This case involves a patient who presented to defendant with an extensive history of neurofibromas and complaints of a cough. The doctor scheduled a CT scan to explore for changes in her neurofibromas. The patient had a CT scan performed, however there was no indication that the CT scan was reviewed. The patient was not seen again until some months after her last CT scan, when the treating physician had been ordering CT scans at a minimum of every six months based. Eventually, a CT scan was performed which showed a large mass with a mass effect on the trachea. The physician indicated in the medical records that he was aware of the mass. Some months later, as a result of complications from the inoperable nature of the mass due to the delay in treatment, the patient died. It is alleged the defendants failed to properly monitor patient’s known medical condition for which he was under their care by failing to order appropriate follow-up after the mass was discovered.
Question(s) For Expert Witness
- 1. Do you have extensive experience treating patients with neurofibromas?
- 2. Are you familiar with the proper way to monitor patients with neurofibromas?
Expert Witness Response E-004713
I have seen and treated patients with neurofibromas and neurofibromatosis. Generally, yearly CT or other imaging is not recommended. However, if there are new symptoms, as in this patient, it is required to image the area related to the symptoms. While these are often benign lesions, they cause difficulties due to mass effect and airway compression and debulking surgery can be lifesaving. In this case, the MD who initially ordered the CT chest is negligent for not following up on the results of the initial CT chest and for not maintaining proper surveillance every 6 months fro growth. This is especially important given the new symptom of intermittent cough that prompted the initial CT scan.
This Dallas area neurologist earned both his MD and PhD from the Baylor College of Medicine. After his residency at UCSF, he completed a prestigious fellowship program at the National Institutes of Health. An active member of the American Academy of Neurology and the Society for Neuroscience, he is widely published in his field and is frequently invited to present his work at national conferences. In addition to his clinical responsibilities, he currently serves an as associate professor of Neurology at one of the most prominent medical institutions in Texas.
Expert Witness Response E-008764
Thank you for asking me to comment on this case. I do have experience caring for patients with Neurofibromas. We saw many cases during my residency at the Cleveland Clinic and fellowship at the National Institutes of Health. I have continued to see individuals with Neurofibromatosis as well as other Neurofibroma syndromes in private practice. The key to taking care of these individuals is careful radiological monitoring, patient education and establishing a care team with an appropriate surgeon. In cases such as the one presented it is ‘standard care’ to maintain regular office visits and acquire follow-up imaging studies. The decision when, and if, to proceed with surgical excision of these tumors is often challenging and always crucial to the eventual outcome. Fortunately, neurofibromas do not metastasize, however they cause morbidity through ‘mass effect’ or compression, upon surrounding structures. It is therefore paramount to monitor the growth of these tumors with regular, accurate, radiological imaging.
This well-credentialed neurologist received a Bachelor’s of Science degree in neuroscience at the University of Rochester prior to commencing his medical education at Albany Medical College in upstate New York. He completed his residency in neurology and pursued a fellowship in neuromuscular disease at the National Institutes of Health. He is a member of the American Academy of Neurology and has published multiple peer-reviewed journal articles, most notably an article published in the New England Journal of Medicine on IVIG therapy for dermatomyositis. This expert is currently a Clinical Assistant Professor at a major Florida university.