I Am To Sue Dr. Laskin For Medical Malpractice

I’m to sue Dr. Laskin for medical malpractice

 

 

  

My wife, Xiaowen Ou, passed away on December 12, 2022 in the Royal Columbia Hospital mainly because of the misdiagnosis made by Dr. Laskin, the oncologist in Vancouver BCCA, on sept.15, 2022.

Clinical History

At the end of 2019 and the beginning of 2020, my wife was diagnosed with hydrocephalus  and non-small cell lung cancer with LM disease (leptomeningeal intracranial metastases) . On January 20, 2020, she began to take a chemo medicine, Osimertinib, and two days later, was placed a VP shunt. After three months, the cancer cells on her LM (leptomeninges) completely   disappeared. The lung cancer mass had also shrunk by more than half. From the end of April 2020, she could live like a normal person.

Both the original oncologist (Dr. Mariano) and the surgeon (Dr. Lee) are in RCH (the Royal Columbian Hospital). In February 2021,  my wife’s oncologist changed. The new one was Dr. Laskin in Vancouver BCCA(BC Cancer Agent).

Dr. Laskin’s Diagnosis In July, 2022：

From June 2022, my wife suffered from nausea, vomiting, walking instability and other symptoms. 

We reported this situation to Dr. Laskin. She wants my wife to have an MRI examination soon. Based on the examination results (no signs of cancer development were found), she concluded that my wife's symptoms are not related to cancer and should be addressed by other doctors. On August 5th, my wife fell and broke her wrist, a.nd was admitted to RCH. A RCH neurosurgeon examined my wife's head and said that the VP Shunt he placed two years ago was still working properly. He believes it may be a problem with the development of cancer. The surgeon exchanged opinions with Dr. Laskin, who insisted on her own opinion.

Dr Laskin's Diagnosis On September 15th, 2022

On August 24, the neurosurgeon of RCH did a lumbar puncture procedure on my wife  and they said they found lung cancer cells in cerebrospinal fluid.

Based on the information from the neurosurgeon of RCH, Dr. Laskin changed her opinion。 She put forward her diagnosis opinion on September 15. The main contents are as follows: 1. The finding of cancer cells in cerebrospinal fluid indicates the relapse of LM disease; 2,  the relapse of LM indicates the chemo medicine,Osimertinib, is no longer effective and should stop using it; 3, there is no other feasible treatment plan; and 4. The best place for my wife is the hospice. (Laskin: page 2 of 3, paragraph 5)

Dr. Laskin`s 9.15 Diagnosis Was Wrong.

After knowing Dr. Laskin's 9.15 diagnosis, I  immediately proposed to seek a second opinion. RCH doctors promised to help me. On November 23, I got the second diagnostic opinion made by Dr. Yu, oncologist  of BH (Burnaby Hospital). 

Dr. Yu believed that there was no evidence of the relapse of  LM disease, and thus overturned Dr. Laskin's conclusion that the chemo medicine, Osimertinib,  was invalid.( Dr. Yu also pointed out why there was a wrong diagnosis. Ordered by Dr. Yu, my wife got a brain MRI  and the result confirmed Dr. Yu's opinion: there's no any evidence of relapse of LM. 

Because there was no relapse of LM disease, indicating that Osimertinib was still effective. Dr. Yu  resumed using the drug.

Serious Consequence Of The The Misdiagnosis Is The Main Cause Of My Wife`s Death.

Dr. Laskin's 9.15 diagnosis caused irreversible and fatal results in more than two months.

1.Stopping to take Osimertinib is fatal

The chemo medicine, Osimertinib, is my wife's lifesaver. It is precisely because of taking this medicine that all cancer cells on LM had been eliminated and lung tumors had shrunk by more than half and the lung cancer had been effectively controlled for more than two years and my wife could be living a normal life.

However, following Dr.Laskin' s diagnosis and particular instruction , the hospital doctors in RCH stopped giving the chemo medicine, Osimertinib, to my wife since September 17. Then the lung cancer became out of control. The consequences can be imagined.

On October 7, my wife was examined for pneumothorax and after three or four days, the doctor said that my wife had got bronchopleural fistula. The doctors said these new problems were caused by the development of lung cancer.

The report of  the brain MRI on November 25 shows that several small dots were found in the brain, which is the imaging evidence of the development of lung cancer after stopping taking the chemo medicine, Osimertinib.

2) Negative effects on the RCH doctors 

 Dr. Laskin’s 9.15 diagnosis 

 was bound to have some negative effects on the treatment of the RCH doctors for the diseases of my wife after Osimertinib withdrawal, such as pneumothorax, bronchial rupture and COVID-19 infection.

Obviously, the misdiagnosis let the neurosurgery doctors in RCH to stop any efforts to improve my wife's hydrocephalus. *

3. Causing my wife’s death

My wife's general condition was obviously getting worse and worse day by day. From the end of November , almost every time the doctor met me ,he would tell me that my wife was dying and asked me whether to continue treatment.

Although the RCH doctors let my wife resume taking Osimertinib from November 25 according to the prescription of Dr. Yu, they stopped using the drug less than a week, when my wife caught COVID-19, which was in urgent need of anti-bacterial and anti-inflammatory treatment. With the development of lung cancer and the popularity of COVID-19, my wife finally died on December 12. 

Why Dr. Laskin Made The Incorrect Diagnosis 

A comparative analysis of Dr. Laskin's 9.15 diagnosis and Dr. Yu's 11.23 diagnosis reveals four main reasons:

1. Dr. Laskin lacked a full understanding of the patient's medical history

Dr. Laskin's 9.15 diagnosis was based on the LP (lumbar puncture) performed by the RCH neurosurgeon on August 27. Dr. Laskin stated: “She (Li: my wife) remains on osimertinib but the presence of adenocarcinoma in her recent LP suggests that this drug is no longer controlling her cancer.” My wife had a relapse of leptomeningeal metastasis (LM). In his 11.23 diagnosis, Dr.Yu  pointed out why Dr. Laskin made the wrong diagnosis. Dr. Yu wrote: “She (Li: my wife) did have a lumbar puncture in August 2022, and cytology once again showed adenocarcinoma of the lung, but this was never necessarily checked to see if it 'cleared' between her initial diagnosis and this particular presentation.”

I learned online that targeted drugs like osimertinib can effectively kill cancer cells on the meninges but not those in the CSF (cerebrospinal fluid). The unique environment of the CSF allows cancer cells there to survive without causing harm. 

Dr. Yu was not criticizing the laboratory report for being non-compliant. If he had been, he would have pointed it out clearly.  —--Dr. Yu was the second diagnostician designated by Dr. Laskin.

I think Dr. Yu hinted that Dr. Laskin didn't know my wife had an LP in January 2020 at all. This doesn't surprise me. Dr. Yu's diagnosis states clearly: "Lumbar puncture also confirmed adenocarcinoma" in January 2020. Since Dr. Laskin became my wife's primary oncologist in February 2021, she never mentioned the previous LP.

Had Dr. Laskin known about it, she would have compared the cytology reports from both LPs and would not have concluded, "this drug is no longer controlling her cancer". Dr. Laskin is a lung cancer treatment expert, and this basic knowledge is readily available online. Dr. Yu told me on November 23,2022 that the cytology report from the second LP was exactly the same as the first one.

2. Dr. Laskin did not understand the patient’s clinical presentation

In the 9.15 diagnosis, Dr. Laskin stated: "Although we cannot measure any change on her MRI, it is common that LM disease can progress with clinical worsening that is difficult to measure on imaging." Dr. Laskin made this statement simply to make me believe that my wife’s LM had relapsed. She did not specify any new, unique clinical symptoms that suggested the LM had relapsed. In fact, she could not know what new clinical signs were present.

Since my wife’s onset of illness in July 2022, Dr. Laskin and her team had never seen her. On August 5, my wife was admitted to RCH for a wrist fracture. On August 15, an assistant doctor from Dr. Laskin called for a consultation, and I requested that my wife be transferred to vancouver BCCA for an in-person consultation with Dr. Laskin. The assistant doctor said it wasn’t necessary and that Dr. Laskin would call for a phone consultation on September 15.

My wife’s symptoms in June and July 2022, like nausea, vomiting, and difficulty moving, were considered unrelated to cancer by Dr. Laskin, and these symptoms didn’t develop significantly. However, compared to January 2020, there was an important difference:  no symptom of headache in 2022, and the LP in August 2022 showed normal intracranial pressure. Headache due to high intracranial pressure is a significant symptom of LM disease. Dr. Yu emphasized this point in his diagnosis. He wrote: "She did have a lumbar puncture showing normal pressure." (Yu: Page 2, Paragraph 2, Line 7).

My wife’s overall clinical presentation also differed significantly.  On August 27, Dr. Lee, the RCH neurosurgeon who performed the LP,  noted in the medical record that “ She has not had the same degree of cognitive issues and confusion as on her previous in 2020. She is alert speaking and responsive …”.  (RCH medical report ID : 2408-2976, page 2 of 3, Paragraph 2). Unfortunately, it seems Dr. Laskin was unaware of these details. Had she known, she should not have made such a rash diagnosis.

3. Dr. Laskin Ignored the fact that Even If the LM relapsed Due to Osimertinib failure, It was not irreversible

Even if LM relapsed because osimertinib was no longer effective, it wasn’t a dead-end with no possible solutions. There are many other options to control cancer progression,for example:

a)Alternative targeted therapies (In February 2021, during the first consultation, I asked Dr. Laskin what would happen if osimertinib failed. She said other medications could be used).

b)Radiation therapy (On January 17, 2020, under the guidance of the RCH sent my wife to visit Vancouver BCCA  radiology department. The radiologists said the intracranial pressure was too high to proceed with radiation therapy. Once the pressure was under control and osimertinib was ineffective, radiation could be an option).

c)Immunotherapy (Dr. Yu specializes in immunotherapy for lung cancer. He mentioned “novel treatment” in his diagnosis (Yu: page 2, line 33)).
I called Dr. Yu in early December to inquire about immunotherapy. My wife’s condition in September 2022 was suitable for immunotherapy.

4. Dr. Laskin lacked basic respect for the patient's life.

Based on the above three points, I can only say that Dr. Laskin did not treat my wife as a patient, the object of her services. Dr. Laskin shows no respect for my wife's life and dignity. Analyzing Dr. Laskin's 9.15 diagnosis, it can be seen that the cause of diagnostic errors is not only the doctor's negligence, but also the doctor's lack of basic respect for the patient's life. This conclusion was reinforced by the failure of Dr. Laskin to fo.llow through with the scheduled consultation on September 15. **

Dr Laskin’s Lawyer’s Possible Defense And My Rebuttal

In the first two-and-half months after my wife passed away, I was unable to sleep at night and find taste in food. My health deteriorated dramatically. At the end of February, I suddenly developed a high fever and was sent to RCH and spent almost a month there. Sometimes I might be in a semi-comatose state, delirious and constantly dreaming, often seeing my wife smiling at me, as she had done when I first met her 53 years ago. There were constant voices in my ears, I think, from lawyers who tried their best to defend Dr. Laskin and shift the blame for her. I argued fiercely with them in a daze. I have summarized and organized the debate as follows:

1.Was Dr. Laskin’s misdiagnosis due to the patient’s peculiarities?

The targeted  drug osimertinib is a lifesaver for my wife. Some said that this drug could generally only extend a patient's life by 15 months. In medical terms, osimertinib’s progression-free survival (PFS) is said to be 15 months. while the patient had been using the drug for more than 30 months, therefore Dr. Laskin’s 9.15 diagnosis  concluding that the drug was no longer effective, was based on valid reasons. 

My rebuttal: The PFS from some studies is a statistical median. The real PFS varies from person to person.To my knowledge, this drug has no effect on some people (mainly Europeans), and for these patients, the real PFS may be zero or close to zero. On the other hand, for some people (mainly Asians), the real PFS can be much longer than  the median one. 

Moreover, the median PFS obtained from these studies  prolongs over time. In early 2020, when my wife started using the drug, the doctor said it would only extend her life by 8 months. By 2022, the median had increased to 15 months. Recently, AstraZeneca, the pharmaceutical company, states: "Clinical studies show that osimertinib`s median PFS  has now been extended to over 3 years." (See their website).

Therefore, an oncologist cannot conclude whether the drug is still effective simply based on how long a patient has been taking it.  Dr. Laskin understands this principle. She never mentioned Teresa’s  PFS in the 9.15 diagnosis.

Someone  said that Dr. Yu's diagnosis explicitly mentioned PFS and indicated it was expected in treatment. I don't think Dr. Yu was defending Dr. Ruskin; he was simply stating the facts, especially, he clearly emphasized that the PFS, which doctors often refer to,  is a median. The expected life of a Canadian is 81.3 years old,  but so many folders are receiving attentive care from doctors and nurses in hospitals across Canada. 

Some said the patient's illness has its own unusual characteristic, implying that Dr. Laskin's misdiagnosis was neither due to her negligence nor other unforgivable reasons. Indeed, my wife’s illness did have its peculiarities. She had a much better than expected response to osimertinib. Dr. Yu dedicated an entire paragraph in his diagnosis to describe her peculiarities. (Yu: Page 2, Paragraph 8). However, none of them can serve as an excuse or justification for Dr. Laskin’s misdiagnosis. On the contrary, these peculiarities highlight the absurdity of her error. These peculiarities make it reasonable for my family to believe that she could have lived much longer than the average non-small cell lung cancer patient. And also because of these characteristics, the harm caused to us by her death due to Dr. Laskin's misdiagnosis is particularly severe.

2.Why am I not sue at the doctors at RCH?

Someone asked: The patient was initially treated at RCH, and the doctors there always believed that the patient's symptoms were caused by cancer, unrelated to hydrocephalus. However, it now seems that the issue was hydrocephalus. Why am I suing Dr. Laskin but not the doctors at RCH?

My rebuttal: The reasons are as follows:

a)The doctors at RCH  are not specialists. They may only know that finding lung cancer adenocarcinoma cells in cerebrospinal fluid is the gold standard for diagnosing leptomeningeal metastasis (LM). However, they didn’t know that it was necessary to determine when these lung cancer adenocarcinoma cells appeared—whether it was before taking osimertinib in early 2020 or two years later, in 2022, after taking osimertinib. I have no reason to equate the diagnosis level of a highly respected lung cancer expert with that of a non-specialist doctor.

b) They did not make a definitive diagnosis. The RCH doctors  did not 100% conclude that it was a cancer issue. The doctor who diagnosed the patient with LM recurrence and stopped osimertinib was Dr. Laskin from the Vancouver BCCA, not the doctors at RCH.

c)They did not think the patient was beyond saving. In early September, the RCH doctors told me "If it were cancer, Dr. Laskin might change the medication or try a different treatment method." After September 15, they supported and helped me seek a second opinion from a cancer specialist.

d) RCHl doctors did not completely deny the possibility of hydrocephalus. Had Dr. Laskin maintained her opinion that the patient's lung cancer was still under control with osimertinib, I believe the doctors at Royal Columbian Hospital would have conducted a more thorough investigation into the hydrocephalus. They might have even agreed to transfer the patient to another hospital, such as Vancouver General Hospital. *

3.Is the misdiagnosis without consequence?

Some people even asked: if Dr. Laskin didn't misdiagnose, without stopping osimertinib, wouldn't the patient die? 

My rebuttal: Is death avoidable? Everyone will eventually die. But saying that taking osimertinib as usual would also lead my wife to death at the same time is definitely nonsense. Osimertinib is my wife’s life-saving medicine, without which her life would have come to an end in January 2020. She passed away on December 12, 2022, more than two months after stopping taking the life-saving medication. Her death was not predetermined on that day. If you truly understand that PFS of osimertinib is a median, and that there are many treatment options other than osimertinib, and  that the development of medical science and treatment technology around the world is very rapid, then you will not raise this question. Some people who raised this question believes that cancer patients, especially those in advanced stages, have no essential difference between life and death. This is a form of discrimination against cancer patients. Cancer patients have the right to fight for their lives and to have their lives and dignity respected.

4)Is this the doctor's fault, or the healthcare system's fault?

Some said this was a problem with the Canadian healthcare system, and I shouldn’t sue Dr. Laskin. 

My rebuttal: I can't agree with this. The supply-demand imbalance between doctors and patients is very prominent in Canada. If this problem didn’t exist, the RCH probably wouldn’t have canceled its oncology department, and my wife wouldn’t have been transferred to the Vancouver BCCA, and she wouldn't have met Dr. Laskin, which means the terrible 9.15 diagnosis wouldn't have happened. However, the medical system problem doesn’t necessarily result in Dr. Laskin’s 9.15 misdiagnosis. 

Some who claimed the responsibility lies with the Canadian healthcare system argued that high-level specialists are extremely scarce in Canada’s universal healthcare system. Dr. Laskin, a lung cancer expert at the Vancouver BCCA is very busy. (I was told that that she has over 100 patients and supervises 6 or 7 young assistants/interns). Dr. Laskin’s workload may have contributed to her not knowing the patient’s important medical history after one and a half years, but this does not necessarily imply a direct causal relationship. If this were the case, such kind of diagnostic errors would be widespread. Many specialists in Canada are as busy as Dr. Laskin. Would they all diagnose carelessly and haphazardly? We’ve lived in Canada for 26 years and have seen many other specialists, all of whom were responsible and conscientious. Since we arrived in Canada, we have heard that the most respected professions here are nurses and doctors. We strongly agree. My wife's experience can be divided into two very different phases: the first phase, from January 2020 to mid-2022, thanks for doctors at RCH and ERH(Eagle Ridge Hospital), she overcome death and lived a normal life; the second phase, from August 2022 to December 12, 2022, due to Dr. Laskin’s 9.15 misdiagnosis, she was stopped to take her life-saving medication,  and her body was deteriorate until death. Both phases occurred within the same healthcare system, but due to different doctors and different approaches, the outcomes were drastically different.

If we cannot sue Dr. Laskin, it would mean that the “service” she provided is considered acceptable. Dr. Laskin’s 9.15 misdiagnosis was not simply a mistake. Not only did Dr. Laskin wrongly believe the patient’s LM had recurred and that osimertinib was ineffective, but she also irrationally refused further treatment, declaring that the patient was beyond help and should go to hospice care. She made this death sentence-like diagnosis without proactively informing us, handling such a life-and-death matter in a trivial manner. I firmly believe that doctors like Dr. Laskin are extremely rare in Canada. Her actions tarnish the reputation of Canadian doctors and contradict the Canadian spirit of emphasizing human rights, fairness, and justice. Her behavior is appalling, and Canada’s healthcare system definitely should not bear the blame for Dr. Laskin’s actions.

5.Why do I insist on suing Dr. Laskin?

Somene said that in Canada, for a patient or their family to sue a doctor, they must first pass through the CMPA (Canadian Medical Protective Association). This organization has billions of dollars and employs many of Canada’s best lawyers to defend doctors being sued. Very few patients win lawsuits against doctors in Canada. They implied  I would waste  time and and energy in vain.

My rebuttal: I believe I can win. I trust that CMPA only defends cases that can be argued. I don’t think Dr. Laskin is able to obtain a reasonable defense. I don't think CMPA would say: "because Canada has universal healthcare, medical resources are scarce. Dr. Laskin’s 9.15 diagnosis was not incorrect. It was to save the country money, and she should not be held responsible, but rather rewarded and become a model for doctors." Such a “defense” would not protect Dr. Laskin’s reputation but would destroy the reputation of Canada’s healthcare system and the country itself. It would send the message to the world that Dr. Laskin's careless, life-threatening approach to patient care is a direct result of Canada’s healthcare system. With CMPA as their backing, Canadian doctors can do whatever they want without taking any responsibility. It would endanger the lives of Canadian patients, going against the original intent of CMPA. 

What Is My Purpose To Sue Dr. Laskin?

I know I will get little even I win. I don’t care how much compensation I receive. If I get only one dollar, I’ll consider it a win. My purpose in this lawsuit is as follows:

1.Fulfilling a promise
I made a promise to my late wife to share her cancer-fighting insights with everyone, aiming to boost people’s confidence in fighting cancer. I want people to know that osimertinib can eliminate 100% of brain cancer cells, allowing patients to fully recover with normal physical functions and without pain. The progression-free survival (PFS) of osimertinib is a median value that varies by individual. For Asian patients, it is often much higher than the median. Additionally, this median has been increasing as medical science continues to advance. I want people to know that, thanks to the tireless efforts of medical scientists and clinicians worldwide, cancer is gradually being conquered. While some cancers have not been completely cured yet, it is now possible for patients to live with them for extended periods.

2.Seeking justice for my wife
I want everyone to understand that my wife did not die from cancer but from a misdiagnosis by Dr. Laskin at Vancouver's BCCA. I hope the medical community will learn from this mistake and take steps to avoid similar errors in the future. I hope my wife will be the last person to die due to such a misdiagnosis.

3.Improving the Canadian Healthcare System
I aim to address some issues within the Canadian healthcare system to make it stronger and more effective. Specifically:

a). Accountability in Diagnoses
A specialist like Dr. Laskin should not be allowed to make critical diagnoses—akin to a death sentence, such as stopping life-saving targeted therapy—without knowing the patient’s medical history, clinical presentation, or having solid laboratory and imaging evidence. Such diagnoses should require the signatures of at least two doctors.

b). Second Opinions
There should be more robust support for hospitalized patients seeking a second opinion, along with a clear process to facilitate this. For example, on August 16th, I requested a second opinion from an oncologist, but it took an unacceptable 66 days for me to receive.

_____________________________________________________

Note:

    *In fact, after learning of Dr. Yu's diagnosis, they reviewed all the patient's CT and MRI scans from 2022 to compare and try to find any issues related to hydrocephalus and the VP shunt placed two and a half years ago. Later, when they saw the MRI report from November 25, which showed a few gray spots on the brainstem, they interpreted them as evidence of cancer progression. Since the patient was already in critical condition, they abandoned further efforts. Even though the hydrocephalus could not be fully resolved, the danger from hydrocephalus is not comparable to the danger from lung cancer; the symptoms were not life-threatening. The patient was admitted to the hospital on August 5, 2022, mainly due to a wrist fracture.

**Dr. Laskin’s diagnosis, similar to a death sentence, should have been made after the results of the lumbar puncture were received in early September. In early September, the doctors at Royal Columbian Hospital informed us that they had already passed the test results to Dr. Laskin, and she should be calling us soon. We waited eagerly every day, but after more than ten days, there was still no call. I foolishly told my wife that it seemed like Dr. Laskin wouldn’t call until September 15th (the time we had previously scheduled for a phone consultation). I thought this might be a good sign — if the cancer had indeed recurred, she would have called us immediately. If there was no urgent news, she might wait until the scheduled consultation time on September 15th.

My hearing is not good, so I asked Royal Columbian Hospital to arrange for an interpreter to help me hear the doctor clearly. The scheduled phone consultation was at 11 a.m. on the 15th, and the interpreter arrived 10 minutes early. We waited in a quiet place for Dr. Laskin’s call. But after a full hour of waiting, no call came. The interpreter had another task and had to leave. I waited for another two or three hours, still no call. By 3 p.m., I couldn’t wait any longer, so I called her office to ask why Dr. Laskin hadn’t called despite the appointment. It was another half hour before she finally called. Dr. Laskin and her assistant did not offer any explanation for the delay or the apparent mix-up with the appointment. Clearly, Dr. Laskin didn’t proactively share her diagnosis with me.

This shows that, to Dr. Laskin, my wife's life or death was completely insignificant, as inconsequential as a falling leaf. It’s accurate to say that her attitude was "disregard for human life."