LUNG CANCER MEDICAL NEGLIGENCE FAILURE TO REFER TO A SPECIALIST 

John Whelan Solicitor with specialist expertise in Lung Cancer Medical Negligence gives an example of the failure to refer to a specialist where the failure led to delays in treatment and worsened the Patient's outcome:

Case Example: Failure to Refer to a Pulmonologist for Lung Cancer Evaluation

Patient Background:

The Patient presents to their GP with complaints of a persistent cough, fatigue, and occasional shortness of breath lasting for over two months.   The Patient has a history of smoking for 25 years but gave up smoking 5 years ago.   The Patient denies any weight loss or chest pain.

Initial Evaluation:

The GP performs a physical exam, which is unremarkable, and orders a chest Xray. The chest Xray reveals a 2 cm solitary pulmonary nodule in the right lower lobe of the lung. The radiology report suggests that the nodule is indeterminate and advises follow up with a CT scan to better characterise the lesion.

GP’s Decision:

a) The GP, assuming the nodule is likely benign, reassures the Patient that the nodule is probably scar tissue or a benign lesion. Instead of referring the Patient to a pulmonologist or ordering a CT scan for further evaluation, the GP suggests watchful waiting and advises the Patient to return in 6 months for another chest Xray to monitor for changes.

b) No referral to a specialist (such as a pulmonologist or oncologist) is made at this point.

Missed Opportunity for Early Diagnosis:

During the following months, the Patient’s cough persists, and develops unexplained weight loss and fatigue.  The Patient returns for a follow up chest Xray six months later, which shows that the nodule has grown to 4 cm.    At this point, the GP orders a CT scan, which reveals a more suspicious lesion, and refers the Patient to a pulmonologist for further evaluation.

A biopsy performed by the pulmonologist confirms stage IIIA non small cell lung cancer with involvement of nearby lymph nodes. The Patient is now facing more aggressive treatments, including chemotherapy and radiation, due to the advanced stage of the cancer.

Delay:

The failure to refer the Patient to a pulmonologist or order a CT scan after the initial abnormal Xray led to a significant delay in diagnosis. During the 6 month period of watchful waiting, the lung cancer grew and progressed, reducing the chances of early intervention and curative treatment.

Important points from the Case:

1. Missed Specialist Referral.
2. Failure to Escalate Care.
3. Inadequate Response to Red Flags.  

What should have been done:

a) Early Referral to Specialists.

b) Timely Diagnostic Testing.

c) Multidisciplinary Approach.

For more detailed insights into how the Patient Safety Act 2023 impacts you and how Whelan Law can support you, please visit our Lung Cancer Medical Negligence https://www.whelanlaw.ie/news/rising-lung-cancer-medical-negligence-claims-a-reflection-of-modern-medicine/