The Camo Case
Sixty-nine year old Mrs. Camo died of miliary TB (tuberculosis spread beyond the lung). Miliary TB is unusual because its symptoms first appear outside the lung—most often in the rapid deterioration of one major joint or through mini-strokes. In the United States, TB is an uncommon disease and when diagnosed, is universally survivable and curable.
The Plaintiff underwent elective knee replacement surgery. A preoperative chest X-ray showed multiple masses in both lungs. The surgeon did not review the chest x-ray until the day of surgery. He delayed the surgery for several hours to allow for a lung CT which was also showed multiple lung masses and was interpreted as metastatic cancer. The surgeon did not tell the family, the patient or the PCP of the ominous CT finding but instead proceeded with the surgery. Had surgery been delayed a lung biopsy would have diagnosed the lung masses as TB rather than cancer in time for a cure.
During the knee replacement the surgeon encountered unusual soft-tissue in the knee joint consistent with an infection. Since the knee had never been opened before it should not have been infected. The surgeon sent portions of the tissue for immediate evaluation. The pathologist advised the surgeon during the surgery that the knee appeared to be infected, possibly with TB, and needed to be cultured. The surgeon failed to submit swabs for the appropriate culture which would have shown TB. Post-operative pathology of the knee tissue again showed tissue consistent with infection and TB. The surgeon and PCP, despite discussing a possible connection between the lung masses and apparent knee infection, discharged the patient to rehabilitation without consulting oncology, infectious disease or pulmonology specialists. The Plaintiff got worse during rehabilitation, was readmitted, and after three weeks in the hospital had become comatose as the TB spread to her brain. After four weeks in the hospital she was finally evaluated by pulmonology and infectious disease specialists who confirmed that she had diffuse TB (miliary TB) infecting her lungs, brain, and the knee which had been operated on three months before. By the time the illness was diagnosed it was too extensive to be successfully treated. She was given palliative care, was discharged to a nursing center, and died.
Suit was filed against the surgeon and PCP for proceeding with the elective knee surgery in the face of dire lung masses without telling the patient or her family, failing to obtain appropriate consultations following the lung CT findings and abnormal knee pathology; and for discharging the patient without taking biopsies of the lung. The surgeon also failed to obtain the right cultures of the knee as directed by the pathologist.
Had the TB been diagnosed from either the abnormal lung CT scan or the knee culture, the Plaintiff would have had a significantly greater chance of a cure and survival.