Opinion ID: 3163349
Heading Depth: 2
Heading Rank: 1

Heading: The Surgery

Text: After experiencing shortness of breath and persistent pain in her right arm and wrist following a 2002 car accident, Mrs. Bradley underwent magnetic resonance imaging (MRI) in November 2004. The MRI revealed a mass at the top of Mrs. Bradley's right lung that her physician feared was cancer. After learning the results of the MRI, Mrs. Bradley was scheduled for a positron emission tomography (PET) scan and FNA biopsy.1 On 1 An FNA biopsy is an outpatient procedure in which a radiologist inserts a long, hollow needle through the skin and into the mass to extract cells. A pathologist then examines the specimen under a microscope. The diagnostic yield -- or the positive yield rate -- is between ninety to ninety-five percent. -2- December 1, 2004, Mrs. Bradley received her PET scan results, which suggested that the mass was benign, although malignancy [could not] be entirely ruled out. Mrs. Bradley met with Dr. David Sugarbaker, the Defendant-Appellee, a thoracic surgeon at Brigham & Women's Hospital, in Boston on December 7, 2004. During the appointment, Dr. Sugarbaker took Mrs. Bradley's medical history and learned that she had scarring on her right lung from the 2002 car accident. Dr. Sugarbaker stated that he was more than 50 percent sure [Mrs. Bradley had] cancer, and that Mrs. Bradley would need to undergo a biopsy. Dr. Sugarbaker's notes from that day indicated that [a] malignancy needs to be ruled out. We will see whether an FNA can be done to secure a diagnosis. Later that same day, Mrs. Bradley met with Dr. Lambros Zellos, another thoracic surgeon at Brigham & Women's, to review her MRI results. Mrs. Bradley explained to Dr. Zellos that she had an FNA biopsy scheduled and asked whether she should proceed with that procedure. Dr. Zellos said it was necessary to check with the radiologist first to see if the biopsies could be done that way. As recounted in more detail herein, Mrs. Bradley never received an FNA biopsy. After a second PET scan, Dr. Sugarbaker again met with the Bradleys on December 14, 2004. The scan indicated that the mass was unlikely to be cancerous. After -3- reviewing the scan, Dr. Sugarbaker advised the Bradleys that [t]his looks like it might not be cancer and recommended scheduling a surgical biopsy to remove and test tissue samples. Dr. Sugarbaker did not discuss the next steps once he determined whether the mass was benign or malignant. Mrs. Bradley proceeded to surgery, which took place on December 17, 2004. The informed consent form that she signed indicated that she would undergo a bronchoscopy,2 mediastinoscopy,3 and minithoracotomy4 and described the risks associated with these procedures. During the operation, Dr. Sugarbaker took six samples, all of which tested negative for cancer. To obtain a sixth sample, Dr. Sugarbaker performed a pulmonary wedge resection, during which he excised a larger sample including portions of healthy lung tissue. This section measured 8 x 3.5 x 3.5 centimeters, which was larger than each of the other samples. Following surgery, Mrs. Bradley was dismayed to wake up in the surgical intensive care unit. At that time, she discovered 2 During trial, Dr. Sugarbaker described a bronchoscopy as a procedure in which a camera is used to examine the airway passages to look for signs of cancer. 3 One of Dr. Sugarbaker's colleagues, Dr. Christopher Ducko, described a mediastinoscopy as a procedure to sample and biopsy the lymph nodes. 4 A minithoracotomy is a procedure whereby doctors biopsy a mass to remove tissue samples. -4- that during the surgery they actually removed a piece of my lung when they removed the mass. Her admission notes indicate that the procedure had become more extensive [secondary] to significant scarring from prior trauma and surgery. The notes also indicate that Mrs. Bradley suffered multiple air leaks as a result of the wedge resection. She was not discharged until approximately a week later, on December 25, due to the air leaks. Subsequent X-rays revealed a pneumothorax, otherwise known as a collapsed lung, where the mass was removed. In the intervening months, Mrs. Bradley developed a cough and worsening arm pain. A PET scan revealed what resembled an empyema -- a collection of pus -- near her lung. Samples from Mrs. Bradley's right upper chest area tested positive for a fungus known as aspergillus fumigatus, and Mrs. Bradley was diagnosed with a bronchopleural fistula, a leak which allowed the space where her right upper lobe was removed to be infected with aspergillus. Persistent infections have led to years of complications and pain. In March 2006, Mrs. Bradley stopped working in her position as a law librarian because she was too sick to go to work. During the summer of 2006, she received intravenous treatments containing antifungals and antibiotics to treat the infection. When these remedies proved unsuccessful, Mrs. Bradley underwent additional surgeries in 2006 and 2009 to treat her -5- ongoing infections. Mrs. Bradley still takes pain medications and an expensive antifungal medication to prevent further aspergillus infections.