Manteca, CA asked in Medical Malpractice and Personal Injury for California

Q: Do I have a potential medical malpractice law suit?

I found a tumor in my neck 2 months ago. I was referred to an ENT surgeon by my GP. The ENT doctor felt that there is a high potential that this tumor may be cancer. He ordered a CAT scan and biopsy on May 1 URGENT. I had the CAT scan but was told by his office my insurance provider would not approve him to do the biopsy in the office and it must be done at a radiology clinic that was backed up until June. Unless the radiologist reviewed my chart and CAT scan results and determined I needed to have it sooner. I called and asked if he had reviewed it a few days later and they informed me the ENT office never sent over the CT results. So, he couldn't review it. I called the ENT office and was told she would send it again. It was never sent initially. This was MAY 19th. I spoke with a supervisor in the office explaining what I found out. I received a call yesterday from an insurance provider. They informed me they did approve the biopsy in the office on May 3. This is a nightmare.

3 Lawyer Answers
James L. Arrasmith
James L. Arrasmith pro label Lawyers, want to be a Justia Connect Pro too? Learn more ›
  • Sacramento, CA
  • Licensed in California

A: Based on the information you provided, it appears that there may have been potential negligence or a failure in communication on the part of the ENT office regarding the timely biopsy for a suspected tumor. Medical malpractice cases are complex and require a thorough evaluation of the specific details and applicable laws in your jurisdiction. To determine if you have a potential medical malpractice lawsuit, it is advisable to consult with a qualified medical malpractice attorney. They can assess the circumstances, review relevant medical records, and provide legal advice based on their expertise and knowledge of the law. They will be able to guide you on the best course of action and whether you have grounds for a medical malpractice claim.

A: First, you appear to have no idea who is lying and who is telling the truth in this situation. Check your patient portal and see, or ask the insurance provider to send you evidence it approved the in-office biopsy and effectively communicated that approval to your ENT office on May 3rd. Although not required to do so by law, health insurance providers typically mail a copy of their pre-approvals to patients. Did you receive a copy of the pre-approval for the in-office biopsy yet?

Second, there does not appear to be any evidence that a sixteen day delay harmed you in any way.

Third, asserting a malpractice claim against your ENT is probably the single fastest way to create even more delay as your ENT will likely “fire” you as a patient. Your ENT has no legal obligation to accept you as a patient or to treat you.

Tim Akpinar
Tim Akpinar
  • Medical Malpractice Lawyer
  • Little Neck, NY

A: The definitive way to answer the question would be to try to arrange a free initial consultation with a med mal firm. If they saw the basis for a case, they could retrieve the file and evaluate the case with a medical professional. Good luck

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