The Pathology Blawg had a recent note about a class action lawsuit against the University of New Mexico over inadequate treatment of children diagnosed with leukemia between 1989-1996 (see: Class action malpractice lawsuit may cost New Mexico taxpayers up to $165 million). Here is an excerpt from the note:
The suit revolves around Dr. Marilyn Duncan, former chief of pediatric oncology at UNM, and the treatment she provided to children with acute lymphoblastic leukemia (ALL). She claimed patients were getting state-of-the-art therapy, but it is alleged that up until 1996, she gave pediatric ALL patients therapeutic regimens from the 1970s with some modifications. In all, UNM has identified about 277 patients treated by Dr. Duncan during that time frame; only 110 of the patients (and/or their parents) are involved in the suit so far. An investigative series by the Albuquerque Journal in 2000 showed pediatric ALL patients had a 75% 5-year survival rate nationwide, whereas the patients treated at UNM only had a 50% five-year survival rate. Of the survivors, many are blind, quadriplegic or have other disabilities. Within that series it is also revealed that despite the fact Dr. Duncan chaired a very important committee in the Pediatric Oncology Group (a nationwide research consortium), at one point in time there were no children in the entire state of New Mexico enrolled in clinical trials. Additionally, UNM was on and off of probation numerous times in the 1990s for failing to enroll at least six patients in clinical trials....State officials now also feel losing the suit is “reasonably possible”....Dr. Duncan was allegedly forced to leave UNM in 1998, subsequently retired and forfeited her medical license.
I generally advise friends with cancer to seek treatment in academic cancer centers. The rationale behind this advice is that such centers usually offer state-of-the-art treatment and enrollment in clinical trials. Academic oncologists usually focus on a particular type of neoplasm such as lung cancer and become proficient because of this specialization. In the case referenced above, something seems to have gone badly awry. The former chief of pediatric oncology at the University of New Mexico was not enrolling her patients in clinical trials and also not providing up-to-date treatment for her patients. This despite the fact that she chaired a committee of the Pediatric Oncology Group, a nationwide research consortium.
A detailed article from the ABQ Journal in 2000 attributes Dr. Duncan's mistakes, in part, to stress and overwork (see: Tragic Consequences). Here is an excerpt from it:
[A nurse] said [Dr.] Duncan was rude to some families and sometimes would not return their telephone calls. Yolanda Vinajeras, a social worker in the pediatric oncology division, said in a deposition that Duncan worked long hours and often was at the hospital late into the night. "I think Dr. Duncan was very fragile," she said. "She looked tired. ... It seemed that she didn't have the energy at times." Duncan did not always take families' concerns about their children seriously, Mary Leasure, a nurse in the pediatric oncology division, said in a deposition...."The main problem I saw was that Dr. Duncan quit thinking of patients as people. It was reflected in a disassociated disregard of patients and their families." [The mother of a patient] described the doctor as stoic, detached and unsmiling. "I always felt that she was hurrying out of the room...
So what can we learn from this sad episode? For me, the major lesson is clear. Physician colleagues, patients, and the families of patients should be aware that overworked physicians can make mistakes (see: Surgeon stress affects cognitive and psychomotor performance both inside and outside of the operating room). If a physician appears distracted and "fragile," steps should be take to relieve him or her from duties (see: Reporting of Impaired Physicians by Their Colleagues). These can be hard a action to take but the welfare of patients is at stake as shown by the tragic case of mistreated children in New Mexico.