Nearly all oncology (cancer) cases allege that a delay in diagnosis or treatment resulted in harm. Consequently, oncologic causation is the primary determinant of case strength. In Case #391, the woman ultimately succumbed to metastatic squamous cell carcinoma. Given the fact that her diagnosis was only delayed by 60 days, it is far more probable than not that her cancer was at the same dismal stage 60 days earlier. In fact, most cancers (aside from leukemia, invasive tumors, and a few other exceptions) do not require urgent treatment at all. The lethality of the woman’s cancer was affirmed by her failure to respond to treatment, and this supports the assertion that earlier treatment would not have altered her outcome. This is not unexpected since metastatic squamous cell lung carcinoma is a particularly aggressive form of cancer with high immediate mortality and a 5-year survival rate of only 4.2%.

Despite obvious breach and harm, the case would have a high probability of collapsing on causation. This gives an overall low score [3] for Elements of Negligence. The Subjective Appeal is strong [8] since the trier of fact would easily appreciate an obvious X-ray misread that was plainly visible to a layperson. The overall economics are precarious [5] since at least three experts would be required (Oncology, Radiology, Emergency Medicine) and the compensable harm is tempered by the woman’s age.

For all of these reasons, the case may seem strong at first glance, but a Case Strength Score of 16 argues that the case should be rejected.