LaRosa v. Banks

$300,000 Date of Verdict: May 4. Court and Case No.: C.P. Westmoreland County No. 616 of 2017

Judge: Anthony G. Marsili Type of Action: Wrongful death, medical malpractice. Injuries: Death. Plaintiffs Counsel: Todd D. Bowlus, Harry S. Cohen & Associate, Pittsburgh. Plaintiffs Experts: Dr. John A. Chabot, oncologic surgery, New York, New York; Dr. Lorenzo Mannelli, radiology, New York, New York. Defense Counsel: David M. Chmiel, Matis Baum O'Connor, Pittsburgh. Defense Experts: Dr. Barry D. Daly, radiology; Baltimore, Maryland; Dr. Daniel A. Laheru, oncology, Baltimore, Maryland; Dr. Michael A. Bruno, radiology, Hershey, Pennsylvania. Comment: On Oct. 21, 2014, plaintiff's decedent Paul LaRosa, 66, presented to the emergency room at Frick Hospital, in Mount Pleasant, with complaints of back pain. LaRosa rated his pain a 10 out of 10 and was given pain medication. He underwent a CT scan of his abdomen and pelvis. Radiologist Matthew Banks, in his review of the scan, noted an unremarkable pancreas and no acute intra-abdominal or pelvic findings. LaRosa was discharged with a diagnosis of back pain and given instructions to follow up with his primary care physician. Over the next 15 months, LaRosa consulted with his primary care physician and returned to the emergency room three times with complaints of back pain. On each occasion, physicians noted in the records that the CT scan from October 2014 was "negative." LaRosa was given pain medication, which remedied the pain, and he was diagnosed with back pain. On Jan. 31, 2016, LaRosa presented to Frick Hospital with complaints of upper-abdominal pain. A CT scan showed a tumor on his pancreas, which was later confirmed as cancerous. LaRosa died the following year, on July 6, 2017. Prior to his death, LaRosa sued Banks and his practice, Radiologic Consults Ltd., alleging negligence amounting to medical malpractice. Specifically, he claimed that Banks failed to detect a cyst on the CT scan of Oct. 21, 2014. LaRosa also sued Frick Hospital, which was dismissed, prior to trial. Following LaRosa's death, his estate was represented by his wife. The estate's expert in radiology testified that there was a pancreatic cyst on the CT scan of October 2014, and that Banks had failed to diagnose it. The cyst was between 1 centimeter and 1.5 centimeters in size. According to the expert, Banks, in his review of the scan, failed to take into account that LaRosa was a patient in his 60s presenting with back pain, which would have led Banks to closely scrutinize the pancreas. If LaRosa had been properly diagnosed, a follow-up CT scan with pancreas protocol or an endoscopic ultrasound would have been ordered, to further determine whether the cyst was benign or malignant, the expert concluded. The estate's expert in oncologic surgery confirmed that Banks had failed to diagnose the cyst. According to the expert, pancreatic cancer tends to be fatal because it is often diagnosed too late. However, if Banks had properly detected the pancreatic cyst, it could have been monitored and surgically removed if malignant, or removed at the first signs of it becoming malignant, and LaRosa's chances of survival would have been much higher. The expert maintained that LaRosa would have most likely undergone a Whipple procedure, also known as a pancreaticoduodenectomy, to remove the head of the pancreas, the first part of the small intestine, the gallbladder and the bile duct. The estate's counsel pointed out that the radiologist who had diagnosed the pancreatic tumor in the CT scan of Jan. 31, 2016, also reviewed LaRosa's scan of Oct. 21, 2014, and noted in his report that the cyst was "evident." The defense counsel maintained that Banks had properly interpreted the CT scan. The defense's expert in radiology acknowledged that the pancreatic cyst was present in the scan of October 2014, but opined that it was too subtle to expect a reasonable radiologist to recognize it. The defense's expert in oncology testified that even if the cyst had been recognized and removed earlier, LaRosa would have died, because LaRosa, when diagnosed in 2016, had a carcinoembryonic antigen level over 10,000, which indicated that there was underlying metastatic disease present well before the diagnosis. The expert further disputed that LaRosa would have even survived a complex surgery such as the Whipple procedure, given his extensive comorbidities. LaRosa had two prior heart attacks, had seven cardiac stents, suffered from diabetes and chronic obstructive pulmonary disease, was morbidly obese and was a former smoker. The estate's counsel argued that metastatic disease was not diagnosed until February 2017, more than a year after LaRosa's initial cancer diagnosis, when the cancer had spread to his liver, and that the defense expert's testimony was not supported by the treating doctors' medical records. Following his cancer diagnosis, LaRosa underwent several courses of chemotherapy in attempt to shrink the pancreatic tumor so that it could be removed. The tumor shrank at first but then started growing again. Given its close proximity to the mesenteric artery, it was determined that it would be too risky to remove the tumor. LaRosa also treated with radiation therapy. He is survived by a wife, two sons and a daughter. LaRosa's family members talked about how LaRosa, a retired coal miner, was the patriarch of the family who promoted the values of family and hard work. His estate sought damages under the Wrongful Death and Survival Acts. The jury found that Banks was liable and awarded LaRosa's estate $300,000. This report is based on information that was provided by plaintiffs' counsel. Counsel of Banks and Radiologic Consults did not respond to calls for comment, and Frick Hospital's counsel was not asked to contribute. —This report first appeared in VerdictSearch, an ALM publication