Timeline based on Medical Record Summary

re: Professional Negligence

Excerpt from summary of medical record.

Margaret Eve Miyasaki


Re: Medical records entries dated from 11.28.98 to 3.28.01, including date of discovery of right breast lump, diagnosed as Infiltrating ductal carcinoma, and surgical removal by modified radical mastectomy.






It appears that the patient discovered the right breast lump when she was seven months pregnant and didn't report it until 06.21.99, one week before her due date.



Dr. Goodfellow examined the right breast lump, but did no immediate lab work, sonogram, mammogram or other testing regarding it. Patient was encouraged to breast feed even though the lump was present.



Dr. Taylor delivered baby and the lump was examined and patient was scheduled for an appointment with Surgery for 07.02.99. There is no further reference made to the appointment scheduled for 07. 02. 99.



Patient no show. Patient's appointment was rescheduled for 07.15.99 and again rescheduled for 07.19.99.



Patient was treated for lower back pain which was diagnosed as being caused by epidural/delivery prescribed isometric exercise and Motrin for pain advised to both sit and stand when breast feeding and referred to physical therapy. Neither a biopsy nor a mammogram nor other exam or testing of the lump was done at that time.



Patient didn’t show up for her appointment, was still breast feeding, but having difficulty, and right breast was engorged.



Patient came to her appointment. She complained regarding lower back pain and the lump hindering breast feeding since 07.30.99. was treated for back pain and prescribed Advil.



Sonogram =mass 2.4 x 2.6 cm, indistinct. Patient phoned and requested the results of the ultrasound done 09.27.99. Patient was advised the ultrasound of the right breast showed that there was a mass, size 2.4 x 2.6 cm.


10.15.99 - 11.9.99

Patient was sent to physical therapy for her back pain and was given a medical excuse from work. There was no record showing that she received further examination testing or treatment for the right breast lump during that time.



Sonogram = infiltrating ductal cancer B-R score 8/9, mass 2.3 x 3 x 4.3 cm, located about 10 - 12 o'clock, speculated margins with increase in size since September 1999. 



Surgical Pathology Consultation Report (Ku & Kunno) Final Diagnosis: Infiltrating ductal carcinoma, needle biopsy, right breast, and upper outer quadrant. Comment: The infiltrating duct carcinoma reveals 3/3 tubule formation, 3/3 cytologic atypia, and 2/3 mitotic activity for a score of 8/8 or Scarf Bloom Richardson grade III.


Dr. Ku's phone mail was notified.


Specimen: R. breast needle core BX UOQf

Clinical Data: 2.3 x 3.0 x 4.3 cm solid suspicious mass, right breast at 10-12 o'clock.

Gross Description: Four needle core biopsies ranging in length from 0.5 to 1.2 cm. All. DAT/1mr



Dr. Ku did a breast exam; sketch indicated the location of the mass.  He is opinion was that patient was a lactating woman with infiltrating breast cancer. Patient complained to Dr, Ku about the continuing pain in her lower back. She had difficulty sitting because of the pain. She was advised to call if she wanted a disability certificate.



Patient was given a medical excuse from work since she would be unable to perform her duties until 02.01.00 because she had cancer and was to undergo surgery and chemotherapy.



Request For Operation, Anesthesia, Transfusion And Medical Services (Ku) Modified radical mastectomy to remove the right breast and lymph nodes.



Radiology Report:

Patient had minimal lower thoracic levoscoliosis, a sideways curvature of the spine, and osteoporosis, excessive skeletal fragility resulting in bones that break easily. The rest of the lungs and chest cavity was normal.


11.24.99 A biopsy of right breast tissue was performed at time of surgery shortly before the mastectomy. Tests of the specimen confirmed that she had cancer of the right breast and surrounding axillary lymph nodes. The right breast and lymph nodes were removed. Surgery was uneventful. When patient was recovering, she was encouraged to breast feed using the remaining breast.


11.24.99 - 05.26.00 After surgery she received chemotherapy until 05.26.00, when she was released from treatment. She was evaluated 07.16.00 and considered to have no further cancer, mastectomy had healed well, and she had full mobility of the right arm. Her left breast was also free of lumps.