Settlement for failure to investigate lung abnormality resulting in terminal diagnosis

We settled a claim against Princess Royal University Hospital in Kent for a radiologist’s failure to investigate a lesion identified on our client’s chest X-ray, which resulted in him losing the likely prospect of curative surgery. He was faced with a terminal illness by the time of his actual diagnosis.

When the events took place, our client was 40 years of age and in good health. He was and always had been a fit and active individual, a non-smoker and had no notable family history.

In 2011 he was due to undergo nasal surgery, and as part of the preparation for this required a chest X-ray which was performed at the Princess Royal Hospital. The radiologist noted a 17mm opacity in the left mid zone and a repeat chest X-ray was recommended following a course of antibiotics. Our client subsequently attended a follow up X-ray at the Princess Royal a few weeks later to see if the 17mm area identified by the radiologist had reduced / resolved as a result of the medication. This time the radiologist observed: ‘The previously noted 1.7cm opacity in the left mid zone persists. This may present a pleural plaque. The rest of the lung fields are clear. If the patient is symptomatic I would recommend a referral to a respiratory physician with a view to investigating his left mid opacity’.

The GP was aware that our client had no symptoms of concern and so no follow up was arranged.

In the summer of 2015, our client began to develop joint and back pain and so underwent an MRI scan which showed likely bone cancer. Further investigations were almost immediately commenced and shortly afterwards he was diagnosed with metastatic lung carcinoma. He was told that his condition is terminal and too advanced for any cure. While he has been undergoing treatment, this is palliative only and his disease is now progressing, meaning he has significantly reduced life expectancy.

Our client was advised by the clinical team at the Princess Royal Hospital that his lung cancer may have been present at the time of the X-ray performed in 2012. He subsequently instructed our clinical negligence team to investigate the claim.

We obtained expert evidence from a consultant radiologist who was supportive of a claim against the radiology team at the Princess Royal Hospital on the basis that, at the time of reviewing the second chest X-ray, the radiologist had identified a 1.7cm abnormality which had not responded or changed in any way as a result of antibiotics. It was therefore extremely unlikely to be inflammatory. The radiologist should have considered the potential for this to be an intrapulmonary nodule and in the circumstances, the only appropriate course of action was urgent referral to a chest physician for CT scanning and other investigations. The consultant considered that there was a complete failure on the part of the radiologist to take appropriate action and to make an urgent referral via the patient’s GP and/or directly onto a respiratory team for a CT scan to have been arranged. He was of the opinion that to advise review only if the patient became symptomatic and not to recommend any further investigation was entirely unacceptable and fell below an appropriate standard of care. It is well known that lung cancer is often asymptomatic until a late stage, and to suggest investigation only if and when a patient becomes symptomatic when an abnormality is clearly demonstrated on a chest X-ray would be entirely inappropriate.

Various guidelines were in place at the time (including from NICE), all of which would indicate that a lesion such as this should have been regarded as suspicious and an urgent referral made, whether or not the patient was symptomatic.

Expert oncology opinion was then sought, and both specialists were in no doubt that the lesion identified on the chest X-ray in January 2012 was the lung tumour seen on the CT scan in November 2015. It was their opinion that had the radiologist taken appropriate action and advised the patient’s GP to make an urgent referral through the expedited two week cancer wait pathway, our client would have received a referral to the local chest physician in early February 2012, undergone a CT scan, and on the balance of probabilities a PET scan and biopsy within four weeks of coming to the respiratory physician, and a diagnosis would have been made. It was the view of our experts that at the time of the missed diagnosis, surgery would have been curative.

Our team presented a case to the hospital on the basis that the radiologist had been negligent in not arranging further follow up to investigate the lesion. It was alleged that with timely diagnosis, our client would have had a normal or very near normal life expectancy.

As a result of this breach of duty, our client claimed for the severe pain and discomfort he has suffered through the side effects of treatment, the chemotherapy treatment he has to undergo, his health deterioration and ultimately his death. He also claimed for future aids, equipment and care that will be required as a result of his deteriorating and terminal condition, loss of earnings to date, and loss of income in relation to future lost years of life.

We submitted a letter of claim on the basis of the above evidence, which the trust investigated promptly. It made a full admission of liability and apologised to our client. We disclosed the evidence in support of our valuation of his claim and the parties engaged in a successful settlement meeting.

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