A nurse is an effective witness who can explain the medical treatment of a patient with cancer. This pain and suffering report provides a clear explanation of the details of symptoms. The expert’s report can be structured several ways. This post describes some of the components of such a report. Med League’s nurses provide pain and suffering reports.

Descriptions of Procedural Pain

The expert fact witness report may include a narrative description of the pain associated with procedures. Pain may arise from the cancer and as consequences of the medical and nursing care that was provided.

There are myriad ways that healthcare providers add to the pain and suffering of patients who are being treated for cancer.

This iatrogenic (caused by healthcare providers) pain and suffering has many sources. A few will be described below. For example, insertion and removal of medical devices can cause pain.

Many oncology patients develop pleural effusion, or fluid within the lung cavity, as tumors in the lung progress.

Suctioning involves inserting a flexible clear tube down the nose or mouth. Once the tube has passed beyond the back of the throat where the gag reflex is located, suction is applied to remove accumulated secretions from the lungs. Deep suctioning involves advancing the catheter far into the airways of the lungs.

The presence of thick yellow secretions or fluid necessitates frequent suctioning, as often as every 30-60 minutes. Painful medical procedures may be explained in the report.

Example:

There were multiple painful medical procedures and diagnostic tests performed on Mrs. Tucker, as illustrated on the Treatment Calendar. The procedures, which are uncomfortable or painful, include:

• Insertion of Foley catheter: This procedure involves invading the most private area of the body as it is passed up the urethra to the bladder. The catheter must be cleaned and manipulated by the nursing staff on a daily basis.
• Insertion of intravenous needles: Intravenous needles were inserted into Mrs. Tucker’s arms and neck. The insertion of the needles is painful.
• Two large chest tubes: Chest tubes were inserted in the operating room. One of the chest tubes was removed on 12/18/09, and the second one was taken out shortly before Mrs. Tucker died. The tubes, which are the size of a man’s thumb, are sutured to the skin. The manipulation of the tubes to prevent fluid clots is painful, as is also the removal of the tubes.
• Multiple punctures: Several times each day Mrs. Tucker’s skin was pierced by needles. Multiple tests were performed on the blood withdrawn from Mrs. Tucker’s arms and hands. See figure X.3.
• Nasogastric tube: The nasogastric tube is inserted into the nose and must be swallowed by the patient to bring it to the stomach. The medical record showed that the nurses reinserted the nasogastric tube on 12/5/09, 12/12/93, 12/15/09, and 12/22/09. The insertion of a nasogastric tube causes a sensation of gagging when the tube touches the gag reflex in the back of the throat. Mrs. Tucker pulled the nasogastric tube out of her nose on 12/10/09 and on 12/23/09, the day she died.

Treatment

Treatment for cancer may consist of surgery, radiation therapy, chemotherapy, or hormone therapy. These treatments are described in terms of frequency, side effects, and complications.

The summary of medical records may include a listing and description of medications. The example below lists a portion of the treatment given to Mr. Kelley.

Example:

Walter Kelley
Medications (Prescriptions or as noted in medical records)

8/4/11 At the time of the lymph node removal, Mr. Kelley was not taking any medications.

9/12/11 Chemotherapy was begun consisting of Prednisone 100 mg (steroid) every day for 5 days, Compazine 10 mg (to control nausea), Cyclophosphamide 1500 mg, Adriamycin 100 mg, Vincristine 2 mg.

10/5/11 Chemotherapy was administered consisting of Compazine 10 mg, Ativan 1 mg (for sedation), Cyclophosphamide 1500 mg, Adriamycin 100 mg, Vincristine 2 mg.

10/11/11 Restoril was prescribed for difficulty sleeping.

10/26/11 Chemotherapy was given consisting of Prednisone 100 mg per day for five days, Compazine 10 mg, Ativan 1 mg (for sedation), Cyclophosphamide 1500 mg, Adriamycin 100 mg, Vincristine 2 mg.

11/21/11 Chemotherapy was given consisting of Prednisone 100 mg per day for five days, Compazine 10 mg, Ativan 1 mg (for sedation), Cyclophosphamide 1500 mg, Adriamycin 100 mg, Vincristine 2 mg.

11/27/11 Prednisone 100 mg per day was taken for five days.

12/14/11 Chemotherapy was given consisting of Compazine 10 mg, Ativan 1 mg (for sedation), Cyclophosphamide 1500 mg, Adriamycin 100 mg, Vincristine 2 mg

5/21/12 These drugs were prescribed:
Decadron (reduces swelling of the brain)
Zantac (decreases stomach acid)
Dilantin (anticonvulsant)
Tylenol (for fever and pain)
Percocet (for pain)
Milk of Magnesia (laxative)

5/26/12 These drugs were being used:
Dilantin
Zantac (reduces stomach acid)
Decadron

Images and icons may be used to graphically display information about painful treatments and diagnostic tests.

Side Effects of Treatment

Chemotherapy and radiation therapy kill normal cells as well as cancer cells. Side effects of treatment can be severe. The summary of medical records includes descriptions of the side effects of cancer treatment.

Example:

The medical records of Mrs. Tucker reflect that she suffered from the side effects of the various chemotherapeutic agents given to her over 5 years. She lost her hair three different times. Hormonal therapy provided in 2011 resulted in hot and cold flashes, trouble sleeping, a deepening voice, and change in hair growth patterns.

Mrs. Tucker learned in 2011 that the chemotherapy had damaged her heart, when a test revealed that her cardiac ejection fraction had decreased. The chemotherapy also irritated her stomach and esophagus, forcing her to take medication to alleviate the burning.

The administration of chemotherapy caused a depression in her white blood cell count, which resulted in a hospitalization in 2011 when she was unable to mount an attack against a blood infection.

Med League provides medical expert witnesses to trial lawyers. Please call us at (908)788-8227 or contact us today to discuss your next case.