CDC) has found that only 42.5 percent of adults in the U.S. over the age of 50 have undergone sigmoidoscopy or colonoscopy within the past 10 years or had utilized a fecal occult blood test (FOBT) within the preceding year. Almost 60 percent of the over-50 population has not received proper screening. The CDC estimates that 60 percent of colorectal cancer deaths could be prevented if everyone over the age of 50 were screened regularly. An analysis of PIAA closed claim data involving colorectal malpractice claims reveals that the most prevalent presenting symptom is rectal bleeding, followed by abdominal pain.

Breast Cancer
Breast cancer accounts for 15 percent of all female cancer deaths. It is among the most prevalent and expensive types of medical malpractice claims, accounting for 13 percent of all malpractice claims. Because of its prominence, the PIAA has commissioned several studies of malpractice claims involving breast cancer. The most recent study indicated that 75 percent of claims involved premenopausal and perimenopausal women, categories generally considered to be less likely candidates for breast cancer. Sixty-eight percent of the patients were under the age of 50.

Most diagnostic errors involving breast cancer are due to the misinterpretation of mammography, inadequate medical record documentation, system failures within the practitioner’s offce, and communication failures. A majority of the cases indicated a reliance on negative or equivocal mammography. One noteworthy caveat brought to light by the PIAA breast cancer studies is that a biopsy should follow suspicious findings. A prevalent root cause for delay in diagnosis is the failure to recommend biopsy for suspicious findings. In nearly 30 percent of cases, further diagnostic pursuit was not pursued in the face of a diagnosis of fibrocystic disease. Although the patients in these studies were ultimately diagnosed with breast cancer, more than half of the patients received a negative mammogram report following the initial presenting examination.

Prostate Cancer
Prostate cancer is the second most deadly form of cancer in males in the US, accounting for 10 percent of all male cancer deaths. Significant risk factors include age (50+), race (African-American), family history of prostate cancer, and high-fat dietary habits. Screening tests for prostate cancer (PSA, DRE) are known to be effective in detecting prostate cancer in its early stages. Although the use of these tests on a widespread basis has become controversial, patients should be given information about these tests. Screening and diagnostic efforts should be well-documented. To prevent claims involving diagnostic error entailing prostate cancer, document the patient’s personal and family history. Conduct physical exams with specificity. Patients that are noncompliant with recommendations for consultations, additional testing or procedures should be asked to sign an informed refusal form. Most importantly, ensure adequate follow-up and recall of high-risk patients.

For more information regarding this and other medical professional liability insurance risk management issues, please contact the risk management consultants at First Professionals Insurance Company at (800) 741-3742, ext. 3016, or send an e-mail to rm@fpic.com.

The information in this article does not establish a standard of care, nor is it a substitute for legal advice. this information and suggestions contained here are generalized and may not apply to all practice situations. First Professionals recommends you obtain legal advice from a qualified attorney for a more specific application to your practice. This information should be used as a reference guide only. Cliff Rapp is a licensed healthcare risk manager and Vice President for Risk Management of First Professionals Insurance Company, a leading professional liability insurer. Mr. Rapp is widely published and a national speaker on loss prevention and risk management. First Professionals Insurance Company is Florida’s Physicians Insurance Company^SM and the endorsed carrier for professional liability insurance by 22 county medical societies, 15 specialty societies, and two statewide associations in Florida.

Last Revision: July 15, 2010