ER Doctor Fails to Recognize Patient’s Risk for Cancer


Emergency Medicine Expert WitnessThe case takes place in Minnesota and involves a male patient who presented to the ER with abdominal pain. He underwent a CT scan and was diagnosed with an enlarged prostate. The treating physician allegedly did not mention the possibility of cancer during his interactions with the patient, and did not recommend any mitigating procedures such as prostate laser surgery or laser photoselective vaporization (PVP) therapy. The patient was referred to a urologist for follow up, but was allegedly told by the emergency room physician that his condition was not serious. On this information, the patient declined a follow-up appointment with the urologist, believing that he was not in any danger. Some time later the patient presented to another hospital complaining of the same abdominal pains, which had grown more severe since his original hospital visit. The patient underwent another CT scan at the hospital, when it was discovered that he had advanced-stage prostate cancer. The patient died shortly thereafter.

Question(s) For Expert Witness

  • 1. How often do you see patients with this type of presentation?
  • 2. What is the standard work up for this presentation?
  • 3. Should the ER physicians have ensured that the patient followed up with a urologist?

Expert Witness Response E-000615

I have seen cases like this, but they are uncommon. I don’t know what the rest of the workup was, but if a CT was done, it typically is ordered along with a complete blood count (CBC), metabolic panel, and urinalysis. Depending on the wording of the CT report, the recommendation for follow up varies. It appears that the CT results implied that his condition was not immediately life-threatening but required follow up for definitive diagnosis. Even if the doctor played down the likelihood that his condition was serious, it nevertheless required follow up and further evaluation, since the patient’s presentation included cancer in the differential diagnosis. It was the doctor’s duty to advise the patient to follow up, and it was the patient’s duty to do so, even if he had the impression it was nothing serious. I think the doctor met the standard of care, although “best care” would be to make the patient aware that even if the appearance is not serious, the condition needs further evaluation to rule out cancer or other problems.

Expert Witness Response E-000754

The radiologist is responsible for interpreting the images of CT and the emergency physician incorporates this interpretation into the rest of the evaluation and communicates this to the patient. A course of action is then recommended. Enlarged prostate doesn’t imply a life threat or need for urgent urological evaluation. The prostate cancer may or may not have been present at the time of the first evaluation but apparently wasn’t significant enough to be seen on CT.

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