This case involves an elderly male patient in Florida with a history of cancer, as well as a chronic respiratory condition, who reported to the hospital for breathing treatment. Following this treatment, the patient was made aware that his WBC count was high, which was attributed to his previous cancer diagnosis. He had stated in the past, and reiterated on this visit, that he did not want to be administered chemotherapy. Despite these instructions, he was admitted to the hospital and chemotherapy using Taxotere was initiated. Soon after the initial dose, he experienced acute respiratory failure, shock, electrolyte abnormalities, as well as cardiovascular and renal problems. He was then transferred to the ICU, where, despite his critical condition, chemotherapy was continued nightly for five days before passing away. The ultimate cause of death were complications related to tumor lysis syndrome, which was brought on by the administration of chemotherapy.
Question(s) For Expert Witness
- 1. Do you routinely treat patients similar to the one described in the case?
- 2. Have you ever had a patient develop the outcome described in the case?
- 3. Do you believe there may have been a deviation in the standard of care that contributed to this patient's poor outcome?
Expert Witness Response E-000979
I do routinely treat patients with chronic leukemia and have for over 20 years. Depending on the type of chronic leukemia, prior therapies, and status of the disease (e.g., later stage CLL or accelerated/blast phase CML), yes such patients can develop tumor lysis and complications thereof. From what is described, and certainly if the chemotherapy was against the expressed wishes of the patient, it is possible that there was a deviation in the standard of care. I have served as an expert witness in cases of leukemia, including chronic leukemia. I feel qualified to serve as a potential expert witness in the case based on what is described and considering that much of my clinical focus is on leukemia. As well, I have training in medical ethics and am a recognized authority in my respective field in this regard. I am a board certified medical oncologist with over 20 years of experience with the majority of my clinical work focused on hematologic malignancies.
Expert Witness Response E-026302
As a medical oncologist at a large university affiliated medical center, I routinely treat patients such as the one described in this case. I treat CLL patients regularly but normally we observe CLL patients for many years and only treat symptomatic patients. I have had a patient develop tumor lysis syndrome and require dialysis due to acute renal failure, but I have not had a patient who did because of tumor lysis syndrome. I believe it would be a deviation in the standard of care to administer chemotherapy without the patient’s consent. Additionally, it would be inappropriate to administer chemotherapy without first assessing the patient’s risk for tumor lysis syndrome and initiating prophylactic therapy, if necessary.