Court Upholds Oncologist’s Defense Verdict in Delayed Diagnosis Case

oncologist showing x-ray to patient

An appeals court upheld a defense verdict for a Georgia oncologist who was sued for failing to diagnose a patient’s breast cancer recurrence. The plaintiff’s appeal centered around whether the trial court erred in allowing altered records from another physician to be admitted into evidence. The appeals court ruled the decision to include the records had no impact on the verdict.

Ross-Stubblefield et al. v. Weakland et. al.

Helen Ross-Stubblefield and her husband brought a medical malpractice lawsuit against Dr. Laura Weakland and her practice, Georgia Cancer Specialists, alleging that Dr. Weakland failed to follow up on abnormal test results, which led to a delay in the diagnosis and treatment of the plaintiff’s breast cancer. After a jury sided with the defendants, the plaintiffs appealed, arguing that the trial court erred by admitting medical records of a non-party treating physician whose records were improperly certified and altered with an intent to conceal relevant facts. The Court of Appeals of Georgia, First Division, affirmed the trial court’s decision, finding that any error was harmless.

Background

Ross-Stubblefield was diagnosed with stage III breast cancer in 2012. Dr. Rogsbert Phillips performed a mastectomy, and Ross-Stubblefield underwent chemotherapy with Dr. Weakland. Ross-Stubblefield responded well to the treatment and, one year later, Dr. Phillips ordered a PET scan and MRI in preparation for reconstructive surgery. The PET scan indicated a nodule behind the sternum, and the radiologist recommended additional imaging. The plaintiffs met with Dr. Phillips but apparently were not told that the scan was abnormal.

The following month, Dr. Weakland, who had reviewed the report, told Ross-Stubblefield there was no evidence of recurrent cancer and that she would follow up on the PET and MRI results.

However, Ross-Stubblefield’s cancer had returned and was not discovered until Dr. Phillips ordered new scans in early 2015. At that time, Ross-Stubblefield was diagnosed with incurable stage IV cancer.

In addition to the lawsuit against Dr. Weakland, the plaintiffs filed a separate action against Dr. Phillips.

Altered Records

In the matter against Dr. Weakland, the plaintiffs sought to exclude Dr. Phillips’ medical records, which included a note from 2015 and an altered version of the same note. In the original, Dr. Phillips wrote that Ross-Stubblefield was “still thinking about reconstruction. Wants a complete staging prior to surgery.” After litigation began, Dr. Phillips changed that entry to read: “Still thinking about reconstruction suregry [sic]. She has not been consistent in keeping her appointment. The office has been trying to get patient in fot [sic] a follow up CT-Pet scan. Denies any symptoms. Last time seen in office was almost 8 months ago.”

Dr. Weakland, who wanted to use the altered record to point the finger at Dr. Phillips, certified the record, and it was admitted by the trial court. The plaintiffs referred to the altered note in opening statements, asserting that Dr. Weakland would likely use the comments to show Ross-Stubblefield was responsible for the delay in treatment, but Dr. Weakland never argued that the patient was noncompliant or at fault in any way.

Expert Testimony

The plaintiffs presented expert testimony from a medical oncologist and a surgical oncologist. The oncologist testified that Dr. Weakland breached the standard of care by failing to follow up on the PET scan results and for noting in the patient’s chart that there was no evidence of disease when the PET scan was, in fact, abnormal. The surgical oncologist opined that the failure to act upon the abnormal PET scan in a timely manner caused the patient to need extensive surgery and reduced her life expectancy.

Dr. Weakland testified that she had reviewed the PET scan report, but that she assumed that the doctor who ordered the test had investigated the abnormal results and that the MRI had confirmed there was no reason for concern. She stated that the patient was well-educated about her condition and treatment, and that the patient informed her that the scans were clear. Dr. Weakland explained that she wrote that there was no evidence of disease in the chart because she did not believe the PET scan showed an active cancer, as it was not unusual for a scan to show some abnormality after surgery and radiation. Dr. Weakland further explained that there was only a very small chance of recurrence so soon after treatment based on her experience, the patient’s lab work, and physical examination.

Two oncologists provided expert testimony in Dr. Weakland’s defense, stating that she adhered to the standard of care. The experts opined that the guidelines did not call for routine imaging where a patient did not complain of new symptoms; that doctors would not have expected the cancer to recur less than a year after completion of radiation and chemotherapy; that it was not one physician’s role to oversee and monitor another doctor’s orders; and that it was within the standard of care for Dr. Weakland to assume that Dr. Phillips had followed up on the scan results.

The Appeal

After the jury found in favor of Dr. Weakland, the plaintiffs appealed, contending the trial court erred in admitting Dr. Phillips’ altered record, and that the error was not harmless.

To be reversed, it is not enough that the trial court erred; the plaintiffs also must show that the error influenced the outcome of the proceedings, the appeals court said. Dr. Phillips’ altered medical record alleging that Ross-Stubblefield was noncompliant had no bearing on the core issue before the jury – the plaintiffs’ claims that Dr. Weakland breached the standard of care by failing to follow up on the abnormal PET scan and noting in the record that there was no evidence of disease. Indeed, nothing in Dr. Phillips’ notes involved the applicable standard of care. Ross-Stubblefield’s alleged noncompliance and Dr. Phillips’ credibility were not the core issues of the case, and the defendants never argued that the patient’s noncompliance was the cause of the delay in treatment. Instead, they placed the blame on Dr. Phillips’ failure to follow up concerning the abnormal scan results. Further, the plaintiffs were able to argue to the jury that Dr. Phillips’ records were unreliable and had been altered after litigation began. As such, the plaintiffs cannot show they were harmed by the admission of Dr. Phillips’ altered record.

Conclusion

The court held that even if there was an error in admitting the records, that it did not lead to the defense verdict. The court therefore affirmed the trial court’s finding.

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