Stage 4 Neuroblastoma in a 3 year old (Malpractice) South Carolina

[challa]

*South Carolina*

Hello. My very good friend has a 5.5 year old little boy. When he was 2.5 years old, he became ill with flu-like symptoms. She took her son the the pediatrician (actually the MD was 'family medicine') for 6 months EVERY THREE DAYS. He was diagnosed with everything from acute ear infections to sinus infections to severe allergies. To make a long story short, (more details will be provided if requested or needed to help make a determination), after 6 months of meerly 'treating the symptoms', my friend took her son to the ER out of sheer desparation and frustration. A CT scan was immediately done. He had a tumor occupying 3/4 of his chest wall, going up the side of his neck and into his sinus cavity. He was dx with stage 4 neuroblastoma at 3 years of age. That evening he was admitted to the hospital and treated with aggressive chemo to try to save his life. He is still struggling, remission only lasted a few short months, and is not expected to live 6 more months. What makes this case most tragic is that neuroblastoma is curable if the diagnosis is rendered prior to three years of age. After the three year mark it is ALWAYS fatal. Each doctor who is now treating her son has said (on several occasions) that a simple urine test would have immediately show the problem. As previously stated, she took her son every three days to the family physician for six months. During that time NOT ONCE did the doctor draw blood or take a urine. This appears to me to be a GROSS negligence at it's finest. Based on this limited information, does this present itself as a case for medical malpractice? Why or why not. If so, I need a really good attorney in South Carolina who would be willing to take this case without a retainer. My friend hasn't worked in over a year and being a single parent of 4, she can hardly afford to feed herself. Thank you for your reply and any assistance you can offer.

 

[rmet4nzkx]

I am truly sorry for your friend and their situation, unfortunately this cancer is most often diagnosed after it has metastasized, so while unfortunate it is not necessiarly negligence just because it was difficult to diagnose. Your friend can consult a medmal attorney and perhaps there will be something in the records that will help make a determination. Here is something from nih, statistics that can help put this in perspective without the sadness and anger you are feeling. The urine test is not reccommonded as it produces more false positivies, the tumors it identifies either go away or mature, so it causes needless stress. The age at which it can be diagnoses is linked to the form. You have not provided enough information to determine. No where do it say that if it is diagnosed after age 3 that it is ALWAYS fatal or that it is cuarble if diagnosed before 3 yo, that is a statistical false.


http://www.nlm.nih.gov/medlineplus/neuroblastoma.html
Detailed Guide: Neuroblastoma
What Are The Key Statistics About Neuroblastoma?

Neuroblastoma is by far the most common cancer in infants and the third most common type of cancer in children. There are approximately 650 new cases of neuroblastoma each year. This number has held steady for many years.

Boys are somewhat more likely to develop neuroblastomas than girls. For every 6 cases in male children, there are 5 in females.

The average age at the time of diagnosis is about 17 months. Around one-third of cases are diagnosed by the first year. Nearly 90% of cases are diagnosed by age 5. And about 2% of cases are found in people over the age of 10, including in some adults. In rare cases, neuroblastoma is detected by ultrasound even before birth.

In as many as 7 of 10 cases, the disease is not diagnosed until it has already spread (metastasized).

Revised 10-28-03

 

[ellencee]

Call a SC medmal attorney and ask about the statute of limitations. If I were reviewing your post for an attorney, I would recommend reviewing the records and the events.

EC

 

[challa]

To the first responder to my thread, yes, this is ALWAYS fatal if dx after three years of age. There are no survivers past age 8 - period. Prior to three the recovery rate is 80% so timing IS everything. Hard to find these statistics online.

Yes, I am certain it is difficult to diagnose as the symptoms are so generalized. But when you take your 2.5 year old to the family doctor every three days for six months and the doctor fails to draw blood or urine AS A MATTER routine or just to rule out x,y or z, that should constitute malpractice. I take my children to the pediatrician if they aren't feeling well and the first thing that they do is a finger prick. When my friend went to the ER it was only after the same doctor refused to refer her out for a spinal tap. By this point she was convinced her son had spinal menengitis and the doctor refused to even entertain the idea that it could be something OTHER than a persistent cold and ear infection. Upon his admittance to the ER the oncologists told her that in another two weeks he would have been dead.

As a side note, at the children's cancer center my friend met two other parents of children who went to the same idiot doctor. Their children have leukemia and were also misdiagnosed.

Seems to me that because the oncologists KEEP bringing up the urine testing (or lack thereof), I have to believe they are telling her that for a reason. Otherwise, why bother?

As for a med mal attorney in my area, I need the name of a good one with whom to consult. I believe this case can be litigated but it won't make it very far with a generalized 'personal injury' atty.

It's about accountability and this doctor should be forced to answer as to why she failed to render standard medical treatment. Let's hope she doesn't miss many more pediatric cancers in the meantime.

 

[rmet4nzkx]

As I said before, the child's mother may take this to a med-mal attorney and the case if any can be evaluated.

While it may seem to be meritorious, there may be strong defenses to it.

First of all, you didn't answer what form of neuroblastoma the child had, that is the first fact that will be needed to determine the merit of the case.

Second, the urine test has a high degree of false positives, that is why NIH doesn't reccommend it's routine use as a screening tool, furthermore, this high rate of false positives occurs in the first three years so of course there would be a high cure rate. There is another implication of this fact, consider the implications of treating a child who doesn't have cancer? Now that c/would be a meritorious claim for mal-practice.

Third, there are <700 new cases diagnosed each year, in children of all ages, figure the odds of a family practice physician having a case when the symptoms are so vague?

My oldest child had had frequent ear infections and other symptoms, such as bloody nose, until he was about 2.5 when we went to a new doctor and discovered it was the same infection that had never been cleared up by the prefered antibiotic, it was changed and the infection finally cleared, other symptoms remained and others developed because he had something else, something inheirited. Never did they prick his finger, do a urine test or speak of cancer.

In fact if your child's doctor pricks their finger each time they are sick, as you claim, unless they have diabetes. I would question that sort of care. It must frighten your child to even go to the doctor at all! We are not talking about the care your child receives or the care other children with a different form of cancer about whos care we know nothing?

My other child had sudden onset of neurological symptoms at 3 months, he was hospitalized and tested thoroughly, including LP, he did not have cancer.

Assessing what kind of care this child received or the mother's account of that treatment may be very different than what the chart shows, that is why we can't determine if malpractice occured. A physician evaluates many things by looking at a child or even smelling a child.

Lastly, just because the mother brought the child in with various vague or common complaints of illness approx 2 times a week points more to the mental health of the mother than to the possibility that the child has cancer. We don't know how the child actually presented when they were examined or how they responded. If a parent with a history of frequent medical care for a child presented demanding invasive tests like a LP, if there were no clinical signs to indicate that one was needed a physician is not going to submit the child to unnecessary and invasive tests. Another question would be why, this mother didn't take the child elsewhere if her child was so ill all the time? If the mother has a mental health issue, that is going to play a large part in how this goes no matter the facts of the case, it will be the main issue.

You are right though, we are all going to die at some point and it is sad when it is a helpless and innocent child, it is not always possible to prevent or cure childhood cancer.

 

[ellencee]

challa
You must immediately make at least one phone call to a SC medmal attorney. Look up medical malpractice attorneys in SC on the web; you will find thousands of firms listed. Ask about the statute of limitations. Generally the statute of limitations begins to run when the person knew or should have known that negligence caused injury. In your claim, it appears the statute began to run when the child was aged three when the child was seen in the ER. Some states allow for "tolling" the statute if the patient is still undergoing treatment; some states do not. The statute for a minor's claim is different from the statute that applies to an adult. Whether or not the statute of limitations allows your claim to be still viable is something we can not tell you.

The Charleston area of SC has some great medmal attorneys as does the Newberry area of SC. I've not been impressed with the larger firms in and around Spartanburg, Greenville, or Columbia. If you are in one of the latter areas of SC, I suggest a smaller firm of no more than three or four attorneys. That's all I can suggest as far as seeking an attorney in SC--well, one more thing--If the physician is a part of one of the larger teaching hospitals, you will have to go outside of the hospital's 'treating area' to find an attorney willing to take your case.

Your claim may not be as open and shut as you think it is. Certainly, a physician should not simply accept a mother bringing her child into the office every three days for six months without seeking an outside opinion on the state of the child's health, safety, and welfare; but, that leaves the question of why a parent would take their child to the same MD once a week for six months without seeking additional medical advice.

Find out the statute of limitations--today.

EC

 

[rmet4nzkx]

Ellen,
Remember this is a "good friend" not OP, so while OP may make some inquiries re consultation with a medmal attorney, the child's parents will have to be the ones who actually consult with the attorney.

 

[challa]

There is only one type of 'neuroblastoma'. It is diagnosed in 'stages' based on the child's age and how far it has metastisized. This cancer is stage 4, the most severe. While a large portion of neuroblastoma is missed early on, it is rare to be diagnosed with stage 4 at 3 years of age. Generally speaking a child is diagnosed with stage 1 or 2. It can progress to 3 or 4 after the initial dx is made obviously, but you can see the point. With neuroblastoma there are enzymes in urine that can immediately show up if you have this specific cancer. Urine, as a matter of routine, can indicate several things but can and will show this specific enzyme without necessairly 'screening' the urine itself for it. That is what is most tragic. Yes, it is most often diagnosed after it has metastisized. The stage of cancer is at diagnosis is what separates curable from terminal.

As for pediatricians taking urine or blood, my ped always does (urine and blood on well visits and blood on sick visits.) My children are 4 and 5 and are not frightened as this is done via finger prick and I have yet to see tears becaus of it. We went in for a sick visit two weeks ago. Both were sick and finger pricks were done. One had a bacterial pneumonia and the other a viral. Was this 'excessive'? Hardly. I would consider it the 'standard' of care. I would question any pediatrician who failed to do either as a matter of routine, let alone failing to do it on a chronically sick child who, by all accounts, was not getting better after six months of antibiotics and persistent low grade fever. One would think this would have been done at SOME POINT during this six months just to rule out various infections, etc.

As for the mother, I find it most distasteful that her mental health would be brought in to question. Her hands were tied as this MD was her point of reference and she could not go anywhere without a referral from that specific MD. She asked for a more to be done. She requested marrow to be drawn, she requested blood and urine tests. As mothers we would like to think that somehow this couldn't happen to OUR child... we would KNOW better, WE would do something different - If thinking that way makes some feel better then so be it, but I am hear to tell you that it can happen to YOU and it very well could have been my child instead of hers. No, I don't blame her. She did nothing wrong. I blame a skilled doctor who in my opinion failed to render the standard of care and the lack of that standard has cost a little boy is life.

I am a realist and I do realize that this is not nearly as cut and dry as someone who had the wrong leg removed during surgery. However, there is the 'standard of care' issue at hand here and at the very least I am interested to know why this doctor failed to render basic care. This is basic care. We are talking about a urine test on a TODDLER. I am not sure what will come out of this and if there is a case at all but I would not fogive myself if I didn't at least check into this on behalf of my friend. I am worried that this MD is still treating children and has missed two cases of childhood leukemia since her son was dx with neuroblastoma. Three cases of missed cancer in two years? Same doctor? Would you want your children to be treated by this doctor?

Thank you for the posts. I will do some more checking and calling around. I appreciate the replies and some of the information has been very helpful.

 

[ellencee]

rmet
Never forgot it or overlooked it...the mother has not posted and I assume the poster is the one who will, at this juncture, make all inquiries.

challa, et al...
I've researched neuroblastoma in sources from all over the world. I am not finding corroborating evidence for the claim of 'curable before the age of three' or easy to diagnose with a 'simple urine test'. I am finding that the prognosis is poor, 20% survivabilty, when neuroblastoma is diagnosed after the child reaches the age of one as neuroblastoma is USUALLY stage IV at this time. Apparently children under the age of 5 whose primary tumor site is in the chest have the greatest chance of survival (regardless of the stage of the tumor). The urine tests are performed after a tumor has been visualized on CT scan or MRI or simple x-ray OR after symptoms of a CNS lesion are suspected. Nowhere did I find that the urine tests should be performed routinely or as a screening tool. I did find that routine urine screening of infants in Japan was found to be of little impact in the study and treatment of neuroblastoma in children and the study's results are considered controversial. Apparently, another study is underway in Quebec but has yet to yield results for analysis.

Whether or not the child's regular physician should have sent the child for x-rays, batteries of blood work, urine tests (24 hour collections), or such is in question. Certainly, a physician has the duty to investigate, to rule-in or rule-out, the root cause for a parent's bringing their child to the office once or twice weekly. Simply to treat the child for this period of time without further investigation into the child's health, safety, and welfare is below the minimum standard of care--too many red flags to simply ignore the situation and write prescription after prescription for antibiotics and cold symptom relief. But--did such failure to rule-in or rule-out the root cause result in significant damages that would otherwise not have occurred? Probably not; but, in claims involving cancer, depriving the person of his or her last best chance at successful treatment can be all that is needed.

Here is information regarding the statute of limitations in South Carolina:
Statutes of Limitations

Medical malpractice claimants must bring suit within three years from the date of the occurrence or the date when the occurrence should have been discovered, but in no case more than six years from the date of the occurrence. S.C. Code Ann. § 15-3-545 (Law. Co-op. Supp. 1997). Foreign object cases may be brought within two years from the date of discovery. Id. The statute of limitations is tolled during the claimant's minority; however, the period may not extend beyond seven years from the date of the occurrence, or more than one year after the child attains the age of majority, whichever period is shorter. Id. The statute is also tolled during a claimant's insanity, but the tolling period cannot extend more than five years from the date of the occurrence or one year beyond the date the disability ceases.. S.C. Code Ann. § 15-3-40 (Law. Co-op. Supp. 1997).

An action to recover for medical malpractice resulting in death is governed by the foregoing, not by S.C. Code Ann. § 15- 3-530 (Law. Co-op. Supp. 1997), the wrongful death statute of limitations. Garner v. Houck, 312 S.C. 481, 435 S.E.2d 847 (1993).

EC

 

[panzertanker]

There is only one type of 'neuroblastoma'. It is diagnosed in 'stages' based on the child's age and how far it has metastisized. This cancer is stage 4, the most severe. While a large portion of neuroblastoma is missed early on, it is rare to be diagnosed with stage 4 at 3 years of age. Generally speaking a child is diagnosed with stage 1 or 2. It can progress to 3 or 4 after the initial dx is made obviously, but you can see the point. With neuroblastoma there are enzymes in urine that can immediately show up if you have this specific cancer. Urine, as a matter of routine, can indicate several things but can and will show this specific enzyme without necessairly 'screening' the urine itself for it. That is what is most tragic. Yes, it is most often diagnosed after it has metastisized. The stage of cancer is at diagnosis is what separates curable from terminal.

As for pediatricians taking urine or blood, my ped always does (urine and blood on well visits and blood on sick visits.) My children are 4 and 5 and are not frightened as this is done via finger prick and I have yet to see tears becaus of it. We went in for a sick visit two weeks ago. Both were sick and finger pricks were done. One had a bacterial pneumonia and the other a viral. Was this 'excessive'? Hardly. I would consider it the 'standard' of care. I would question any pediatrician who failed to do either as a matter of routine, let alone failing to do it on a chronically sick child who, by all accounts, was not getting better after six months of antibiotics and persistent low grade fever. One would think this would have been done at SOME POINT during this six months just to rule out various infections, etc.

As for the mother, I find it most distasteful that her mental health would be brought in to question. Her hands were tied as this MD was her point of reference and she could not go anywhere without a referral from that specific MD. She asked for a more to be done. She requested marrow to be drawn, she requested blood and urine tests. As mothers we would like to think that somehow this couldn't happen to OUR child... we would KNOW better, WE would do something different - If thinking that way makes some feel better then so be it, but I am hear to tell you that it can happen to YOU and it very well could have been my child instead of hers. No, I don't blame her. She did nothing wrong. I blame a skilled doctor who in my opinion failed to render the standard of care and the lack of that standard has cost a little boy is life.

I am a realist and I do realize that this is not nearly as cut and dry as someone who had the wrong leg removed during surgery. However, there is the 'standard of care' issue at hand here and at the very least I am interested to know why this doctor failed to render basic care. This is basic care. We are talking about a urine test on a TODDLER. I am not sure what will come out of this and if there is a case at all but I would not fogive myself if I didn't at least check into this on behalf of my friend. I am worried that this MD is still treating children and has missed two cases of childhood leukemia since her son was dx with neuroblastoma. Three cases of missed cancer in two years? Same doctor? Would you want your children to be treated by this doctor?

Thank you for the posts. I will do some more checking and calling around. I appreciate the replies and some of the information has been very helpful.

Somebody call me???

I agree with both responses: have your friend take their case to a medmal atty in your area.

I question why she chose to go to the 'family practice' MD 3 x week for 6 months and NEVER go visit another provider (you state she needed to be referred, but as you point out that a parent wants the best for their child, I read her visits to mean she was happy with the care she saw her son receiving otherwise she would not have gone back so frequently). That is over 70 visits in 6 months time... What other tests were performed on the boy? You are telling me that a doc sees a pt roughly 3 x a week and NO bloodwork/urine was performed???
I am stumped as to that being true. Have you seen the records?

You state you will give us more info:
I am asking for just that. I think it is trajic that it has happened, and am not blaming the mother. I just want to know if there were truly NO tests performed at all.

 

[ellencee]

challa
Calm down. Until your last post, you made perfectly good sense and presented your concerns in a very intelligent manner; now emotions are detracting from your concerns--example--The urine test required is not a simple 'pee in the cup'; it is a 24-hour collection of urine. How easy would it be to get a 24 hour urine collection from a toddler? Pretty darn impossible without a catheter!

As for bringing up the mother's mental health, frequent visits to a child's MD is a red flag for a very twisted mental condition known as Munchausen syndrome by proxy (a parent, usually the mother, makes the child sick to gain attention--it was portrayed in the movie The Sixth Sense). If the physician had attempted to rule-out this condition in the mother, it would have been done by expanding the testing of the child's physical health which would have in-turn revealed the neuroblastoma. So--don't be offended by the comments regarding the mother's mental health or the safety and welfare of the child.

I find the circumstances you have described to be abhorent. I believe any prudent physician would have sent the child for another medical opinion but I can not find information that supports your claim that the child could have been cured if the neuroblastoma had been diagnosed earlier.

EC

 

[challa]

Urine should be done as a matter of routine in pediatrics and family medicine. My pediatrician does? It should most certainly be done in a chronically sick child just to rule out x,y or z. We aren't talking looking for neuroblastoma or cancer in every child, we are talking standard medical care. As an adult I am asked to give urine at annual visits and sick visits. I expect this to be done for my children and have never had to question why it wasn't being done because it always has been?

I have been to the same websites as you I am positive. Statistics can often be confusing and misleading to the layperson. In speaking with the pediatric oncologists here in South Carolina and having gone to numerous appointments with my friend, I can promise you that if diagnosed prior to age 3 it is usually curable. After 3 there is no one who has made it past age 8. The general rule of thumb is the younger the better. If diagnosed in an infant the cure rate is nearly 100%. As yes, this cancer has actually been dx in-utero before.

The bottom line is that this doctor should have know better. The tumor was bulging on one side of his neck for three weeks prior to the ER visit. This should not have slipped by a physician after the 200th visit. I also realize that knowing better and being held legally accountable are not the same. We shall see what happens.

An attorney contacted me this moring and wants to meet with the mother and myself immediately and is willing to drive from Spartanburg to do so. So, while I certainly don't have my hopes up, this has obviously caught the attention of a legal progessional and he obviously thinks it's worth his time to investigate it a little further. I would consider this 'encouraging' news and we will go forth with caution.

Thanks again.

 

[challa]

"You are telling me that a doc sees a pt roughly 3 x a week and NO bloodwork/urine was performed"

YES, that is exactly what I am telling you. It is hard to believe but true nonetheless. I believe this is why the current doctors who are now treating her son keep reminding her of the 'lack of standard care' issue.

Her doctor was a family physician. There was ONE referral to an ENT who inserted tubes in his ears three months prior to the dx of neuroblastoma. I really have to question if he really had ear issues at all but in giving the benefit of the doubt I hope this wasn't done just to 'appease' the mother.

She tried to get her medical records to no avail. The family physican has not ONE TIME called to check on this little boy and she treated the entire family for six years. I find that very odd at best.

The bottom line is that the attorney will get the records, review all the facts and make a determination and advise of whether there is a case here.

 

[challa]

I am not a physician and I don't believe anyone posting in this thread has a license. I am going by what I was told by two pediatric oncologists have told me on more than one occasion. I need not defend that position or spend hours visiting statistical info on this cancer. I believe what was told to me and I think these two oncologists would not provide erroneous information to the mother of a dying child.

I know of two cases where parents successfully sued medical providers when their child was dx with this rare form of cancer at a late date. So, while this is not cut and dry I do believe that when lack of basic care results in injury or death, legal avenues can be explored and sometimes won, even with neuroblastoma.

Thank you for your time.

 

[rmet4nzkx]

You are overly invested in this case, this is not a question of how to persue a medmal claim, it is a sounding board for some personal agenda you have. This is a site for legal issues and advice, not a support group, venting or ranting site.

We have already informed you that the mother can seek consultation with a medmal attorney and some of the possible problems with such a case. No one has said that the parents should not do that. We cannot determine if the case is meritorious based on your 3rd hand account or your beliefs about what the standard of care should be. The NIH doesn't find the urine test a reliable screening tool because of the high rate of false positives, with that being the case, it is not the SOC and therefore, if a doctor or insurance carrier doesn't order this test without reason, it does not violate the SOC, there may still be a case, but not based on lack of a urine test, unless there was a reason to order the test and we don't have the chart to determine that.

In any event, neither you nor we know what is actually in the patient's chart, what tests were done, or the results of those tests. The parents can consult with a medmal attorney, give permission for the records to be reviewed, a part of that will include a review of the parents actions and review of child and parents medical histories. Let's say, mom had an ultrasound and the radiologist who read the images failed to Dx signs of the tumor inutero, or failed to suggest more tests, you could be accusing the wrong doctor. But you don't have that information, it is up to your friend to consult the medmal attorney.

Neither you nor we can change the SOC here, that is beyond the scope of this forum.

What you think the standard of care should be is beyond the scope of this forum.

Insofar as the question of the mother's mental health, that will be an issue for a number of reasons. Apparently you are uninformed both about medical issues in general but also, all the issues raised in a lawsuit. A lawsuit is not a pleasant experience, there is a very good reason why that pound of flesh has always been an issue. Just because something is not diagnosed early or the first time symptoms present, doesn't mean there is misdiagnosis or negligence, if that were the case, NO, doctor or healthcare provider would be in practice and the courts would be cloged with lawsuits for EVERYONE who was sick and not diagnosed the first time.

Your good friend, had other options. While you didn't say whether or not they had insurance, HMO, medicaid or self pay, in each and every case there are means to change doctors, to make complaints, to seek a second opinion, to appeal, there must be some reason that didn't happen if this child was so sick with no improvement.

There are psychological disorders that present in a similar manner and requesting all the tests throws up a red flag, so if there is a lawsuit, this is an issue that will come up as to why the mom acted as she did, it is not disrespectful, it is a fact for which she will need to be prepared. But everything you have so emoptionally presented here is not a first person account by a person in a place to really know what happened or answer our questions, such as what type of neuroblastoma, not what stage, there is a difference.