Robert Filiatrault v. Kathleen M Perkins Do
331541
Mich. Ct. App.Jul 18, 2017Background
- Robert Filiatrault presented in late 2010–2011 with throat irritation, cough/gagging, and red (irritated) vocal cords; he was a former smoker and heavy alcohol user.
- Dr. Perkins (family medicine) treated and referred him; Dr. Downs (otolaryngology) examined him Nov. 4, 2011 using flexible fiberoptic scope and saw only cord irritation; she diagnosed allergic rhinitis and laryngopharyngeal reflux and advised follow-up.
- A chest CT performed Nov. 3, 2011 partly imaged the larynx; interpreting radiologist Tarr later testified he saw no radiographic evidence of a mass in the portions imaged.
- A neck mass consistent with laryngeal cancer was discovered on CT on Nov. 21, 2012 (glottic mass extending above and below the true vocal cords); patient later had chemo/radiation and was cancer-free by 2014 but died in 2016 of unrelated causes.
- Plaintiffs sued for malpractice alleging two narrowed theories: (1) failure to order a neck CT timely and (2) failure to warn patient that symptoms might indicate cancer; defendants moved for summary disposition arguing lack of proximate causation.
- Trial court denied summary disposition; on appeal the Court of Appeals reviewed only proximate-causation issues and affirmed in part, reversed in part, and remanded.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether failure to order an earlier neck CT was a cause-in-fact of delayed cancer diagnosis | Failure to order neck CT more likely than not delayed detection; experts (family med & ENT) say chest CT inadequate to visualize larynx | Radiologist Tarr testified the actual 2011 CT imaged part of the larynx and showed no mass; plaintiffs offered no admissible contrary radiologic opinion | Reversed as to this theory: plaintiffs failed to present admissible evidence showing it was more likely than not that an earlier neck CT would have detected the cancer sooner |
| Whether failure to warn patient that symptoms might indicate cancer caused delayed diagnosis (failure-to-warn) | Plaintiff’s family-medicine expert opined the word “cancer” might have made patient more attentive; plaintiff’s affidavit states he would have followed recommendations immediately if warned | Defendants contend experts’ and plaintiff’s statements are speculative given plaintiff’s history of noncompliance | Affirmed as to this theory: plaintiff’s affidavit created a genuine factual dispute for trial; expert’s speculation was weak but credibility is for the factfinder |
Key Cases Cited
- Robins v. Garg, 276 Mich. App. 351 (discussing summary disposition standard and proximate causation in medical malpractice)
- Lowrey v. LMPS & LMPJ, Inc., 500 Mich. 1 (summary disposition burden-shifting when nonmovant has ultimate burden at trial)
- Elher v. Misra, 499 Mich. 11 (elements plaintiff must prove in medical malpractice action)
- Albro v. Drayer, 303 Mich. App. 758 (expert testimony limits under MRE 702 and scope of expertise)
- Skinner v. Square D Co., 445 Mich. 153 (distinguishing reasonable inference from speculation for causation)
