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State reprimands 2 doctors in cancer case (The Arizona Daily Star)...that the lung mass had not grown much over time, and its shape suggested a scar, rather than a tumor.......It was immediately biopsied and found to be metastatic cancer that had spread to her brain....- Apr 14 2:40 AM ET

Al Musella's Comments: (This is his personal views and are not necessarily the views of the Musella Foundation!)


Posted on: 04/14/2001

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Local - The Arizona Daily Star - updated 2:40 AM ET Apr 14
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Saturday April 14 02:40 AM EDT "State reprimands 2 doctors in cancer case"

State reprimands 2 doctors in cancer case

By Carla McClain, Arizona Daily Star

Two Tucson physicians have been disciplined by the state after failing to diagnose a woman's cancer - despite repeated X-rays showing a mass in her lung.

The cancer was diagnosed 16 months after the first suspicious X-ray when the woman switched health plans and physicians, records show.

During that time, the cancer grew and spread, contributing to her premature death, family members say.

The two physicians - internist Horacio Ore-Giron and pulmonary specialist Thomas Rotkis - were given "letters of reprimand," the lightest possible punishment by the Arizona Board of Medical Examiners, or BOMEX.

A "letter of reprimand" carries no fine or remedial action, and does not restrict a physician's practice.

Meanwhile, two other Tucson physicians - who missed diagnoses of cancer and diabetes complications - have lost their right to practice in Arizona.

Both of those doctors - longtime El Rio Health Center internist Gregorio Samoy and rural general practitioner Morris Powell - were already retired when BOMEX took action against them last month.

These disciplinary actions are among nearly 100 issued by BOMEX against Arizona doctors during the past year. Nearly half of them were given letters of reprimand, while the remainder got tougher punishments, ranging from probation to forbidding a doctor to practice.

In the case involving Ore-Giron and Rotkis, the patient, Tucsonan Maria Hoffsmith, then 69, went to St. Mary's emergency room in February 1994, complaining of pain, shortness of breath, rapid heartbeat and weakness, according to BOMEX documents.

A chest X-ray taken then showed a mass in the upper lobe of her left lung.

Two days later, Hoffsmith was seen by her treating physician, Ore-Giron, who did not mention the abnormal chest X-ray, say BOMEX documents. Nor did he mention it when he saw Hoffsmith later that month and again in April, even though she had a constant cough.

"He just kept giving her cough syrup," said Richard Hoffsmith, her husband. "I kept asking him, 'What is the problem,' and all she got was cough syrup. He never said anything about a problem on an X-ray."

Seven months later, still suffering a bad cough and losing weight, Maria Hoffsmith went to urgent care, where another X-ray was taken, again showing a mass in the left lung, according to the BOMEX investigation.

Two weeks later, in November 1994, Ore-Giron ordered another X-ray, again showing the mass. This time, he referred Hoffsmith to pulmonary specialist Rotkis.

"That's the first time we heard anything at all about something showing up on an X-ray," Richard Hoffsmith said.

In a BOMEX hearing on this case in February, Ore-Giron testified he discussed the lung mass with Hoffsmith early on, and told her it could be biopsied, or she could wait several months to see if it grew.

"She decided to wait . . . she didn't want to have anything done," he told the board.

Ore-Giron did not document this discussion in the patient's chart, and Richard Hoffsmith denies it ever happened.

Apparently believing Ore-Giron, the board issued him a letter of reprimand for "failing to document (in his records) any discussion of the abnormal chest X-ray with the patient."

In an interview, Ore-Giron admitted he "forgot" to note the discussion in Hoffsmith's chart. He said he should have done it "to protect" himself from a "passive-aggressive" patient.

After pulmonary specialist Rotkis took over Maria Hoffsmith's care, he ordered a CT scan of her chest, in November 1994, which showed the lung mass. In Hoffsmith's chart, Rotkis noted her CT scan was "consistent with CA" (cancer), BOMEX documents say.

However, Rotkis did not order an immediate biopsy of the mass - the definitive test for malignancy. Instead, two months later, he had Hoffsmith undergo a bronchoscopy - an analysis of bronchial tissue, which is not a definitive test for cancer. That test came back negative.

"He (Rotkis) told us she was OK, and we were so happy," said Richard Hoffsmith. "He never told us there was a possibility of cancer. "

In his testimony at the BOMEX hearing, Rotkis noted that Maria Hoffsmith was a non-smoker, that the lung mass had not grown much over time, and its shape suggested a scar, rather than a tumor.

"I probably see several hundred cancers a year. I see perhaps well under 1 percent of those in non-smokers. . . . This is a woman who had symptoms of cancer and a low risk for cancer," Rotkis told the board.

At the end of the hearing, the board issued Rotkis a letter of reprimand for "failing to follow up the patient after he received the CT scan and found it to be consistent with cancer."

Rotkis declined to comment on the Hoffsmith case, but confirmed he is appealing the BOMEX disciplinary action.

"I thought they (the board) did a very poor job. . . . They did not have a pulmonary specialist evaluate the case, and I was not given a separate hearing (from Ore-Giron)," he said.

Three weeks after her negative bronchoscopy - and a year after the first X-ray showed a mass in her lung - Hoffsmith went back to Ore-Giron, still coughing and suffering upper respiratory symptoms, say BOMEX records.

An X-ray taken then again showed the lung mass. Still, nothing was done to determine what it was.

Two weeks later, Hoffsmith went to urgent care with severe chest pain and coughing. A sixth X-ray was taken.

At this point, frustrated after getting no relief and no treatment, according to her family, Hoffsmith switched health plans, dropping the now-defunct Group Health Medical Associates, where Ore-Giron and Rotkis then worked, for CIGNA.

Shortly after that, Hoffsmith developed what her daughter Lynn Hoffsmith described as a "rock-hard" lymph node. It was immediately biopsied and found to be metastatic cancer that had spread to her brain. Hoffsmith died a year ago.

The Hoffsmith family filed a medical malpractice lawsuit against GHMA, Ore-Giron and Rotkis, and settled out of court for a confidential amount.

In the other recent BOMEX action, longtime El Rio Health Center physician Dr. Gregorio Samoy agreed to permanently surrender his medical license after a teen-age diabetic died when he failed to diagnose and treat a potentially fatal complication.

Samoy, who retired in 1997, said he did not intend to practice again, and did not want to prolong a fight with BOMEX.

BOMEX also temporarily suspended the license of Tucson general practitioner Dr. Morris Powell - now retired after a long career in rural Arizona.

Powell was disciplined for failing to diagnose bladder cancer in a female patient, despite tests showing blood in her urine and a mass in her bladder.

The patient, who received no treatment, died five years later of advanced, metastatic cancer, according to BOMEX records.

Powell, who has a long history of patient complaints in his BOMEX record, including a previous suspension, said he disagreed with the board's action, but did not plan to contest it.

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