Attention: Myomectomy Patients at the Hospital of the University of Pennsylvania and Philadelphia-Area Medical Malpractice Attorneys
The Following public letter of warning has been submitted, for the record, to Professor Deborah Driscoll - Chairwoman of Obstetrics and Gynecology at the Hospital of the University of Pennsylvania (HUP).
If you are a woman undergoing a Myomectomy operation for symptomatic Uterine Fibroids at HUP, please be sure to ask your Gynecologist about the cancer risk of these tumors and the possibility of cancer upstaging during a Myomectomy operation.
If you are a woman who has already undergone a Myomectomy at HUP and is now fighting cancer, please contact me at hooman@patientrights.org for referral to an appropriate medical malpractice attorney.
If you are a medical malpractice attorney with a client whose myomectomy operation at HUP has resulted in an advanced cancer diagnosis, please note that my communications with the HUP leadership about this patient safety hazard (including the presented email) started in late 2017. I believe my communications with the HUP leadership, as a physician and patient safety advocate, constitute evidence that the HUP GYN leadership and risk management are aware of the avoidable patient safety hazard described in this letter. These warnings to the corporate leadership at HUP (and other hospitals) are discoverable and admissible in court to demonstrate institutional knowledge of this hazard.
Please note, that my efforts directed at informing the HUP leadership (and others), and women patients in the philadelphia area (and elsewhere), about the potential legal liability and danger in performing Myomectomies without adequate pre-operative cancer screening is a public service — I have no personal financial interests in this effort.
The following is my respectful letter to Professor Driscoll and colleagues at HUP:
Dear Professor Driscoll and Colleagues,
I write this email to you, among other leading Gynecologists, at major medical centers across the United States — as a patient safety warning and in my capacity as a physician and patient advocate.
Specifically, I write regarding the operation known as “Myomectomy” or “Uterine-Sparing Myomectomy”, which as you know is offered to women with symptomatic uterine fibroid tumors who wish to maintain their fertility potential.
This group of women are at particularly high oncological risk, because the Myomectomy operation is, by definition, not safe from a cancer perspective.
You are aware that, in literally all cases, Myomectomy exposes women to the risk of, both macro- and micro-scopic, uterine tissue dissemination inside their abdominal cavities. If these tissues contain a “missed” cancer or pre-malignant lesion, this dissemination has a high likelihood of causing an upstaged abdominal sarcomatosis (or carcinomatosis).
As you know, it is now quite clear, from multiple credible studies, that the risk of a “missed” soft tissue sarcoma in a symptomatic uterine fibroid tumor is upwards of one in 300.
Importantly, the recent study by Lentz et al., has demonstrated that the current guidelines proposed by AAGL and ACOG for pre-operative oncological risk stratification of uterine fibroid tumors have almost no useful predictive value. I trust that you are aware of the Lentz study from California:
https://www.youtube.com/watch?v=4LTV_BPiZgs
Of course, the main reason why the current oncological risk stratification guidelines used by GYNs miss malignancies is that you and your colleagues at HUP and elsewhere, are NOT routinely performing pre- or intra-operative tumor biopsies to establish a “reasonable assurance of benignity” — before proceeding with Myomectomy and other non-oncological operations on the uterus.
In this regard, please carefully read the following editorial analysis:
https://cancerletter.com/articles/20191115_5/
The concern, therefore, is that the subset of your patients at HUP undergoing myomectomy for symptomatic fibroids are, at a rate upwards of one in 300, being exposed to an iatrogenic mortality risk resulting from dissemination and upstaging of cancer when their uterine soft tissue malignancies are “missed” preoperatively. This complication is not a matter of random misfortune, or an unpredictable technical problem, but rather because GYNs are NOT establishing a “reasonable assurance of benignity” before proceeding with a Myomectomy procedure, as a matter of routine practice. Your department cannot understate or ignore this risk, because it is an avoidable mortality risk to patients, and one which you can mitigate against by establishing institutional guidelines at HUP to biopsy (pre-operatively or intra-operatively) the uterine tumors your surgeons subject to Myomectomy.
From a legal liability perspective the equation is quite simple and should concern all HUP risk managers: 1) uterine fibroid tumors are potentially malignant at a rate of over one in 300, 2) myomectomy operations are non-oncological operations which almost certainly cause dissemination of “missed” uterine malignancies, 3) iatrogenic dissemination of uterine cancers in the abdominal cavity is an avoidable mortality risk, and 4) NO attempt is currently made by HUP GYNs, or others, to mitigate against this mortality risk by performing biopsies to establish a “reasonable assurance of benignity”, before proceeding with an operation that will almost certainly upstage or spread a “missed” malignancy.
The above 4 elements, should alert any reasonable defense attorney and institutional risk manager, to a serious patient safety and liability exposure — this warning, I write to you, as a friend to HUP.
Here, I have also CC’d the HUP chair of anesthesiology, Dr. Lee Fleisher, because every unmitigated Myomectomy operation performed at HUP is enabled by a member of the anesthesiology faculty.
The duty to protect patients from harm belongs to all physicians who participate in an operation: surgeons and anesthesiologists. Therefore, Dr. Fleisher and his faculty, knowing of this specific avoidable mortality risk in GYN surgery, are duty bound to protect patients and are potentially liable if/when a myomectomy patient they have anesthetized, falls to disaster from from an iatrogenic cancer upstaging in their OR.
I had previously proposed an anesthesia/GYN cross-check protocol to Dr. Fleisher and yourself in this regard, to which you have likely not been responsive to date. I respectfully ask that you reconsider this suggestion and compile a multi-disciplinary group of expert HUP GYNs, Surgical oncologists, pathologists, anesthesiologists, as well as, legal defense experts — in order to create a reasonable way to protect your Myomectomy patients from the iatrogenic cancer mortality risk intrinsic to their disease and the surgical approach to it. I believe the only reasonable pathway will be to biopsy these tumors pre- or intraoperatively, before you proceed with myomectomies.
As a patient advocate, I want to assure you that I am actively connected to GYN cancer patient communities and routinely come across uterine sarcoma patients from across the nation whose diagnoses were being missed preoperatively by GYNs, and whose cancers are being iatrogenically upstaged in Myomectomy (and hysterectomy) operations. I have been assisting such patients in finding appropriate treatment and legal representation for the past several years with good success and with no personal financial incentive. I certainly hope that I NEVER come across any such patients from HUP given the institutional awareness in both GYN and Anesthesia — as well as my affection for the institution to which I belonged.
I believe that the present communication to you is an adequate formal note to establish that your department is now aware of this patient safety hazard in gynecology — and that your risk managers and legal defense team have clarity on the nature of the potential liability in performing blind Myomectomies in patients whose cancer risk are not stratified or mitigated.
My respectful suggestion: Biopsy these uterine tumors before you perform your Myomectomies — your pathologists at HUP are quite capable!
Sincerely,
Hooman Noorchashm MD, PhD (For Amy and the others).
