Oncology Expert Witness Report

To whom it may concern: I am responding to your request to review the records that you electronically provided of Ms. M’s medical course and treatment in regard to the squamous cell carcinoma of the left inner ear that was diagnosed at ***** Hospital in NY in July 2011. These records were sent to me as electronic files:

1. Radiology Reports from Imaging Center ****
2. Metropolitan, Hospital Metropolitan, and Services *****
3. Medical Records from ***** **** Medical Center
4. Medical Records from ****** Medical Center
5. Department **** Medical Records
6. Laboratory Reports
7. 4/19/2011 MRI
8. 1/26/11 CT, 3/17/2011 CT
9. Complaint

Ms. M was born on 7/9/1938. Medical problems included hypertension, dyslipidemia, and diabetes. She developed various symptoms, including ear pain, referring to the inner ear for over a year and, at ****** Medical Center, the diagnosis was first established. She eventually developed left eye blindness, left facial paralysis, lost more than 50 lbs of weight, and she significantly deteriorated. The note by Dr. A on 5/13/2011 indicates that she had been treated for an ear infection, with various antibiotics, including Vancomycin for the diagnosis of MRSA; MRI 4/19/11 was interpreted to support this diagnosis. I also reviewed records from the Department of Health, that included ***** University Hospital records. Some of the notes are faded and unclear, but she was admitted there in 6/11 and had a CT scan, which was also understood to show chronic infection and mastoiditis. It appears that her symptoms have begun significantly before that time.

She came to ******* Medical Center, where the diagnosis of cancer was made in July 2011. She subsequently deteriorated, having lost 50 lbs over the previous 6 months and was at risk of developing bedsores. She had a PEG inserted in ******* Medical Center but it had to be removed because of vomiting. She ultimately passed away in ***** Hospital in *****, NY and an autopsy restricted to the brain on 12/22/2011 confirmed squamous cell cancer of the pituitary that penetrated pituitary capsule and sella turcica.
I am a licensed and board-certified physician in internal medicine and medical oncology. I am licensed in NY and NJ and I am certified by the American Board of Utilization Review and Quality Assurance and have a Worker’s Compensation Board number in New York State. All my opinions are reasonable to a degree of medical probability and may be revised if more information becomes available.

My opinions:

I hold the following opinions in this matter: There was a violation of the standard of care in failing to timely diagnose and treat Squamous Cell Carcinoma of the left ear while she was in **. The cancer was curable at that point. Because of the pain, left facial paralysis, pain and other left ear symptoms, this 73-year-old woman significantly deteriorated, lost weight and was otherwise negatively affected, leading to her demise in December of 2011.

This is a kind of cancer that can be easily treated and cured when symptoms first occurred. Had it been diagnosed and treated in a timely fashion, the patient more probably than not would have lived much longer with a much better quality of life.

Because the diagnosis was missed and treatment delayed, her life expectancy and her quality of life were very significantly decreased. Had the cancer been diagnosed and promptly treated in the localized stage, Ms. M would not have died in December 2011 and would have had a better quality of life prior to her demise.