The Baer Law Firm Investigates a Year-Long Delay in Diagnosing a High School Student’s Brain Cancer After a Pediatric Emergency Department Failed to Act on Recommended Follow-Up Imaging

The Baer Law Firm has been retained to investigate the medical care of a Georgia high school student whose malignant brain tumor was visible on a CT scan almost a year before anyone told his family it was there.

The student was 15 years old when he collapsed and was seen at a pediatric emergency department operated by a large children’s health system. A CT scan of his head was performed that same day, and the radiologist reported a small, calcified lesion in the right side of the cerebellum — the part of the brain that controls balance — and specifically noted in the radiology report that an MRI of the brain was “advised for adequate evaluation.”  Unfortunately, the attending Emergency Department physician either did not read the Radiologist’s report or read it incorrectly and did not order an MRI. The ED physician’s notes regarding his discussion with the family report, “The CAT scan of the head shows no signs of abnormality of your child’s brain at this time.” The family states they were never told about the calcified lesion finding, nor that an MRI was recommended. As a result, the MRI was not ordered nor performed.

For roughly the next eleven months, the student was seen again and again for persistent dizziness, lightheadedness, ear pain, and headaches. He underwent an extensive cardiac work-up — EKGs, echocardiogram, chest x-ray, and extended rhythm monitoring — all of which came back normal. His symptoms were repeatedly attributed to orthostatic intolerance, POTS, or anxiety, and he was placed on a psychiatric medication. None of the medical professionals ordered the brain MRI that the radiologist recommended.

Nearly a year after the first CT scan, an ENT practice in an entirely separate health system independently ordered a CT scan of the student’s temporal bones to evaluate the student’s persistent complaints of right ear fullness and, by then, hearing loss. That scan revealed a mass in the right posterior fossa measuring approximately 1.6 x 1.3 cm, with mass effect on the brainstem region. An MRI confirmed it. When the large children’s health system’s own neuroradiologist compared the new images against the CT from the prior year, the neuroradiologist concluded that the mass “has significantly enlarged since” the original scan and showed “some high grade imaging features.”

The student underwent a craniotomy to remove the tumor. Pathology returned a diagnosis of medulloblastoma — a malignant embryonal brain tumor — with focal anaplasia. In plain English, the tissue removed from his brain turned out to be a brain cancer. Shortly after brain surgery, the young man received radiation treatment, followed by chemotherapy, which he continues to receive. His treatment has been complicated by chemotherapy-induced peripheral neuropathy, an autoimmune inflammatory spinal cord condition requiring high-dose steroids and monthly IVIG treatment, as well as urinary retention and hearing loss on the side of the tumor.

Unfortunately, the medical system’s failure to act is not unique to this family. Follow-up on radiologist recommendations is a well-documented weak point in American medicine. Published compliance with obtaining recommended follow-up imaging for an abnormal finding has ranged widely, from roughly 29% to 77% according to the University of Rochester Medical Center. Even at an institution studying itself with structured reporting, roughly one in seven recommendations was not acted on within the recommended timeframe, and reviewers judged 31 of those open-loop cases to pose substantial clinical risk (AuntMinnie, reporting on JAMA Network Open).

What Families Can Do

Parents should not have to function as their own radiology tracking system. But until health systems reliably close these loops, it helps to know what to ask:

• Ask for the actual radiology report, not the summary. “The scan was normal” is a conclusion. The report is a document. Request a copy and read the impression section.
• Ask the specific question: “Did the radiologist recommend any additional imaging or follow-up?” This one sentence would have changed this case.
• Ask who owns the follow-up. “Who is responsible for making sure this MRI gets scheduled, and how will I know if it doesn’t?” Then verify it yourself.
• Make sure every new provider sees the report itself. Records do not automatically follow a child between unaffiliated health systems. And providers within a hospital network often DO NOT look at the previous electronic records closely. Carry paper copies with you.
• Treat a normal cardiac or lab work-up as a beginning, not an ending. If your child’s symptoms persist or worsen after a negative work-up, ask directly: “What serious causes have we not yet ruled out, and what imaging would rule them out?”
• A mental health referral should never close the file. Anxiety and a tumor are not mutually exclusive, and a child can have both. If a psychological explanation is offered for physical symptoms, ask what organic causes were excluded, and how.
• Write down the timeline. Dates, symptoms, and what each provider said. In this case, the pattern became visible only when the entire chronology was assembled.

Our Firm’s Commitment

The Baer Law Firm holds providers and institutions accountable for these breakdowns, both to obtain recovery for the children and families who bear the consequences, and to push for the tracking systems and diagnostic humility that would prevent the next one. Our investigation in this matter is ongoing. Additional records have been requested, and expert review of standard of care and causation is underway. Nothing in this article is a conclusion that any provider breached the standard of care.

If your child was diagnosed with a tumor or another serious condition after months or years of being told the symptoms were anxiety, stress, or growing pains — or if you have learned that a recommended follow-up scan was never performed — contact us for an honest assessment.

Bryan Baer

Attorney Bryan Baer has twenty (20) years of legal experience representing clients in serious and serious personal injury and medical malpractice cases. He has been first chair in more than a dozen twelve-person jury trials on both the plaintiff and defense sides. Recognized as a leader in his legal community, he is frequently asked to speak at legal seminars on trial topics ranging from “Best Practices in Voire Dire” to “Maximizing Damages at Trial” as well as insurance issues such as “Navigating the Insurance Landscape” and “Injury Demands & Negotiations.” Learn more here.