Identification of Causation between Misdiagnosis and Death by the “Loss of Chance” Theory: Two Case Reports

Case 1: A 62-year-old patient was admitted to a provincial hospital for dull epigastric pain and was diagnosed with chronic atrophic cholecystitis, turgid type of gallstone and suspected gallbladder lesion. Two days later a laparotomy and cholecystectomy were performed. The result of the tests on the intraoperative quick diagnosis showed chronic cholecystitis. Several days later the surgeon in charge received the regular paraffin pathological diagnosis report which showed suspected adenocarcinoma of the gallbladder. He did not pay any attention to this report and the patient was not informed of this matter. Consequently the patient visited another hospital and the correct diagnosis, carcinoma of gallbladder, was made. The patient died 8 months later. Case 2: A 54-year-old patient went to a county hospital because of abdominal discomfort and underwent an abdominal computed tomography CT) examination. The results of this examination showed that the body of the pancreas appeared abnormally large in size. The doctor failed to make a correct diagnosis. Later, doctors in another hospital made the diagnoses of suspected carcinoma of the pancreas based on the primary computed tomography imaging mentioned above. The patient eventually died 10 months later. The family members of the deceased held the opinion that the patients deaths resulted from the misdiagnosis, while the hospital held the opposite opinions. Utilizing the theory called “loss of chance” and epidemiological investigations, we, forensic medical experts, point to the fact that the misdiagnoses were predisposing factors of death, and the degree of contribution should be between 20% and 40%, 10% and 15%, respectively.