ADENOID CYSTIC CARCINOMA (ACC): MARYLAND ENT MALPRACTICE ?

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This medical malpractice case involves a 35-year-old female who was diagnosed with adenoid cystic carcinoma (ACC) of the salivary gland by her dentist. The dentist promptly referred the patient to an ear-nose-and throat (ENT) physician/surgeon who, as it happens, had never operated on a patient with ACC nor had ever seen a patient with ACC.

The ENT decided to perform a surgical procedure on the patient with an internist and a radiation oncologist assisting. The radiation oncologist had advised the ENT doctor on two separate occasions to monitor the patient with chest x-rays on an annual basis. The treating ENT  -- even though his group practice had closed--- still forwarded letters to the treating ENT office every year for over 13 years recommending that chest x-rays be performed on the patient annually. The ENT, however, failed to advise the patient of the radiation oncologist's recommendations, and never gave the patient an option or recommendation to have the chest x-ray done.

The ENT maintains his belief that a chest x-ray in the circumstances of this case was not in line with the standard of care for this patient --- but, instead, he maintains that it was standard of care to wait until the patient became symptomatic for chest x-rays.

The patient never missed an appointment and routinely followed up with this same ENT as her treating physician. The patient eventually began to develop respiratory distress and presented to the ER. At that time she was diagnosed with late-stage lung cancer in both lungs, as well as metastatic disease in her brain and kidneys.

Question for Expert Consideration:  Should a chest x-ray have been ordered for this patient, given her past medical history of ACC (Adenoid Cystic Carcinoma) along with the recommendations made by the radiation oncologist ?

Our Otolaryngology Expert opines:  Yes. " This type of cancer requires long-term monitoring for metastatic disease including routine chest x-rays or CT scans ...."

[http://www.theexpertinstitute.com/case-studies/otolaryngology-expert-witness-advises.../May 28, 2014/ Faiza Patten]