Failure to Diagnose Hepatic Lobe Cholangiocarcinoma
The Kramer Case
In this case, Dave Kramer was in his 40’s, and went to his PCP for a check-up. His PCP ordered blood tests, which showed a high alkaline phosphate (“ALP”) level. An elevated ALP level may indicate liver dysfunction. At the same time, blood tests also showed a high gamma-glutamyl transpeptides (“GGT”). If the ALP and GGT levels are both elevated, a doctor should suspect a disease in the bile duct or liver disease. However, rather than investigate further, Mr. Kramer’s PCP just ordered new lab tests.
The follow-up tests still showed a high levels of ALP and GGT, but again the doctor did not order any further testing.
A few years later, Mr. Kramer returned to his PCP, and again blood was drawn for a yearly physical. Again, the tests showed high ALP and GGT levels. The PCP again did nothing.
A few years after that, Mr. Kramer applied for life insurance. The insurance company questioned the high liver enzyme levels in his blood, and wrote a letter to the PCP, which should have given him another reason to check into the abnormal blood levels, but he didn’t, and instead he wrote a letter to the insurance company stating that Mr. Kramer’s blood levels were elevated because he was on asthma medications.
Unfortunately, after a few years, Mr. Kramer began to look jaundice, and went to a hospital for evaluation. A CT scan of the abdomen and pelvis showed a large hepatic mass. Unfortunately, at this point, Mr. Kramer was diagnosed with metastatic carcinoma involving his liver. An ERCP test was performed, which confirmed a mass surrounding the hepatic duct consistent with cholangiocarcinoma.
Mr. Kramer was taken into surgery, and a tri-segmental liver resection was performed, but it was too late. Mr. Kramer suffered metastatic cancer, underwent extensive chemotherapy and radiation, and died at the age of 58.
Suit was filed against the PCP in Allegheny County, Pennsylvania. After the lawsuit was filed, it was discovered that the defendant PCP had been suspended from the practice of medicine due to drug and alcohol use. This factored into his mental state as to whether or not he was able to appropriately treat his patients and to understand the disease process which was involved with Mr. Kramer.
Prior to trial, the case settled for a substantial sum.