Facts

Roberto Quinones Jr. was treated at Southern California Permanente Medical Group, specifically under the primary care of physician Dr. Arora, since 1993. In January 2005, at age 49, he participated in the first portion of a Health Appraisal evaluation. This included the drawing of blood and a PSA test. At that time, Quinones was experiencing urinary tract complaints, including frequent urination and weak stream.

Although he did not follow up with the second portion of the Health Appraisal Clinic, he made an appointment five months later with Dr. Arora for both a follow-up and an acute care visit. His specific complaint was rectal bleeding. At the time of the appointment, Dr. Arora performed a digital rectal examination, noting a 3+ enlargement of the prostate. He did not discuss additional PSA testing with the claimant. Dr. Arora made no further follow-up on the urinary tract complaints, but sent the patient to a gastroenterologist.

Six months later, Quinones called inquiring about additional blood work, including testing for diabetes. A fasting blood sugar was ordered.

In June 2006, Quinones again saw his primary care physician, this time for a sore throat. Despite the visit being designated as an acute visit for specific complaints, Dr. Arora ordered a series of laboratory testing, including Lipid Panels, TSH and liver enzymes. A PSA was not ordered nor discussed with the patient, although it had been a year and a half since his first PSA testing.

In November 2007, Quinones was diagnosed with fourth stage prostate cancer with distant metastasis of his brain, lungs, spine and bony extremities. He failed chemotherapy and several protocols. At the time of the arbitration, he was given less than two weeks to live.

The lawsuit was instigated in September 2008 and brought to arbitration and resolution by February 2009.

PLAINTIFF'S CONTENTIONS:
The plaintiff contended that defendant had a statutory obligation to discuss PSA testing in May 2006 when the digital rectal examination was done and that the defendant doctor was negligent per se for not doing so. The plaintiff also contended that the telephone call on January 2006 and the visit and ordering of laboratory testing in June 2006 gave rise to a duty to offer or perform a PSA test. Had Quinones' PSA been tested at any of the above-referenced dates, it would have been elevated, necessitating a referral to urology and a diagnosis of prostate cancer. With a radical prostatectomy, Quinones' prognosis for a long-term cure was greater than 50 percent.

DEFENDANT'S CONTENTIONS:
The defense contended that the standard of care was not breached, that the PSA taken in January 2005 was sufficient for the purposes of the examination performed in May 2005 and that the defendant doctor had no duty to offer or order a PSA by way of either a telephone call or at the visit in June of 2006 since this was for an acute care matter. The defendants also contended that because of the virulent nature of Quinones' prostate cancer, even if he had been diagnosed in May 2005, his chance of surviving was less than 50 percent.

Specials in Evidence

$163,002 $2,877,394

Result

Arbitration award for claimants totaling $3,547,031. After costs and interest, $3,704,160.82 was paid.