Medical Negligence

• Author: International Law Group
• Pages: 67-71

Page 67

Monique Frances King (plaintiff) was 13 years old in 1989 when she received treatment for cancer at the South Eastern Sydney Area Health Service (SAHS) which operated the Prince of Wales Children's Hospital (defendant 1). Now 29 years old, she sued the SAHS and the estate of the late Professor Darcy O'Gorman-Hughes (defendant 2) for personal injuries suffered as a result of her treatments.

When a neurosurgeon had explored plaintiff's spine, he discovered a highly malignant tumor surrounding the right C-7 nerve root. The surgeon removed as much ofPage 68 the tumor as he could reach. Plaintiff then came under the care of Dr. Hughes for cancer treatments.

One of the treatment modes was intraspinal chemotherapy. This consists of administering three agents: methotrexate (MTX), cytosine arabinoside (Ara-C) and hydrocortisone. The medical profession generally refers to this procedure as "triple intrathecal therapy" or TIT whether or not three agents are involved. After this treatment plan went into effect, the plaintiff began on or about July 21,1989 to show symptoms of myelopathy (damage to her spinal cord); which eventually led to her quadriplegia.

The heart of plaintiff's case was the charge that Dr. Hughes and the other pediatric oncologists at SAHS failed to live up to their professional duties to keep themselves informed as to recent U.S. developments in the management of the children's cancer from which plaintiff suffered.

The defendants do not deny that the plaintiff's quadriplegia resulted from the treatment she received. They blamed the combination of radiotherapy, the administration of Act-D as part of the systemic chemotherapy, and TIT. They do deny that any breach of duty on their part relating to their treatment of the plaintiff was the cause of any compensable damage.

The evidence showed that Dr. Hughes took into account many published writings, plus his own substantial experience. The key issue in this case arose from the fact that his treatment plan rested in part on a protocol known in the U.S. as IRS-II. In particular, Dr. Hughes followed the guidelines in the IRS-II protocol in deciding to use TIT as part of the treatment plan. He also took those recommendations into account in deciding on the size and number of doses of MTX, Ara-C and hydrocortisone to be given by way of TIT and of Act-D to be administered by way of systemic chemotherapy.

A body called Intergroup Rhabdomyosarcoma Study Group (IRS Group) had published a relevant IRS-II protocol (A rhabdomyosarcoma is a highly malignant tumor in children that typically occurs in the head and the neck.). The IRS Group mainly operates in the U.S.; it had regularly been carrying out studies of different types of treatment for malignant head tumors.

The protocol set forth the recommended dosages of chemotherapy agents and their frequency, and the amount of radiotherapy. An article in a medical journal suggested that patients had a substantially improved survival rate when treated with an intensive therapy which included TIT and that it might, with some modifications, also be of value in treating tumors in the spinal region.

The defendants had included TIT in the protocol specifically to prevent metastasis. They refer to it as "prophylactic" TIT. Physicians could also use TIT for "salvage" purposes, that is, to...