From SignOnSandiego.com:
Medical board says physician ignored man’s cancer symptoms
By David Hasemyer
UNION-TRIBUNE STAFF WRITER
October 23, 2006
For the last two years of her husband’s life, Shirley Gaytan watched him wither away.
They both knew something was wrong, yet repeated visits to his doctor failed to provide an answer to his worsening health.
Draining the life out of Jesus Gaytan was prostate cancer. But he didn’t know it because his doctor ignored the symptoms of his cancer for years and then failed to review tests results that warned of the disease, according to an accusation filed against the physician by the Medical Board of California. By the time the cancer was diagnosed, it was terminal.
Now the medical board wants to revoke the license of Kaiser Permanente doctor Michele Lamantia, whom the board accuses of negligence in her care of Jesus Gaytan.
?You can’t imagine how it was to watch my husband dwindle away,? Shirley Gaytan said. ?You don’t know how I mourn.?
Gaytan, who said she and her husband had been married 40 years, declined to talk about his treatment because of a confidentiality agreement signed when the Mira Mesa couple settled a malpractice lawsuit against Lamantia.
Lamantia declined to discuss the accusation, but her attorney called Gaytan’s death a tragedy and blamed Kaiser bureaucracy for not red-flagging the test results.
Laboratory technicians did not notify Lamantia of the abnormal tests, said her attorney, Russell Iungerich. Instead, the results were entered in Gaytan’s central medical file, where records are permanently stored, Iungerich said.
?Had she known, she would have immediately made a referral to a specialist,? the attorney said.
Lamantia, who has been licensed in California since 1991 and has worked at Kaiser since 1992, first examined the 57-year-old Gaytan in 2000, according to the medical board’s accusation filed in Administrative Law Court. Gaytan was complaining of back pain, a symptom that could have suggested prostate cancer as a possible cause.
According to the accusation, Lamantia, who works at Kaiser’s Bostonia office in El Cajon, examined Gaytan twice more in 2000 and three times in 2001 but never performed a digital rectal exam, a simple procedure that could have signaled an abnormality of the prostate and prompted more diagnostic tests.
In early 2002, Lamantia ordered a blood test called a PSA exam that revealed an elevated level of a protein symptomatic of prostate cancer and a few other disorders, according to the accusation. The PSA level was 23. A normal level is between 1 and 4.
The doctor’s records suggest she never reviewed the tests or referred Gaytan to a specialist, according to the accusation, which must be proved in a court hearing.
Four months later, in June, another blood test was performed. The PSA level was much higher, at 52, further evidence of cancer and a warning sign that medical authorities say would have demanded specific testing for prostate cancer. Again the doctor did not note the results, according to the accusation.
In August, Gaytan was referred to a specialist who diagnosed his cancer, according to the accusation.
?In spite of the fact that (Gaytan) continued to exhibit signs of, and complain of symptoms of, prostate cancer, Michele Lamantia failed to take appropriate action to identify, diagnose and treat (Gaytan’s) prostate cancer,? according to the civil lawsuit the Gaytans filed against the doctor.
?Had medical treatment been rendered within the requisite standard of care, (Gaytan) would have fully recovered and properly healed from his prostate cancer.?
But Lamantia had no way of knowing Gaytan needed further care, her lawyer said. The protocol at Kaiser is for the lab to notify doctors of abnormal tests, Iungerich said. When the lab does not call, doctors are not aware there is a problem, he said.
?In this case, there was a system screw-up,? Iungerich said.
Because Lamantia, who has no disciplinary record with the medical board or Kaiser, was never notified, she had no reason to suspect anything was wrong, her attorney said.
A spokeswoman for Kaiser said she could not comment on the state’s accusation against Lamantia or her lawyer’s contention that the responsibility for the errors rest with the organization.
Iungerich said that at the time Lamantia was caring for Gaytan, Kaiser was switching from keeping records on paper to a computerized system that sends results to patients by e-mail and makes the test and other medical records available to doctors and patients online.
Anytime a PSA reading is above 5, doctors have to heed that as a warning, said Barton Wachs, a urologist at Long Beach Memorial Hospital.
?So if you have one that is in the 20s, that is an indicator that something is going on,? Wachs said.
When the number reaches the 50s, it is definitely a matter of concern, he said. ?Something that high means . . . it needs to be looked at immediately,? he said.
That’s where the medical board said Lamantia was incompetent.
Her patient’s PSA tests showed levels increasing from 23 to 52. By ignoring the soaring numbers, Lamantia was ?grossly negligent,? according to the accusation.
By the time Gaytan was examined by another doctor, his PSA number had increased to 152, and a biopsy confirmed prostate cancer, according to the Gaytans’ civil lawsuit. Further tests in 2002 showed the cancer had spread to his bones.
?(Gaytan) was told there was little or no medical treatment that could help him at this point,? according to the lawsuit.
He died in October 2004.
David Hasemyer: (619) 542-4583; david.hasemyer@uniontrib.com
My father died Oct 28, 2006 at Kaiser. For 1 year he complained of back pain, leg pain, shortness of breathe, fatigue, and he had several infections. He was given inhalers and he never used them in his life. He was given vicodan and when that didn’t work he was given oxycodone and nuerotin for nerve pain. A x-ray wasn’t ordered for 8 months and a mri was ordered 2 weeks later. He was given a cortisone shot and his doctor went on vacation. No doctor read the MRI and it showed lymphoma. An agressive type. I took him to the emergency room where he was diagnosed and he never left the hospital. He was exposed to three infections. Two that contributed to his death and are scientificly proven linked to construction and known to infect immunocompromised patients. A new hospital is being built all around the exsisting campus and the exsisting hospital is still operating. The lymphoma was under control at the time of his death as told to us by his oncologist. He was given pills by one nurse with her bare hands and fake fingernails straight into his mouth. I actually wiped feces off the walls ans floor as the nurses had a habit of throwing his dirty linens on the floor as they were changing him. Whenever asked my dad would always deny pain and he would be given sedatives anyway. He also had a reaction to platelets and the orders were for them to be irradiated but they ceased to be and I can only think that the standing order was not found. This place is a nightmare and it got worse. When my father had the second reaction to the non-irradiated platelets it was so bad he had to be intubated. His body was so riddled with infection and the reaction caused anaphylaxis that he never made it out of the ICU. When my mother decided not to re-intubate him and see if he could come around on his own the doctor took it to mean that she agreed to a DNR that stated Not To Resusitate and move to “comfort care”. We only found out when we started to notice that his meds. and eye drops (he had gone blind in one eye because of one of the fungalinfections) and his food. When he wasn’t reintubated we asked what happened next. The doctor stated that he would give him morphine and hoped he slept through it. We thought he meant sleep through this episode not sleep through his death. When the nurse said that she would give him 2 mgs. he replied that they would give him 4 mgs. IV push. I will never forget those words and didnot realize what was happening. We are sick. We took my dad to the hospital to get getter not to die in 9 weeks. How does a doctor get away with placing a DNR on a patient’s chart without the permission of the family? My dad did not have one before he entered the hospital and did not sign one during his hospitalization. My parents were married for 51 years.
I just read your letter and my deepest sympathy to your family. I have a similar story in 2003 early July my mother kept complianing about being tired, coughing,pains in her shoulder ,having trouble catching a breath. She went to the doctor several times each time was told she either had bronchitis, arthritis, or a flu, I told her to demand test that this wasnt normal, she did they finally did them and it was too late, we were told she had stage 4 lung and liver cancer no cure or hope. I lost my mom 3 wks later. Had they listened to her maybe she would still be here.
There are Dr who are just in it for the money. I sometimes think that unless you have connection with the doc. (race, gender etc) They just see you as a meal with legs. I have dealt with some wonderful docs, mediocre docs, and bad docs. Fortunately the bad docs have not “done harm” to me or my family. I hope that the responsible people are prosecuted. I can’t believe that they know the pain that their laziness and inaction causes. If nothing else at least I hope they spend a lot of sleepless night. Not my first rodeo yah know!!! God bless you and your family.