Failure to Diagnose an Abdominal Sarcoma Resulting in Death

In this case, we represented the Estate of Mr. Smick in a suit against the Defendant radiologists for failing to timely diagnose and treat an abdominal sarcoma. As a result of the Defendants’ negligence, Mr. Smick tragically passed away.

Case Details

On October 7, 2019, Mr. Smick presented to the Defendant Hospital for an MRI evaluation of the pelvis after an increase in his PSA level. While the MRI confirmed a prostate cancer diagnosis, the interpreting radiologists failed to identify and document a concerning mass also present on the MRI images.

The interpreting radiologists documented a “masslike area of enhancement in the right colon consistent with postoperative changes following hernia repair with a Prolene plug.” While Mr. Smick had a medical history that included a hernia repair, there was a mass present in the imaging separate and distinct from post-operative changes from a hernia repair. The radiologists failed to mention the mass separate from the post-operative changes. Moreover, no follow-up treatment or imaging was recommended or even suggested. As such, the mass went undiagnosed and unchecked for over one year.

Over the next year, Mr. Smick was treated for prostate cancer, which included a prostatectomy and lymphadenectomy. Pathology from that time was consistent with invasive prostatic adenocarcinoma and was negative for metastatic disease.

On October 26, 2020, more than one year from the time of his prior pelvic MRI, Mr. Smick presented to the emergency room with complaints of abdominal pain that had lasted 4 days. A CT scan was completed, which found a large heterogeneously-enhancing mass in Mr. Smick’s right pelvis that raised concern for possible malignancy. Following evaluations of Mr. Smick in the emergency department, the decision was made to transfer him to a higher-level facility for further evaluation and treatment.

The following day, on October 27, 2020, a physician noted, “further studies today suggest this is a vascularized mass, likely tumor,” while another physician noted, “further imaging suggests that this mass is most likely a soft tissue neoplasm.” That physician also acknowledged that the mass that could be seen on the MRI imaging from October 2019, which he stated “appears to be the origin of the current neoplasm.”

A CTA of Mr. Smick’s abdomen and pelvis found a “15 cm in length x 12 cm ap x 13 cm transverse heterogeneously enhancing soft tissue mass extending from just above the aortic bifurcation and into the right inguinal canal,” and the interpreting radiologist noted, “a large soft tissue neoplasm including retroperitoneal sarcoma should be given strong consideration.”

On October 30, 2020, Mr. Smick underwent an exploratory laparotomy with resection of the retroperitoneal mass, right groin dissection and right external vein reconstruction. The mass that was removed from Mr. Smick’s abdomen was sent to pathology and resulted in a finding of undifferentiated pleomorphic sarcoma with positive margins. Mr. Smick was ultimately diagnosed with Stage IIIB abdominal sarcoma. Mr. Smick remained hospitalized for further treatment and recovery from the procedures for a couple of weeks until he was discharged home with a diagnosis of retroperitoneal neoplasm (sarcoma).

Mr. Smick received extensive chemotherapy treatment and subsequently received palliative radiotherapy with additional chemotherapy. Despite the ongoing treatment, Mr. Smick’s screening CT scans demonstrated advancing metastatic disease and tumors throughout his groin and abdomen that could not be surgically removed. Mr. Smick continued to deteriorate significantly from the time of his diagnosis until he tragically passed away on September 28, 2022 at the age of 70 years old. The death certificate listed a cause of death as pelvic metastatic sarcoma.

Prior to his death, Mr. Smick contacted our firm to inquire into whether his cancer should have been caught earlier, and if better care would have changed his outcome. Tragically, however, due to Mr. Smick’s passing, his dear friend, and the Executrix of his Estate, stepped in to continue the process that he began and pursued the lawsuit.

After taking discovery and depositions, we produced expert reports from an expert radiologist and expert surgical oncologist. Both experts agreed that the Defendant radiologists were negligent by failing to diagnose the abdominal sarcoma shown on Mr. Smick’s October 2019 MRI imaging, and that this negligence led to the progression of the cancer, metastatic disease, and Mr. Smick’s death.

The expert reports filed by the defense did not even deny that the Defendant radiologists failed to identify the abdominal sarcoma present on Mr. Smick’s MRI imaging. Rather, the defense experts took the position that the sarcoma should have been identified by other providers as well. However, the Defendants did not include any additional Defendants in the lawsuit, and therefore, this argument would likely not hold up in court.

Defendants obtained a report from an oncology expert who asserted that Mr. Smick’s cancer was so aggressive that even if the Defendants had properly diagnosed the sarcoma, his outcome would not have been any different. This is a typical defense we encounter in many of the cases we handle.

To succeed in a medical malpractice lawsuit, a Plaintiff must establish that a medical professional owed a duty of care to the patient, the medical professional breached that duty of care (negligence), the breach caused harm to the patient (causation), and the patient suffered damages as a result of the harm.

When Defendants are unable to credibly refute negligence, they will often look to attack the causation aspect of a lawsuit. However, in this case, not even Defendants’ experts could plausibly state that the Defendants’ failure to diagnose Mr. Smick’s abdominal sarcoma in October 2019 did not increase the risk of his death. It is well-accepted in the medical community that the sooner cancer is identified, the better chance there is of successful treatment. Further, the smaller a mass is, the greater the likelihood of cure after surgical resection. Unfortunately, due to the large size and location of the mass by the time it was diagnosed, Mr. Smick lost any opportunity to receive effective treatment options.

Result

Shortly before the scheduled jury trial, the parties mediated the case, and the case settled for a substantial amount.