A nuclear medicine expert witness advises on a case involving a man who claims his cancer was misdiagnosed as kidney cysts. The plaintiff was seen by defendant urologist for pain and difficulty urinating. A CT scan of the abdomen and pelvis without contrast was performed. Defendant radiologist reviewed and interpreted the CT scan images and prepared a report containing his findings, impressions and recommendations. The radiologist reported that he had identified bilateral renal hypodensities and that the hypodensities were presumed to reflect cysts. He further described a larger 5 cm. cyst as demonstrating several minimal areas of lobulations. The radiologist stated that the hypodensities can be confirmed with renal ultrasound if clinically indicated. He did not mention the lobulations in the impressions portion of the report.
The plaintiff alleges that the defendants misdiagnosed his cancer as cysts and that the misdiagnosis resulted in a delayed tumor cryoablation treatment.
Question(s) For Expert Witness
1. What was the standard of care?
2. Did the defendant breach it?
Expert Witness Response
It is my opinion that the radiologist fell below the degree of skill and care employed by physicians generally under similar conditions and like surrounding circumstances in his radiologic diagnosis of the plaintiff. One specific manner in which defendant fell below the standard of care was his misdiagnosis of the plaintiff’s condition and his incomplete and misleading impression in the CT report. Defendant’s statement in the impression regarding possibility of confirming the hypodensities with renal ultrasound leaves the decision of further workup entirely to the ordering clinician without stating or suggesting that there is anything atypical about any of the hypodensities that should raise the clinician's suspicion. Together with the lack of any description in the impression of the atypical features of the larger cyst, the impression does not prompt the clinician to consider the need for further work-up of this patient any more so than other cases of non-contrast CT scans that show incidental probable renal cysts.
The standard of care for physicians generally under similar conditions and like surrounding circumstances required the defendant to report the atypical hypodensity in the impression portion of his report and to recommend obtaining a renal ultrasound or contrast imaging study to evaluate the atypical hypodensity shown on the CT scan.
It is my opinion to a reasonable degree of medical certainty that the misdiagnosis and deviations from the standard of care by the defendant caused injury and harm to the plaintiff.
The expert has been a Diplomat of the American Board of Radiology for more than 30 years. He regularly is responsible for reviewing and interpreting CT scans similar to the one performed in this case and regularly prepares reports containing findings, impressions and recommendations based upon my review and interpretation of that type of imaging study. These recommendations often include additional imaging studies.
About the author
Kristin Casler
Kristin Casler is a seasoned legal writer and journalist with an extensive background in litigation news coverage. For 17 years, she served as the editor for LexisNexis Mealey’s litigation news monitor, a role that positioned her at the forefront of reporting on pivotal legal developments. Her expertise includes covering cases related to the Supreme Court's expert admissibility ruling in Daubert v. Merrell Dow Pharmaceuticals Inc., a critical area in both civil and criminal litigation concerning the challenges of 'junk science' testimony.
Kristin's work primarily involves reporting on a diverse range of legal subjects, with particular emphasis on cases in asbestos litigation, insurance, personal injury, antitrust, mortgage lending, and testimony issues in conviction cases. Her contributions as a journalist have been instrumental in providing in-depth, informed analysis on the evolving landscape of these complex legal areas. Her ability to dissect and communicate intricate legal proceedings and rulings makes her a valuable resource in the legal journalism field.
