Brunozzi v. Straka

Defense Verdict

Date of Verdict: Nov. 12.

Court and Case No.: C.P. Allegheny No. GD-14-010013.

Judge: Patrick Connelly.

Type of Action: Medical malpractice.

Injuries: Breast cancer misdiagnosis.

Plaintiffs Counsel:  John A. Caputo and Elizabeth L. jenkins, John A. Caputo & Associates.

Plaintiffs Experts:  Mark S. Colella, radiology, Natrona Heights; William M. Sikov, oncology, Providence, Rhode Island; William P. Irvin Jr., gynecology; Newport News, Virginia. Defense Counsel: Richard J. Federowicz and Rebecca J. Maziarz, Dickie, McCamey & Chilcote, Pittsburgh; Marian Jean Patchen and Corey C. Kirkwood, Matis Baum O'Connor; Pittsburgh.

Defense Experts: Jay D. Goldberg, gynecology, Philadelphia; Tari A. King, breast surgery, Boston; Ellen B. Mendelson, radiology; Chicago; James L. Cosgrove, physical rehabilitation, Pittsburgh; Renee Wayne Pinsky, radiology; Ann Arbor, Michigan. Comment:

On Sept. 11, 2012, plaintiff Tamara Brunozzi, 38, was diagnosed with high-grade invasive carcinoma and metastatic disease in her left breast. She claimed that her gynecologist, Roberta Renzelli-Cain, and a radiologist, Michelle Straka, failed to properly diagnose the cancerous mass in her breast.

Brunozzi sued Renzelli-Cain and her practice, Greater Pittsburgh OB-GYN Associates, and Straka and her practice, Weinstein Imaging Associates P.C., alleging claims of medical malpractice.

In December 2011, Brunozzi presented to Renzelli-Cain with complains of a lump underneath her left areola, a rash in the area and nipple discharge. Renzelli-Cain sent Brunozzi for a mammography and ultrasonography. Straka, in her interpretation of the tests' results, determined that they showed dense breast tissue but no findings in the areas of palpable concern. Straka reported the findings as benign and recommended that Brunozzi return at age 40, unless clinically indicated.

Renzelli-Cain, after reading Straka's report, instructed her staff to contact Brunozzi and tell her the ultrasonography was negative for cancer. No further workup or follow-up was recommended by Renzelli-Cain, Brunozzi alleged.

In late summer 2012, Brunozzi felt a sudden and dramatic increase in the size of the left-breast mass. She presented to her primary care physician, and a biopsy determined that she had high-grade invasive ductal carcinoma and metastatic disease.

Brunozzi's expert in gynecology testified that, Renzelli-Cain, upon receiving the negative radiology report by Straka, failed to work up the clinical symptoms that remained unexplained. Brunozzi had complained of unilateral spontaneous clear breast discharge, and she had two palpable masses in the left breast that were unexplained. The standard of care mandated that Brunozzi be referred to a breast surgeon to determine the nature of the breast masses, her counsel argued.

Brunozzi's expert in radiology testified that Straka failed to recognize and document concerning areas of abnormality in the left breast that were visible on the December 2011 ultrasound and were in the same area as the palpable mass. According to the expert, Straka failed to order spot-compression views of the areas with palpable abnormalities, and failed to recommend an additional workup as was required, given the two explained palpable abnormalities. The expert concluded that this was not a benign study and that the standard of care required Straka to recommend a surgical consultation. Instead, Straka improperly labeled the study benign and instructed Brunozzi to follow up at age 40, the expert stated.

The defense maintained that Renzelli-Cain and Straka met the standard of care in their treatment of Brunozzi. Straka's expert in radiology, Ellen Mendelson, opined that spot-compression views are not obligatory, whereas an ultrasound is, and it was performed on Brunozzi. The expert determined that Straka's interpretation of the imaging studies were carefully considered and correct.

Straka's other expert in radiology, Renee Wayne Pinsky, testified that Straka appropriately interpreted the mammographic and ultrasound images. Straka spoke with the patient, palpated the area of her breast and performed an ultrasound. Straka specifically advised Brunozzi that simply because something cannot be seen does not mean cancer may not be present. According to the expert, Straka gave Brunozzi specific instructions to continue on with breast examination and to return to Renzelli-Cain for a follow-up. The expert concluded that Straka's treatment was reasonable and appropriate.

Renzelli-Cain's expert in obstetrics-gynecology testified that Brunozzi was appropriately evaluated by Renzelli-Cain, as imaging and laboratory blood studies were appropriately ordered. The imaging findings, which demonstrated no abnormality, were discussed with the patient. Given the normal imaging findings, neither additional breast imaging, a breast biopsy nor a referral to a breast surgeon was necessary, the expert stated. The expert concluded that Brunozzi's development of breast cancer was unpreventable and unpredictable, and there was no delay in diagnosis.

Following the cancer diagnosis, which was stage IIIB, Brunozzi underwent neoadjuvant chemotherapy in order to reduce the bulk of the cancer in her left breast and axilla. For the next year, she received six cycles of chemotherapy. In the ensuing years, she consulted with an oncologist.

In February 2013, Brunozzi underwent bilateral mastectomies and left axillary sentinel lymph node sampling. A 3.5-centimeter mass was found in her left breast. She then consulted with a radiation oncologist, and from April to June, she underwent radiation therapy. Following the treatment, Brunozzi started adjuvant endocrine therapy with estrogen-receptor modulator medication. In the ensuing years, and at the time of trial, Brunozzi consulted with her oncologist and treated with Prolia injections every six months.

Brunozzi's expert in oncology testified that, as a result of the defendants' negligence, she suffered a nearly 10-month delay in the diagnosis of her cancer. The expert opined that, due to the delay, she required a stronger and more toxic chemotherapy cocktail; she had to endure three months of radiation, which she would not have needed had the cancer been diagnosed in December 2011; and Brunozzi's rate of recurrence went from 10 to more than 40 percent.

Brunozzi testified that, although she has been cancer-free, she lives in constant fear that the cancer will return. With three children, she is worried about not being around for them in the future. She sought damages for past and future pain and suffering. Her husband withdrew his claim for loss of consortium, prior to trial.

The defense's expert in breast surgery noted that Brunozzi has remained cancer-free for five years. According to the expert, Brunozzi's outcome is less likely influenced by her initial tumor size or nodal status, and more likely influenced by the underlying biology of her disease and her compliance with continued hormone therapy. The expert concluded that any alleged delay in cancer diagnosis did not affect Brunozzi's mortality rate.

The jury rendered a defense verdict.

This report is based on information that was provided by plaintiffs counsel. Defense counsel did not respond to the calls for comment.

—This report first appeared in VerdictSearch, an ALM publication.