( 12 ) Prostate Cancer • 40 events closed 2020-2024 • 10 events resulted in death • 22 events noted failure to order a diagnostic test (initial, or follow-up testing) • 29 events (73%) closed with an indemnity payment • $749,000 average payment About one in every eight American males will develop prostate cancer.10 Although the medical community continues to look for consensus on how to approach prostate cancer screening and treatment, it remains a high-profile health concern. Ethnicity and family history must be considered in discussions around PSA testing, and quality-of-life issues must be factored into treatment. Documentation is crucial, including the notation of all discussions about screening and treatment options (and the patient’s informed refusal). If PSA testing has commenced, it is imperative to follow, discuss, and document the trajectory of results. 40 prostate cancer events closed 2020-2024 | HIDDEN IN PLAIN SIGHT | Exposing the Drivers of Diagnostic Error A DOSE OF INSIGHT ® Coverys | $749,000 average payment 73% of events closed with an indemnity payment CASE SUMMARIES Failure to document missed appointments and screening refusals complicated the defense of a failure-to-diagnose prostate cancer claim. The physician’s testimony that they followed protocol could not be supported due to lack of documentation. Failure to recognize and follow up on rising PSA levels led to a missed opportunity for early prostate cancer detection. A significant PSA increase (1.7 to 2.9) was not addressed or monitored over two years, and no related discussions were documented. Lung Cancer • 32 events closed 2020-2024 • 26 events resulted in death • 16 events noted failure to order a diagnostic test (initial, or follow-up testing) • 19 events (59%) closed with an indemnity payment • $555,000 average payment About one in every 17 or 18 Americans will develop lung cancer.11 While tobacco use has dropped, a history of smoking remains a key risk factor and a trigger for screening. A prominent concern is appropriate follow up and communication after an incidental finding from a chest X-ray. Radiologists and primary care providers (PCPs) need to ensure patients are aware of such findings and next steps—even when the patient is undergoing care for a different concern (e.g., what prompted the X-ray). Repeated complaints of an unresolved cough are another red flag that may need further investigation of the possibility of lung cancer. CASE SUMMARIES Failure to follow up on abnormal chest X-ray findings in a long-term smoker with hemoptysis resulted in an 18-month delay in diagnosing lung cancer. Despite a radiologist’s recommendation for a CT scan, no imaging was ordered or discussed during multiple visits. Failure to act on radiology recommendations for a possible mediastinal mass led to a 13-month delay in diagnosing lung cancer. Although the PCP acknowledged the X-ray report advising follow up with a CT scan, the provider did not order follow up imaging despite subsequent visits until symptoms worsened and cancer was confirmed. 32 lung cancer events closed 2020-2024 $555,000 average payment 59% of events closed with an indemnity payment